Multiple myeloma is a rare type of blood cancer. It affects the plasma cells in the blood, which then start to behave abnormally. As a relapsing-remitting type of cancer, sufferers often have long periods of time with no symptoms, followed by periods where they require a lot of medical attention. Like all cancers, this one comes in stages. The treatment options for myeloma also vary by stage.
Solitary Plasmacytomes:
In this stage, the treatment options for myeloma mainly center around radiation therapy. Surgery may be offered if the tumorous plasma cell is not in the bone. Only after multiple myeloma has developed will patients be offered chemotherapy.
Early Myeloma:
This includes stage I disease and smoldering myeloma. Patients can often live for many years without requiring any treatment. In fact, one of the unique characteristics of this cancer is that early treatment does not improve the prognosis. Hence, patients are usually monitored closely so that the time when they need treatment is not missed. At most, if they have developed bone disease, they will be offered bisphosphonate.
Physicians can inspect the abnormal plasma cells under a microscope, while also measuring immunoglobulin levels. This will tell them how quickly someone will likely progress to active myeloma, at which point treatment is required. Some research show that prescribing lenalidomide (Revlimid) at early myeloma can improve prognosis.
Symptomatic (Active) Myeloma:
At stage II and above, people often start to experience light chain amyloidosis. If so, they will be give drugs, with the type depending on their health and particularly their kidney function, as well as on whether they have a planned transplant. Usually, they are prescribed combination drugs with bortezomib if they have kidney problems, or if they have high risk chromosome abnormalities. Alternatively, they may be given combinations of dexamethasone, lenalidomide, thalidomide, and bortezomib (Velcade), although other combinations can be given too. In the case of a patient waiting for a transplant, chemotherapy is usually offered together with prednisone and melphalan, which may be in combination with thalidomide. Usually, when patients start to undergo chemotherapy, they are also offered treatment with bisposphonate straight away. Radiation therapy may be offered should, after this treatment, the parts of the bone that are damaged continue to cause problems.
Myeloma Treatment Options:
A lot of treatment options for myeloma patients center around support. This includes blood transfusions, intravenous immunoglobulin, and antibiotic treatment. Sometimes, they may require a stem cell transplant. After a transplant, extra cycles of treatment may be required. This is known as "consolidation treatment". It has been shown to greatly increase the chance of full remission.
In certain cases, patients, whether they have had a stem cell transplant or not, can also be given bortezomin, lenalidomide, and/or thalidomide as a long term treatment. This type of treatment is called "maintenance treatment", and it is offered to delay the next relapse of the cancer. This is not always prescribed, however, as the potential side effects can be very serious.
In many cases, myeloma responds very well to treatment. As a relapsing cancer, however, it is possible for people to have to try a different type of treatment each time the cancer returns.