Understanding Treatment for Multiple Myeloma

This article is for people who are living with multiple myeloma and their care partners, or anyone who wants to learn more about multiple myeloma. The goal of this activity is to help you talk to and work with your doctor and healthcare team.

You will learn about:

• What multiple myeloma is, and symptoms and complications (additional problems) that may happen

• The different phases of active myeloma

• Types of treatment for multiple myeloma and making a treatment plan

• Questions to ask your doctor and healthcare team

Certain medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for multiple myeloma but are recommended by the National Comprehensive Cancer Network (NCCN).

Myeloma is cancer that starts in plasma cells (a type of white blood cell) in your bone marrow, which is the tissue inside bones where most blood cells are made.

With myeloma, cancerous plasma cells (myeloma cells) grow out of control and can build up in your bone marrow crowding out your normal cells. When myeloma cells grow and spread throughout the bone marrow, it's called multiple myeloma.

There are 2 basic types of myeloma:

• Smoldering myeloma doesn't cause symptoms and may not need treatment right away

• Active myeloma causes symptoms and treatment may be recommended. Smoldering myeloma can sometimes turn into multiple myeloma, but for some people this can take years

The presence of myeloma cells and crowding out of normal cells in your bone marrow can lead to symptoms and complications, such as:

• Low blood cell counts that can cause fatigue (tiredness), weakness, bleeding, bruising, or infections

• High levels of calcium that may cause constipation, belly pain, extreme thirst, or confusion

• Bone problems, such as pain or fractures (breaks)

• Kidney damage or kidney failure that can cause weakness, shortness of breath, itchiness, or leg swelling

The different phases or stages of active myeloma include:

• Early or newly diagnosed myeloma where first-line (induction or frontline) treatment may be recommended to help control cancer and relieve symptoms

• Remission where cancer is no longer detected in your body after treatment and you have little or no symptoms. Maintenance or continuous treatment may be recommended to help keep cancer from coming back (recurrence). Remission can be temporary or permanent

Phases of active myeloma also include:

• Relapsed (recurrent) where cancer comes back after original treatment. Early relapse is when cancer comes back during or shortly after treatment and may happen if cancer doesn't respond to first-line treatment. Most people can eventually relapse. Multiple myeloma can also relapse once or a few times

• Relapsed and refractory when cancer has come back and no longer responds to the most recent treatment

There are several treatments that can help manage multiple myeloma and its symptoms. The goals will be to decrease the number of myeloma cells, control cancer growth and keep it from spreading, reduce symptoms, and help improve your quality of life.

Most people will receive a combination of treatments or medicines that will depend on what phase myeloma is in, your overall health, other conditions you have, and your wishes and personal preferences. A combination of 3 medicines (sometimes called triplet therapy) or 4 medicines may be recommended as first-line treatment for some people.

With relapse, treatment will also depend on what treatment you had before and how long you were in remission. Certain medicines may be recommended for early relapse, or for relapse after 2 to 5 prior treatments have been used.

Types of treatment your doctor may recommend can include:

• Medicines such as:

  • Chemotherapy (or "chemo") to kill cancer cells

  • Targeted therapy to destroy cancer cells or help other treatment work better

  • Immunotherapy to help your immune system find and kill cancer cells

  • Steroids to decrease swelling and kill cancer cells

• Radiation therapy to help with pain

• Stem cell transplant to replace damaged or destroyed stem cells (cells that turn into mature blood cells) in your bone marrow

• Surgery to help with bone fractures

• Joining a clinical trial

• Supportive care to help improve your quality of life

You and your doctor will make a treatment plan together that best fits your individual needs, so be sure to let them know about your personal preferences. You can also ask about the goals of treatment and what to expect during treatment.

Before treatment, ask about which side effects can happen with the treatments you're taking, ways to manage them, and when you should contact your doctor or seek emergency medical care because of side effects.

During treatment, be sure to tell them about any side effects that happen and how they affect your daily life. Tracking and recording your symptoms and side effects in a journal or diary can be especially helpful.

Questions you can ask your doctor and healthcare team about multiple myeloma can include:

• What treatments are available and what are the goals of treatment?

• How will we know if treatment is working?

• What side effects may happen and how can we manage them?

• Are there any lifestyle changes I should make?

• How can I make sure I have the best quality of life possible?

• Is there a clinical trial I can join?

• What should I do if I feel stressed or depressed?

• Where can I find more information and resources?

Congratulations!

You have successfully completed the program Understanding Treatment for Multiple Myeloma.

View Additional Materials on this topic that you may find useful:

Myeloma

Multiple Myeloma

About Multiple Myeloma

International Myeloma Foundation