Treatment generally depends on the stage of the disease, any previous treatments, and how well the patient has responded to previous treatment. Multiple myeloma is usually treated with chemotherapy, although radiation therapy may also be used to kill myeloma cells or to relieve pain in the spine and other areas. Some patients may require high-dose chemotherapy or radiation followed by a stem cell transplant.
Chemotherapy
Chemotherapy destroys the myeloma cells directly. Chemotherapy may be given over a period of months. Most often chemotherapy may be received outside the hospital, but at times it may be necessary to receive it in the hospital. The drugs are given in cycles, giving the patient’s immune system and normal cells time to recover. By destroying the cancer cells, chemotherapy can also relieve many of the symptoms of the disease.
Radiation Therapy
This is usually used to treat a specific area where there is bone destruction and pain. Radiation can kill cancer cells more quickly than chemotherapy and has fewer side effects. For this reason, it is often used to get quicker pain relief and control severe bone loss.
Bone Marrow & Stem Cell Transplantation
There are two types of transplants: autologous and allogeneic. These procedures restore the supply of normal blood cells when they have been destroyed by high-dose chemotherapy. In an autologous transplant, patients receive their own stem cells. In an allogeneic transplant, patients receive stem cells from a donor. The donor may be related (usually a matched sibling) or unrelated (non-family) individual.
Stem cells can be collected in two ways:
- Collected or harvested directly from the hip bone or bone marrow of the patient or donor
- Collected through the peripheral or circulating blood through a process called pheresis, which is similar to donating platelets
Therefore, a bone marrow transplant is a transplant where stem cells are collected/harvested directly from the patient or donor. A peripheral blood stem cell transplantation (PBSCT) is a transplant where stem cells are collected through the peripheral bloodstream by pheresis.
Often, myeloma patients who undergo autologous transplants will have their stem cells collected by pheresis because it is easier on the patient and requires a shorter recovery time. Patients will receive two daily injections over a few days, to stimulate the bone marrow and “squeeze” the stem cells from the bone marrowinto the peripheral blood. During this process, patients are connected to a machine that will remove their blood and selectively collect their stem cells. Once the stem cells are collected, the blood is returned to the patient. Each pheresis session takes approximately four hours. Depending on how many stem cells are collected with each session, the entire process may take one to three days or more. Collected stem cells are frozen and stored until the patient is ready to receive them.
Chemotherapy destroys the cancer cells, but it will also destroy “good” cells. By collecting the stem cells in advance, intense or high-dose chemotherapy can be given safely. Once the patient receives the high-dose chemotherapy, they receive their collected stem cells back. By infusing (returning) these stem cells, patients are able to recover their blood counts and “bounce back” more quickly.
The most common side effects of high-dose chemotherapy include:
- Low blood counts (white cells, red cells and platelets)
- Nausea
- Vomiting
- Hair loss
- Mouth sores
- Diarrhea
When patients have low blood counts, they are more susceptible to getting infections, suffering from fatigueand bleeding. Although patients may have some side effects during administration of the chemotherapy, they usually feel worse a few days after receiving chemotherapy, when their blood counts drop. During this time, they are monitored closely for any fevers (infections), the need for any blood or platelet transfusions, and the need for fluid and electrolyte replacement.
Allogeneic transplantation for myeloma is not as common because it is associated with a higher risk of death. It is mostly for patients who relapse after an autologous transplant or for those with very aggressive myeloma. When patients receive stem cells from a donor, they are essentially receiving a new immune system that may help fight the myeloma. The high risk of allogeneic transplantation is largely from graft-versus-host disease (GVHD). GVHD occurs when the new bone marrow (the graft) recognizes the tissues of the patient’s body as foreign and reacts against the body. Graft-versus-host disease can vary from mild and temporary, to serious and chronic, or even life threatening. Signs and symptoms include: a rash, dry eyes, dry mouth, nausea, vomiting, diarrhea or liver enzymes abnormalities.
Clinical Trials
New treatments are always being tested in clinical trials and some patients with multiple myeloma may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Search MD Anderson's clinical trials database for a current listing of multiple myeloma clinical trials.