How you have treatment for myeloma
This page is about how you have 
and for myeloma.
There are different types of targeted drugs and chemotherapy. You might have these on their own or in a combination.
Common cancer drugs and treatment combinations for myeloma include:
- bortezomib and dexamethasone with daratumumab and thalidomide (DVTD)
- daratumumab with lenalidomide and dexamethasone (DRD)
- lenalidomide
- bortezomib and dexamethasone with daratumumab (DVD)
- carfilzomib, dexamethasone and lenalidomide (KRD)
- carfilzomib and dexamethasone (KD)
- lenalidomide and dexamethasone, with or without ixazomib (RD or IRD)
- pomalidomide and dexamethasone (PD)
- daratumumab
- panobinostat, bortezomib and dexamethasone (PVD)
- selinexor and dexamethasone
Most people start off having treatment as an outpatient. Treatment can be:
- tablets or capsules
- an injection under the skin (subcutaneous)
- an injection into a vein as a drip (intravenously)
You have treatment in or blocks. Each cycle usually lasts between 21 and 35 days. You have some cancer drugs every day and others weekly or less often. After each cycle of treatment, your team will check your side effects. They will also check how well treatment is working.
You might have a set number of cycles of treatment. But some treatments carry on until they stop working or side effects become too severe. Or until you decide you don't want to continue.
You can read more about each separate drug in our cancer treatment section.
Having treatment
There are many different cancer drugs for treating myeloma. You might have these on their own or in a combination. You can read about how you have these drugs below:
You might just have bortezomib, daratumumab and dexamethasone (DVD). Or you have them together with thalidomide (DVTD).
Each treatment cycle lasts 3 weeks (21 days) or 4 weeks (28 days). The number of days you have this treatment for will depend on your individual situation. You might have up to 6 cycles of treatment, or longer.
You usually have bortezomib as an injection just under the skin. You might have it once a week. Or some people have it twice a week at the start of treatment.
You take dexamethasone as tablets for a few days each week, depending on when you have bortezomib or daratumumab.
You usually have daratumumab as an injection under the skin. You usually start off having it once a week but this becomes less often.
You take thalidomide as capsules every day.
We have more information about daratumumab, bortezomib, thalidomide and dexamethasone (DVTD).
Each cycle is 28 days (4 weeks). You usually carry on taking this treatment if it is controlling your myeloma. And if your side effects are not too severe.
You usually have daratumumab as an injection under the skin. You usually start off having it once a week but you have it less often after a couple of months. Eventually you have it every 4 weeks.
You take dexamethasone as tablets. To begin with, you have it for 2 days each week. This becomes less often after a couple of months.
You take lenalidomide as capsules every day for 3 weeks. And then you have a break until the next cycle begins.
You might just have lenalidomide and dexamethasone together. Or you have these drugs with ixazomib.
Each treatment cycle lasts 4 weeks (28 days). You usually carry on taking this treatment if it is controlling your myeloma. And if your side effects are not too severe.
You take lenalidomide as capsules every day for 3 weeks. And then you have a break until the next cycle begins.
You take dexamethasone as tablets once a week for the whole cycle.
You take ixazomib as capsules once a week for 3 weeks and then you have a break for one week until the next cycle begins.
You might have carfilzomib and dexamethasone together with lenalidomide.
Each treatment cycle lasts 4 weeks (28 days). You can have up to 18 cycles of carfilzomib. You can carry on taking lenalidomide and dexamethasone if they are controlling your myeloma. And if your side effects are not too severe.
You have carfilzomib as a drip into your bloodstream (intravenously) over 30 minutes. You usually have it for 2 days every week for 3 weeks. And you then have a week off until the next cycle starts.
You have dexamethasone as a drip or as tablets. You have it for 2 days each week, throughout the cycle.
You take lenalidomide, as capsules every day for 3 weeks. And then you have a week off until the next cycle begins.
You might have pomalidomide and dexamethasone together.
Each treatment cycle lasts 4 weeks (28 days). You can carry on taking this treatment if it is controlling your myeloma. And if your side effects are not too severe.
You take pomalidomide as capsules every day for 3 weeks. And then you have a week off until the next cycle begins.
You take dexamethasone as tablets once a week for the whole cycle.
You might have daratumumab on its own. You also usually take dexamethasone.
Each cycle is 28 days (4 weeks). You usually carry on taking this treatment if it is controlling your myeloma. And if your side effects are not too severe.
You usually have daratumumab as an injection under the skin. You usually start off having it once a week but you have it less often after a couple of months. Eventually you have it every 4 weeks.
You take dexamethasone as tablets. To begin with, you have it for 2 days each week. This becomes less often after a couple of months.
You might just have bortezomib and dexamethasone together. Or you have these drugs with panobinostat.
Each treatment cycle lasts 3 weeks (21 days). You usually have between 8 and 16 cycles. This depends on how well the treatment is working and if the side effects aren’t too bad.
You usually have bortezomib as an injection just under the skin. You might have it once a week. Or some people have it twice a week at the start of treatment.
You take dexamethasone as tablets. To begin with you take it for 4 days in the first and second week. And you then have a week off until the next cycle begins. This goes down to 2 days a week later on in your treatment course.
You take panobinostat as capsules 3 times a week for the first 2 weeks of each cycle. You then have a week off until the next cycle begins.
You might have selinexor and dexamethasone together. You take selinexor and dexamethasone as tablets.
You take it twice a week. Your doctor might respond to your treatment as cycles. One cycle is usually 28 days. You can carry on taking this treatment until it is no longer controlling your myeloma. Or until you are struggling with the side effects.
Treating and preventing problems caused by myeloma
Myeloma and its treatment can affect you in different ways. It can cause symptoms and problems. Supportive treatments can help to either prevent or control these problems.
You might have supportive treatments to prevent or help control problems such as:
- infection
- low red blood cells
- bone problems including pain and spinal bone fractures
- kidney problems
How do you have treatment?
Taking tablets
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
Treatment into the bloodstream
When you have treatment into your bloodstream you usually go to the hospital or a day unit. You can usually go home the same day.
Depending on the drug, you may have your treatment by injection through a small needle (cannula) into a vein over a few minutes.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
Injection under the skin
You usually have injections under the skin into the tummy (abdomen) or thigh. You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much. The skin in the area may go red and itchy for a while.
Side effects
Many people are worried about the possible side effects of treatment. All treatments cause some side effects. But side effects vary from one person to another.
Side effects depend on what treatment you have. There are several types of drug treatments for myeloma. These have different side effects. You can look up your treatment drugs on our cancer drug list and read about the side effects.
Your treatment team can help to manage any side effects that you have. They might give you medicines to help with certain side effects such as anti sickness medicines.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.
Dietary or herbal supplements
We don't know enough about how some nutritional or herbal supplements may interact with cancer drugs. Some could be harmful.
Talk to your specialist about any other tablets or medicines you take while you are having active treatment. Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy or targeted cancer drugs. They could be harmful.
Information and support
You can contact our Cancer Information Nurses on 0808 800 4040 Monday to Friday, 9am to 5pm, with any questions you might have about having treatment for myeloma.
