The primary treatment options for active myeloma include chemotherapy, immunotherapy, targeted therapies, bone marrow transplant, surgery, and radiation therapy. The type of treatment you receive will depend on a number of different considerations, such as the type of myeloma you have, its stage, your overall health and your treatment preferences. Treatment options may differ between what is used in frontline (previously untreated) myeloma and when myeloma relapses. Multiple lines of therapy may be needed. This page aims to give you a comprehensive overview of how myeloma treatment works in the private health system.
Myeloma
Understanding treatment for myeloma and how it is delivered
Last modified: March 2, 2022
Radiation therapy for myelomaRadiation therapy
Radiation therapy is the primary form of treatment for solitary plasmacytomas and can also be used to treat symptomatic sites of disease in patients with active myeloma. Radiation therapy can improve symptoms of myeloma such as bone pain and slow disease progression. Most people who have radiation therapy for myeloma will receive external radiation therapy.
External beam radiation therapy
External beam radiation therapy is used to treat myeloma by delivering radiation therapy beams to lesions on the bones where cancerous cells and tumours have been detected.
Chemotherapy for myelomaChemotherapy
Chemotherapy uses a range of drugs to kill and slow the growth of multiple myeloma cells. It is typically used to treat active myeloma that is causing symptoms or at risk of damaging organs. Chemotherapy medications vary and may include oral tablets and injectable medications. High dose chemotherapy may also be used which requires the prior collection of your stem cells for recovery after.
Learn more about chemotherapy and how it is delivered.
Chemotherapy treatment for myeloma takes place over several sessions, known as a cycle. Your care team will walk you through how many cycles you may need for your course of treatment and how many days per cycle.
Common chemotherapy medicines
There are a number of different chemotherapy drugs that are used to treat myeloma. These drugs are typically combined based on factors such as the type of myeloma you have, its stage and other factors such as kidney function, cardiac function, and lifestyle considerations. Some of the drugs used include:
Cyclophosphamide
This chemotherapy drug belongs to the class known as alkylating agents. It works by damaging the DNA of cells, so they are unable to divide, causing them to stop growing and die. It is delivered together with other chemotherapy or targeted therapy drugs and is given orally as a tablet or by continuous intravenous infusion via a pump over 24 hours.
Melphalan
This chemotherapy drug belongs to the class known as alkylating agents. It works by damaging the DNA of cells, so they are unable to divide, causing them to stop growing and die. It can be given in as an oral medication in combination with other chemotherapy drugs or at high dose via infusion as part of a stem cell transplant.
Doxorubicin
This type of chemotherapy drug is called an anthracycline; it destroys cancer cells by stopping the process of DNA replication within cancer cells so that they are unable to grow and spread. It is given by continuous intravenous infusion via a pump over 24 hours, usually in combination with other chemotherapy drugs.
Cisplatin
This chemotherapy drug is known as a platinum compound, which works by binding to and damaging DNA within cancer cells and preventing them from being able to divide and grow. It is given by continuous intravenous infusion via a pump over 24 hours, usually in combination with other chemotherapy drugs.
Immunotherapy for myelomaImmunotherapy
Immunotherapy treatment uses your own immune system to destroy and slow the growth of myeloma cells. Immunotherapy is typically only used to control active myeloma when symptoms are present. Immunotherapy drugs can also be combined with targeted therapy drugs.
Common immunotherapy medicines
Common immunotherapy drugs used to treat myeloma include:
Daratumumab
This is a monoclonal antibody that targets the protein CD38, which is present on the surface of myeloma cells. It works by triggering and activating your own immune system to fight and kill myeloma cells. It can be used as an initial treatment for myeloma or for relapsed/refractory multiple myeloma and is given by intravenous infusion
Immunomodulatory therapy
Immunomodulatory drugs are a type of immunotherapy which work by slowing the growth of myeloma cells and by stimulating your immune system cells to identify and kill myeloma cells. They are typically given together in combination with a targeted therapy and a corticosteroid drug (dexamethasone) and are taken orally as a tablet.
Some of the drugs used include:
- Thalidomide
- Lenalidomide
- Pomalidomide
Targeted therapy for myeloma Targeted therapy
Targeted therapies use specialised drugs to destroy specific proteins in myeloma cells. Targeted therapy drugs can also be combined with immunotherapy drugs.
Common targeted therapy medicines
Common targeted therapies used to treat myeloma include:
Bortezomib
This is a targeted therapy drug that targets and blocks enzyme complexes called proteasomes within cells. Proteasomes carry out essential functions within cells, including controlling the breakdown of proteins that are needed for cell division and growth. When these functions are disrupted, myeloma cells stop growing and die. Normal cells also contain proteasomes; however, they are far less affected than cancer cells. This drug can be given by subcutaneous injection under the skin or intravenous infusion.
Other proteasome inhibitor drugs used for myeloma include carfilzomib and ixazomib.
Bone marrow transplant for myelomaBone marrow transplant
Bone marrow transplants, also known as autologous stem cell transplants, utilise your own stem cells to rescue the bone marrow and enable recovery after high dose chemotherapy. You will first have your stem cells collected from your blood. Once cells are safely stored you will receive a high dose of chemotherapy. Your own stem cells will then be returned to your blood stream so they will travel to your bones and begin rebuilding healthy bone marrow.
Surgery for myelomaSurgery
Surgery is rarely used in the treatment of multiple myeloma, however if your cancer has caused weakened bones, surgery may be used to implant support structures (including metal rods and plates) to prevent and repair fractures.
Icon offers a wide range of clinical trials providing patients with access to new and evolving treatments. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients.
See current myeloma cancer clinical trials delivered by Icon Cancer Centre.
When you are diagnosed with myeloma, your haematologist will develop your treatment plan as part of a multidisciplinary team based on the type of myeloma you have. Myeloma can sometimes be relatively inactive known as smouldering. This is when the myeloma is not progressing quickly, and it is not causing any damage to organs such as your kidneys or bones. If you do not have any symptoms and your myeloma is smouldering, your haematologist may recommend forgoing treatment in favour of active monitoring. Treating myeloma before you have symptoms, or it becomes active has not been proven to increase life expectancy.
Common treatment options for each type of myeloma include:
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Solitary plasmacytoma
Solitary plasmacytomas can sometimes be cured with radiation therapy alone however most patients with solitary plasmacytomas will go on to develop myeloma in the future. In some rare cases, your doctor may recommend surgery to remove your tumour.
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Smouldering (or asymptomatic) myeloma
Smouldering myeloma usually will not require treatment for many years and instead will be actively monitored. Treatment is usually only needed once your myeloma has progressed to an active stage and you begin to experience symptoms.
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Active (symptomatic) myeloma
You may receive a combination of several drugs to treat your active myeloma, including immunotherapy drugs, targeted therapy drugs and anti-inflammatory drugs. The treatment you receive will depend on your overall health and whether your treatment plan includes a bone marrow transplant. Your doctor may also prescribe chemotherapy, radiation therapy, a bone marrow transplant or a combination of these as part of your treatment plan.
Following primary treatment, you may be prescribed maintenance treatment to delay the recurrence of your myeloma.
ReferencesReferences
For a full list of references, click here.
- American Cancer Society. (2020, August 18). Surgery for multiple myeloma. American Cancer Society. Retrieved December 21, 2021, from https://www.cancer.org/cancer/multiple-myeloma/treating/surgery.html
- American Cancer Society. (2020, August 18). Treatment options for multiple myeloma, by stage. American Cancer Society. Retrieved December 21, 2021, from http://www.cancer.org/cancer/multiple-myeloma/treating/by-stage.html
- American Cancer Society. (2020, August 18). Radiation therapy for multiple myeloma. American Cancer Society. Retrieved December 21, 2021, from https://www.cancer.org/cancer/multiple-myeloma/treating/radiation.html
- Cancer Council. (2020, September). Myeloma: Causes, symptoms & treatments. Cancer Council. Retrieved December 21, 2021, from https://www.cancer.org.au/cancer-information/types-of-cancer/myeloma
- Cancer Council NSW. (2020, September). Myeloma treatment. Cancer Council NSW. Retrieved December 21, 2021, from https://www.cancercouncil.com.au/myeloma/treatment/
- Mayo Foundation for Medical Education and Research. (2021, June 16). Multiple myeloma. Mayo Clinic. Retrieved December 21, 2021, from https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
- Medical Scientific Advisory Group (MSAG) to Myeloma Australia. Clinical Practice Guideline. (2019). Multiple Myeloma. MSAG Clinical Practice Guidelines. Hang Quach and H Miles Prince on behalf of MSAG. Retrieved February 21, 2022 from https://myeloma.org.au/health-professional-resources/
- Cancer Institute NSW. eviQ. Multiple Myeloma. Retrieved February 21, 2022, from https://www.eviq.org.au/haematology-and-bmt/multiple-myeloma
- Cancer Council NSW. Myeloma Treatment. Immunomodulators. Retrieved 21 February 2022 from https://www.cancercouncil.com.au/myeloma/treatment/immunomodulators/
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