Treatment options for myeloma

A team of healthcare professionals decide if you need treatment straight away. They also decide what your treatment options are.

The most common treatments for myeloma are:

• chemotherapy
• targeted cancer drugs
• steroids

Deciding what treatment you need

A team of doctors, and other professionals discuss the best treatment and care for you. They are the multidisciplinary team (MDT). Your MDT might include:

• a haematologist - a doctor specialising in blood cancers
• a clinical oncologist - a doctor specialising in radiotherapy treatment 
• a pathologist – a doctor who diagnoses diseases from examining bone marrow or lymph node biopsies
• a radiologist – a doctor specialising in reading x-rays and scans
• a specialist haematology nurse – also called a clinical nurse specialist (CNS)
• a palliative care doctor - a doctor specialising in controlling cancer symptoms

You might not start treatment straight away if you are well and doctors diagnosed your myeloma by chance. This depends on results of your blood tests, bone marrow tests or scans. 

If you need treatment straight away, your team plans it depending on your:

• symptoms
• results of blood tests, bone marrow tests and scans
• general health and levels of fitness 
• personal wishes

Your doctor will talk to you about your treatment options. They will discuss the benefits and the possible side effects with you.

The main treatments

The main treatments are:

Targeted cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. There are many different types of targeted drugs.

For myeloma the most common ones you might have are:

• thalidomide
• lenalidomide
• bortezomib
• daratumumab

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream. 

The most common types of chemotherapy drugs for myeloma include:

• cyclophosphamide
• melphalan

Steroids

Steroids are naturally made by our bodies in small amounts. They help to control many functions including the immune system, reducing inflammation and blood pressure.

Prednisolone and dexamethasone are types of steroids

Stem cell transplant

You have a stem cell transplant after very high doses of chemotherapy. The chemotherapy kills the myeloma cells and also the stem cells in your bone marrow. 

After the chemotherapy you have the new stem cells into your bloodstream through a drip. You usually have a stem cell transplant using your own stem cells. 

First treatment for myeloma

If you don't have symptoms

You might not need treatment if you are well and your myeloma has been found by chance. This depends on results of your blood tests, bone marrow tests or scans. Some people do need treatment.

Your doctor will keep a close eye on your myeloma. This is called active monitoring, or 'watch and wait'. You start treatment if your myeloma gets worse or you develop symptoms.

First line treatment

If you need treatment, you are likely to have a combination of:

• targeted drugs (such as thalidomide, lenalidomide, bortezomib, daratumumab)
• chemotherapy (such as cyclophosphamide or melphalan)
• steroids (such as prednisalone or dexamethasone)

If you are fit enough, your specialist might suggest intensive treatment using high dose chemotherapy with a stem cell transplant.

The main aim of your treatment is to try to get the myeloma under control. When there's no sign of active myeloma in your body, the myeloma is said to be in remission.

Treatment for myeloma that comes back (relapses)

Your treatment depends on your individual situation, such as how long you were in remission for, what treatment you had and your current level of health and fitness.

You might have:

• a targeted cancer drug such as bortezomib (Velcade), carfilzomib, lenalidomide, pomalidomide, and daratumumab
• a combination of chemotherapy drugs, with or without targeted cancer drugs
• a steroid such as dexamethasone

Treatments to prevent or control problems caused by myeloma

Myeloma and its treatment can cause problems. Supportive treatments can help to either prevent or control these problems.  

You might have one or more of these supportive treatments:

• radiotherapy to an area of myeloma that is causing pain
• surgery to a broken bone, or to stop a weakened bone from breaking
• bisphosphonates to reduce bone pain or lower calcium levels
• plasma exchange (plasmapheresis) to lower protein levels in the blood
• a blood transfusion to treat tiredness (caused by low red blood cell levels)
• antibiotics to treat infections
• fluids to help your kidneys work

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.