Types and Goals of Treatment for Multiple Myeloma

Each type of treatment for multiple myeloma has a different goal. Here is a list of main treatments and their goals for myeloma. They are listed in the order from the most to the least common. You may have more than one of these treatments:

  • Chemotherapy and other drug therapies. This is the use of drugs that kill cancer cells. The goal of this treatment is to control the cancer for as long as possible.

  • Immunotherapy. This treatment stimulates the immune system to fight multiple myeloma. The 2 main drugs used are the immunomodulating agents thalidomide and lenalidomide. They help keep multiple myeloma cells from reproducing within bone marrow. These drugs also work by stopping tumors from forming new blood vessels. 

  • Targeted agents. This type of treatment inhibits or prevents the growth and spread of tumors by targeting specific parts of malignant cells. Bortezomib and Carfilzomib are drugs called proteasome inhibitors that work to treat multiple myeloma by killing cancer cells. 

  • Radiation therapy. The goal of this treatment is to ease symptoms. It can help with bone pain. Radiation can also help prevent or treat a fracture in the area of the bone weakened by the cancer or to cure a single collection of myeloma cells called plasmacytoma.

  • Stem cell transplants. This may be called a bone marrow transplant or a peripheral blood stem cell transplant, depending on where the stem cells are taken from. Stem cells can be taken from your own bone marrow before transplant (autologous) or from a sibling or unrelated donor (allogeneic). The goal is to kill as many of the cancer cells as possible with high doses of chemotherapy and radiation prior to the transplant. These kill almost all your bone marrow and the cancerous cells in it. Then you receive healthy, new stem cells that were previously collected, which allow healthy blood cells to grow in your body.

  • Watchful waiting (also called observation or active surveillance). The goal of watchful waiting is to monitor or check cancer that is growing very slowly and that is unlikely do any harm for a long time, if ever, rather than immediately starting treatment. This kind of myeloma is called smoldering myeloma. Sometimes the treatments for multiple myeloma can cause more harm than living with it. Your doctor may recommend watchful waiting if you don't have symptoms or damage to your kidneys or bones and you have little or no anemia. You'll likely see your doctor about every 3 months for checkups. At that time, you'll have blood and urine tests and perhaps X-rays. These tests check to make sure the cancer is not starting to actively attack your body. If it is, you'll start active treatment.

Research is ongoing in the field of multiple myeloma. New medicines and treatments are tested in clinical trials. Before starting treatment, ask your doctor if there are any clinical trials you should check on.