The list of treatments mentioned in various sources for Multiple Myeloma includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
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To plan a patient's treatment, the doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out what parts of the body are affected by the cancer. Treatment decisions depend on these findings. Results of the patient's exam, blood tests, and bone marrow tests can help doctors determine the stage of the disease. In addition, staging usually involves a series of x-rays to determine the number and size of tumors in the bones. In some cases, a patient will have MRI if closeup views of the bones are needed. (Source: excerpt from What You Need To Know About Multiple Myeloma: NCI)
People who have multiple myeloma but do not have symptoms of the disease usually do not receive treatment. For these patients, the risks and side effects of treatment are likely to outweigh the possible benefits. However, these patients are watched closely, and they begin treatment when symptoms appear. Patients who need treatment for multiple myeloma usually receive chemotherapy and sometimes radiation therapy .
Chemotherapy is the use of drugs to treat cancer. It is the main treatment for multiple myeloma. Doctors may prescribe two or more drugs that work together to kill myeloma cells. Many of these drugs are taken by mouth; others are injected into a blood vessel. Either way, the drugs travel through the bloodstream, reaching myeloma cells all over the body. For this reason, chemotherapy is called systemic therapy .
Anticancer drugs often are given in cycles -- a treatment period followed by a rest period, then another treatment and rest period, and so on. Most patients take their chemotherapy at home, as outpatients at the hospital, or at the doctor's office. However, depending on their health and the drugs being given, patients may need to stay in the hospital during treatment.
Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. In this form of treatment, a large machine aims the rays at a tumor and the area close to it. Treatment with radiation is local therapy ; it affects only the cells in the treated area.
Radiation therapy is the main treatment for people who have a single plasmacytoma. They usually receive radiation therapy every weekday for 4 to 5 weeks in the outpatient department of a hospital or clinic.
People who have multiple myeloma sometimes receive radiation therapy in addition to chemotherapy. The purpose of the radiation therapy is to help control the growth of tumors in the bones and relieve the pain that these tumors cause. Treatment usually lasts for 1 to 2 weeks. (Source: excerpt from What You Need To Know About Multiple Myeloma: NCI)
The complications of multiple myeloma can affect many parts of the body. Chemotherapy and radiation therapy often can help control complications such as pain, bone damage, and kidney problems. However, from time to time, most patients need additional treatment to manage these and other problems caused by the disease. This type of treatment, called supportive care, is given to improve patients' comfort and quality of life.
Patients with multiple myeloma frequently have pain caused by bone damage or by tumors pressing on nerves. Doctors often suggest that patients take pain medicine and/or wear a back or neck brace to help relieve their pain. Some patients find that techniques such as relaxation and imagery can reduce their pain. These and other methods of relieving pain are discussed in the booklet Pain Control: A Guide for People with Cancer and Their Families.
Preventing or treating bone fractures is another important part of supportive care. Because exercise can reduce the loss of calcium from the bones, doctors and nurses encourage patients to be active, if possible. They may suggest appropriate forms of exercise. If a patient has a fracture or a breakdown of certain bones, especially those in the spine, a surgeon may need to operate to remove as much of the cancer as possible and to strengthen the bone.
Patients who have hypercalcemia may be given medicine to reduce the level of calcium in the blood. They also are encouraged to drink large amounts of fluids every day; some may need intravenous (IV ) fluids. Getting plenty of fluids helps the kidneys get rid of excess calcium in the blood. It also helps prevent problems that occur when calcium collects in the kidneys.
If the kidneys aren't working well, dialysis or plasmapheresis may be necessary. In dialysis, the patient's blood passes through a machine that removes wastes, and the blood is then returned to the patient. Plasmapheresis is used to remove excess antibodies produced by the myeloma cells. This process thins the blood, making it easier for the kidneys and the heart to function.
Multiple myeloma weakens the immune system. Patients must be very careful to protect themselves from infection. It is important that they stay out of crowds and away from people with colds or other infectious diseases. Any sign of infection (fever, sore throat, cough) should be reported to the doctor right away. Patients who develop infections are treated with antibiotics or other drugs.
Patients who have anemia may have transfusions of red blood cells. Transfusions can help reduce the shortness of breath and fatigue that can be caused by anemia. (Source: excerpt from What You Need To Know About Multiple Myeloma: NCI)
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Long-term treatment of multiple myeloma consists mainly of chemotherapy to suppress plasma cell growth and control pain. Commonly used combinations include cyclophosphamide, doxorubicin, and prednisone as well as carmustine, doxorubicin, and prednisone. Adjuvant local radiation reduces acute lesions, such as collapsed vertebrae, and relieves localized pain. Other treatments usually include a melphalan-prednisone combination in high intermittent doses or low continuous daily doses and analgesics for pain. Oral thalidomide (with or without steroids) has shown promise in relapsed multiple myeloma, and velcade, a proteasome inhibitor, is a newer agent that has shown promise in myeloma treatment. For spinal cord compression, the patient may require a laminectomy; for renal complications, dialysis.
Clinical trials are currently under way to evaluate the role of biological response modifiers (interferon) in the management of multiple myeloma. In addition, high-dose chemotherapy and radiotherapy with peripheral stem cell rescue have been helpful in select cases.
Because the patient may have bone demineralization and may lose large amounts of calcium into blood and urine, he's a prime candidate for renal calculi, nephrocalcinosis and, eventually, renal failure due to hypercalcemia. Hypercalcemia is managed with hydration, diuretics, cortico-steroids, oral phosphate, mithramycin I.V., or bisphosphonates I.V. (such as pamidronate or zoledronic acid) to decrease serum calcium levels.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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