Find the treatment that’s right for you

The good news is that while multiple myeloma (MM) has no cure, it is more treatable than ever. In fact, the past few years have seen an explosion of new treatments, and today, it’s possible to live with this rare cancer for many years.

As you explore your options, it’s important to be patient. MM manifests itself differently in every person (scientists know there may be various genetic changes that trigger MM), so a treatment that works for someone else might not work for you. Your doctor will consider factors such as your age, other health complications, symptoms and lifestyle goals when recommending a course of treatment. And you may need to try more than one before landing on the best for you. Keep in mind that you may also need to take additional medications to boost your bone strength (more than 85% of those with MM will experience bone health issues) or improve your blood cell counts. Read on to learn more about the different treatments.

1. Localized treatments

Localized treatments may be used to deal with tumors that form on your bones or elsewhere on your body as a result of your MM. The most common include:

Radiation. Radiation therapy involves the use of high-energy X-rays to kill or shrink tumors, particularly those that form on bones.

Surgery. Surgery may be used to repair or splint bones that were damaged due to MM or to alleviate pressure being caused by MM tumors.

2. Systemic treatments

These treatments may be used to control the MM itself, or to shrink or destroy any tumors that have formed.

Chemotherapy. Chemo is a so-called systemic treatment that reaches cancer cells throughout the body. These medications can be given orally (by mouth) or through an intravenous (IV) tube or injection. In those with MM, chemotherapy is sometimes used together with a stem cell transplant.

Stem cell transplant. Some patients get high doses of chemotherapy, with the hope that it will kill many myeloma cells and trigger remission. However, this aggressive chemo also kills normal blood-forming stem cells, so a transplant is needed to replace them. These cells are typically collected from the patient himself before the chemo is given, and today are taken from the blood rather than the marrow. In rare cases, stem cells can be donated by a matching donor, but this increases the risk for complications.

Bisphosphonates. Myeloma cells can cause bone to break down faster; bisphosphonates help slow that process and can slow the progression of MM overall. These drugs are typically given by infusion, initially on a monthly basis.

3. Biologic treatments (or immunotherapy).

Biologic treatments work with the body’s own immune system to fight cancer. Several types of biologics are used to treat multiple myeloma, including:

Immunomodulatory drugs (IMiDs). These drugs, which include thalidomide, lenalidomide and pomalidomide, use the body’s immune system to target myeloma cells, blocking their ability to grow and causing them to self-destruct.

HDAC inhibitors. These drugs interfere with enzymes that myeloma cells use to replicate quickly. Currently, only the HDAC inhibitor panobinostat is approved for treatment of MM.

Proteasome inhibitors (PIs). PIs block enzymes called proteasomes, causing myeloma cells to self-destruct. Currently the PIs approved for MM are bortezomib, carfilzomib and ixazomib.

Cytokines. Cytokines use a protein found in white blood cells to alert your immune system that it should attack the cancer cells. Interferon is a cytokine that’s commonly prescribed for MM.

Monoclonal antibodies (mAbs). MAbs bind and neutralize proteins in your body that keep your immune system in check, naturally increasing the body’s immune response. There are currently two approved mAbs (elotuzumab and daratumumab) for treating MM.

Steroids. These drugs lower inflammation throughout the body, which may help other cancer drugs work more efficiently. In high doses, they have been shown to destroy myeloma cells. The steroids most commonly prescribed for those with MM are dexamethasone and prednisone.

Plasmapheresis. For this procedure, patients have their blood filtered by a machine to remove myeloma proteins. It’s usually used only when the proteins have caused blood to become too thick, and does not treat the MM itself.

No matter which treatment—or combo of treatments—your therapy involves, you’ll be getting regular scans, blood tests and possibly bone marrow biopsies to help your care team gauge how well your body is responding. With so many available options, your doctor will want to make sure your current plan is the best choice for slowing the growth and spread of your MM—and helping you feel your best. Also, if your treatments stop working, ask your doctor if you are eligible to participate in any of the current clinical trials taking place for multiple myeloma. To learn more about these trials, click here.

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