Multiple myeloma is a type of cancer that affects certain white blood cells, called plasma cells, in the bone marrow. The condition can cause people to feel unwell and extremely tired. It can also affect their bones and other organs, such as the kidneys.
The American Cancer Society estimates that in the United States, doctors will diagnose multiple myeloma in 19,320 men and 15,600 women in 2021. Researchers are continually working on new treatments to extend life expectancy for people with this condition.
Multiple myeloma treatment has come a long way since the days when chemotherapy was the only option. Today, more therapies exist than ever before.
Doctors can now customize a treatment plan for each person based on their diagnosis and unique needs. Options may include chemotherapy with stem cell transplantation, immunotherapy drugs, targeted therapies, and novel drug combinations.
This article looks at multiple myeloma treatment options, including chemotherapy and other drugs, bone marrow transplants, and radiation therapy. It also looks at a person’s possible outlook following a multiple myeloma diagnosis.
If a person has multiple myeloma, the altered, cancerous plasma cells build up in the bone marrow, which means that there is not enough space for healthy blood cells. Instead of making antibodies that protect an individual from invading germs, the cancerous cells make an abnormal protein called monoclonal immunoglobulin, or monoclonal protein (M-protein).
Doctors may find these elevated M-proteins while testing the blood for another condition. They may also make a diagnosis because they suspect that someone has multiple myeloma based on their symptoms.
Although there are no specific causes of multiple myeloma, it appears to be more common among males, Black people, and individuals aged 45 years and above.
When treating multiple myeloma, doctors typically use chemotherapy to prepare the body for a stem cell transplant.
Chemotherapy is a powerful form of treatment that kills cells that divide and multiply quickly, such as cancer cells. However, healthy cells that grow rapidly may also become chemotherapy targets. This includes cells in the bone marrow, digestive tract, reproductive system, and hair follicles.
When chemotherapy damages healthy cells, it can cause side effects, including:
People undergoing chemotherapy may also develop low blood counts as a side effect of treatment. Having a low blood count means that an individual has an increased risk of infection. They bruise and bleed more easily, feel fatigued, and could be short of breath.
Most chemotherapy side effects disappear once a person has completed treatment.
Monoclonal antibodies are a form of immunotherapy that uses someone’s immune system to fight the cancer cells by targeting specific proteins. Some monoclonal antibodies target the CD38 protein, while others target the SLAM57 protein. Myeloma cells have both proteins.
Monoclonal antibodies affect cancer cells directly and help the immune system attack them. Doctors often use this treatment in combination with other types of drugs.
These drugs can cause a reaction at the time of administration or a few hours after. Some symptoms of a reaction include:
Immunomodulating drugs regulate certain aspects of the immune system. They can prevent some types of growth signals for cancer cells, activate specific immune cells, and kill myeloma cells.
The first immunomodulating drug that researchers developed was called thalidomide, and it caused severe congenital disabilities. Researchers still question the safety of newer immunomodulating drugs related to thalidomide, and people can only receive them through special programs.
The side effects of immunomodulating drugs depend on the specific drug but can include:
- severe constipation
- painful nerve damage
- serious blood clots
- low white blood cell counts
- low red blood cell counts
Steroids are an essential treatment for all stages of multiple myeloma. At high doses, steroids can kill cancer cells. They can also stop white blood cells from going to the disease-affected areas, thereby decreasing inflammation and relieving pain and pressure.
Some side effects of steroids include:
- weight gain
- high blood sugar
- changes in mood
- sleeping problems
Long-term steroid use may suppress the immune system and weaken the bones. However, these side effects often go away once the steroid treatment is over.
People with myeloma can develop weak bones that may break easily. Bone modifying drugs called bisphosphonates can help strengthen the bones and slow down the weakening process. They can also reduce pain levels.
One rare but severe side effect of bone modifying drugs is osteonecrosis of the jaw. The drugs can destroy the jawbone and create an open wound that cannot heal. The open sore can lead to infection, and some people also experience tooth loss in the area.
One way to prevent this is by maintaining good oral hygiene and treating tooth or gum infections right away.
The standard of care for those with multiple myeloma involves a combination of high-dose chemotherapy and a bone marrow transplant. Getting a bone marrow transplant often means that an individual remains disease-free for a long time.
Whether or not someone is a good candidate for a bone marrow transplant depends on many factors, such as their age and the stage of their myeloma.
People frequently receive chemotherapy before a bone marrow transplant, which weakens their immune system and can lead to infections.
Some other side effects of bone marrow transplants can include:
- nausea and vomiting
- mouth sores
- low platelet counts
- low red blood cell counts
Radiation therapy uses rays of particles to damage multiple myeloma cells and prevent them from growing. Not only can radiation therapy treat multiple myeloma, but it can also reduce complications from bone disease.
Like chemotherapy, radiation therapy can damage some normal cells, especially those that divide quickly. However, most healthy cells recover fully from the effects of radiation therapy.
Some side effects of radiation therapy include fatigue and a loss of appetite. A person may also have some sensitivity and irritation in the skin around the treatment area.
Doctors cannot cure multiple myeloma. There are times when it may lie dormant, but the cancer usually returns. For some people, multiple myeloma may present with no symptoms and progress slowly. A good response to initial treatment can lead to a promising outlook.
Even when treatment is over, regular follow-up testing is necessary to monitor for relapse. The 5-year survival rate for multiple myeloma in 2010–2016 was 53.9%. This rate has been steadily increasing.
Multiple myeloma is a cancer that affects the plasma cells in the bone marrow. There are many treatment options for multiple myeloma.
The standard of care is a combination of chemotherapy and radiation therapy. In most cases, treatment includes a combination of multiple therapies and drugs.
Multiple myeloma has no cure, but people can go into remission. People in remission must have regular follow-up testing to monitor for disease recurrence.