Myeloma Center

What types of treatment are used?

Chemotherapy, usually combined with steroids, is the main treatment for myeloma. Radiotherapy can be very useful to treat painful areas and weakened bones.

Surgery may also have a role in strengthening weakened bones, preventing fractures or occasionally removing myeloma that is pressing on important areas such as the spinal cord. Recently drugs known as bisphosphonates (also called biphosphonates or diphosphonates) have proved useful in reducing bone damage and helping bones to heal.

Some patients may benefit from high dose chemotherapy. For this treatment, your blood stem cells are removed before the treatment and transfused back after the chemotherapy (stem cell transplant). This can help to maintain a remission, but it is an aggressive treatment that is not suitable for everyone.

Interferon can be used after chemotherapy to help keep the myeloma in remission.

You may find that other people at the hospital with myeloma are having different treatment from you. This will often be because their illness takes a different form, so they have different needs. If you have any questions about your own treatment, don’t be afraid to ask your doctor or the senior nurse. It often helps to take a close friend or relative with you to appointments.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion if you feel this will be helpful.

In some cases no treatment is used, either because the chemotherapy drugs have stopped working for you or because the disease is at an early stage. Since the drugs can stop working after a time it may be thought best not to give them until really necessary.

Myeloma is rarely curable. But treatment can be very effective in controlling symptoms and stopping the spread of the disease for a few years.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy myeloma cells. As they circulate in the blood, these drugs can reach myeloma cells all over the body.

One or more chemotherapy drugs are given for a few days every 3 to 4 weeks, followed by a rest period during which time you will have regular blood tests to check the effect of the drugs. The dosage of the drugs may be altered according to the results of your blood tests.

Chemotherapy may be given to you as an out-patient, but sometimes it may mean having to spend a few days in hospital.

Some drugs for myeloma are given by mouth (orally), others by injection into a vein (intravenously). One commonly given treatment is a drug called melphalan . This can be given by mouth (orally) or into a vein (intravenously) and is usually given with an oral steroid (prednisolone). It was previously the standard treatment for myeloma and can still be very helpful, particularly as it has few side effects and does not cause hair loss.

Fitter patients are usually given more intensive chemotherapy, by injection into a vein over a few days, again with steroids. This stronger treatment may be more effective, but it has more side effects and does cause hair loss. If you are going to receive your treatment through a vein, your doctor may suggest that a plastic central line (such as a Hickman or Groshong line) may be inserted. There is more information about this in CancerBACUP’s booklet Understanding Chemotherapy.

The length of treatment will depend on the extent of the disease and how well it is responding to the drugs, but usually the courses of treatment will take four to six months to complete. On average two out of three patients get a remission from their first course of treatment.

Stem cell transplants
If a remission is achieved with the initial chemotherapy, fitter patients can often go on to have high-dose chemotherapy to try to destroy the remaining myeloma cells.

The high doses of chemotherapy destroy your bone marrow as well as the myeloma, so stem cells need to be removed from the body beforehand, stored during the treatment and returned afterwards. In the past these stem cells were always obtained by taking bone marrow. More recently the stem cells are taken directly from the blood (stem cell transplantation). This is easier than taking bone marrow and does not require a general anaesthetic.

As this is an aggressive treatment, it is usually only given to people under 65-70 years, although your general health is the main deciding factor rather than your age.

An experimental treatment that is being tried is donor stem cell transplant. You usually have to be under 55 to have this treatment and you must have a brother or sister with matching bone marrow to your own.

Radiation Therapy

Radiotherapy treats myeloma by using high energy rays which destroy the cancer cells while doing as little harm as possible to normal cells.

Myeloma is very sensitive to radiotherapy, which is usually given to specific bones when the myeloma cells have created a weak area causing pain and sometimes a risk of bones breaking. This treatment can be very effective at relieving the pain and allowing the bones to repair themselves. You may only need one or two treatments. Your pain should improve within 2-3 weeks.

In advanced disease, if chemotherapy is no longer being effective, radiotherapy is given to the whole body, half at a time, in two sessions several weeks apart. This may help greatly in reducing symptoms, and control the disease for some time.

Radiotherapy may also sometimes be used as preparation for a stem cell transplant.

Radiotherapy is given in the hospital radiotherapy department. How the treatment is given can vary a lot, depending on your particular needs. If you only need one or two treatments, you may not need a long appointment first to plan the treatment. If you are having a longer course of treatment, you will need to go to the hospital before your treatment starts so that the area to be treated and the dose to be given can be worked out very accurately. Normally, if you are having a course of treatment, it is given daily, from Monday to Friday, with a rest at the weekend.

Radiotherapy for myeloma only occasionally causes side effects such as nausea and vomiting. If these do occur they can easily be treated, so do tell your doctor or nurse. Any side effects should disappear once your course of treatment is over, but do let your doctor know if they continue.

Radiotherapy can make you feel very tired, so try to get as much rest as you can, especially if you have to travel a long way each day for your treatment.

Follow up

After your treatment is completed, your doctor will probably want you to have regular check-ups and x-rays. These will often continue for several years. If you have any problems, or notice any new symptoms in between these times, let your doctor know as soon as possible.