Multiple myeloma is a type of bone marrow cancer. People with multiple myeloma will require treatment to stop disease progression and improve symptoms.

Multiple myeloma is a cancer of the plasma cells. Plasma cells develop from B lymphocytes, also called B cells, a type of white blood cell produced in the bone marrow.

People with multiple myeloma have a buildup of abnormal plasma cells in the bone marrow that cause bone destruction, anemia, kidney failure, or high calcium levels.

This article explains the treatments available for multiple myeloma. It also explains relapse treatments, treatment side effects, and the symptoms of multiple myeloma.

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Treatment for multiple myeloma depends on many factors. Doctors take into account a person’s:

  • age
  • health
  • kidney function
  • disease progression
  • functional status, such as the ability to walk or take care of themselves

Doctors typically aim for a three-drug regimen in treating multiple myeloma. However, if a person cannot tolerate the side effects of a three-drug regimen, a doctor may recommend a two-drug regimen instead.

Chemotherapy uses a drug that stops cancer cell growth by killing them or preventing them from dividing. Chemotherapy enters the bloodstream and travels throughout the body to reach cancer cells.

The American Cancer Society states that chemotherapy is becoming less important in treating myeloma as newer drugs have become available.

Chemotherapy drugs that treat multiple myeloma may include:

  • etoposide (VP-16)
  • liposomal doxorubicin (Doxil)
  • bendamustine (Treanda)

Doctors often combine one of these drugs with corticosteroids and immunomodulating agents.

Common side effects of chemotherapy may include:

Read more about chemotherapy here.

Corticosteroids play an important role in treating multiple myeloma. They regulate the immune system to manage inflammation and help destroy myeloma cells. They also improve the effectiveness of chemotherapy and targeted therapies and decrease symptoms of nausea and vomiting following chemotherapy.

Side effects of corticosteroids may include:

  • increased appetite
  • weight gain
  • high blood sugar
  • mood changes
  • weakened bones
  • increase in energy
  • difficulty sleeping

Read more about corticosteroids here.

Doctors may recommend immunomodulating agents, such as:

  • thalidomide (Thalomid)
  • lenalidomide (Revlimid)
  • pomalidomide (Pomalyst)

According to the National Cancer Institute, these immunomodulating agents cause cells to release interleukin-2 (IL-2). IL-2 is a protein that increases the body’s white blood cells, such as killer T cells and natural killer cells.

Increasing these cells causes an immune response against cancer and helps B cells produce substances that target cancer cells. Immunomodulating agents also prevent tumors from developing new blood vessels.

Side effects of immunomodulating agents may include:

  • fatigue
  • drowsiness
  • constipation
  • painful nerve damage (neuropathy)
  • low platelets and low white blood cell counts
  • anemia

These drugs increase the risk of severe blood clots, so doctors usually advise taking them with a blood thinner, such as aspirin.

CAR T cell therapy helps the immune system locate and attack cancer cells. It involves altering T cell genes to have chimeric antigen receptors on their surface. These receptors enable the T cells to attach to proteins in cancer cells and attack them.

The Food and Drug Administration (FDA) has approved idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvykti) CAR T cell therapies for multiple myeloma.

Common side effects of CAR T cell therapy may include:

  • fever and chills
  • nausea
  • vomiting
  • diarrhea
  • trouble breathing
  • dizziness
  • lightheadedness
  • headache
  • rapid heart rate
  • fatigue
  • confusion
  • seizures
  • shaking
  • trouble speaking and understanding
  • loss of balance
  • allergic reaction
  • low blood cell counts

A healthcare team closely monitors a person receiving CAR T cell therapy because it can have severe or life threatening side effects.

Read more about CAR T cell therapy here.

Monoclonal antibodies are artificial versions of antibodies produced by the immune system. They attack a specific target, such as proteins on the surface of myeloma cells.

Monoclonal antibodies that attach to the CD38 protein on myeloma cells include daratumumab (Darzalex) and isatuximab (Sarclisa). According to the American Cancer Society, these monoclonal antibodies kill cancer cells and help the immune system attack them.

Elotuzumab (Empliciti) is a monoclonal antibody that attaches to the SLAMF7 protein on myeloma cells. This drug also helps the immune system attack cancer cells.

Monoclonal antibodies may cause side effects such as:

  • fatigue
  • nausea
  • fever
  • loss of appetite
  • cough
  • back pain
  • easy bruising
  • lower blood cell counts
  • respiratory infections
  • diarrhea
  • constipation
  • nerve damage, leading to weakness in the hands and feet (peripheral neuropathy)
  • allergic reaction

Proteasome inhibitors block the action of proteasomes in cancer cells. Proteasomes are proteins that remove other proteins the cells no longer require. By blocking proteasome, proteins build up in the cell, causing the cancer cell to die.

Proteasome inhibitors doctors may recommend for multiple myeloma include:

Common side effects of proteasome inhibitors include:

  • nausea
  • vomiting
  • fatigue
  • diarrhea
  • constipation
  • fever
  • loss of appetite
  • lowered blood counts
  • peripheral neuropathy
  • shingles
  • shortness of breath

A doctor may recommend a person have a stem cell transplant following chemotherapy. Chemotherapy kills cancer cells, but it also destroys healthy cells, such as blood-forming cells. A stem cell transplant replaces the blood-forming cells.

During a stem cell transplant, a healthcare professional removes immature blood cells from the blood or bone marrow of the patient to freeze and store them.

After a person completes chemotherapy, healthcare professionals thaw the stem cells and give them to the person through an infusion. This, in turn, mimics a “rescue” of bone marrow depleted of cells due to high dose chemotherapy.

Research indicates having two transplants 6–12 months apart may help people more than having a single transplant. However, this is a tandem transplant. Not everyone may benefit from this approach.

Stem cell transplants have side effects similar to chemotherapy but tend to be more severe. Low blood counts are a severe side effect of a stem cell transplant, which can lead to a higher risk of severe infections and bleeding.

Read more about stem cell therapy here.

Myeloma cells can cause bones to weaken and break. Bone-modifying agents help slow bone loss, prevent bone fractures, and reduce bone pain. These are called supportive medicines.

A doctor may prescribe bone-modifying agents such as:

  • denosumab (Prolia)
  • pamidronate (Aredia)
  • zoledronic acid (Zometa)

Radiation therapy uses high energy X-rays or other radiation to kill cancer cells or stop them from growing. Doctors may suggest radiation therapy to treat myeloma bone damage that has not responded to chemotherapy.

Side effects of radiation therapy may include:

  • fatigue
  • nausea
  • skin changes in the area receiving treatment
  • diarrhea
  • low blood counts

Read more about radiation therapy here.

When signs and symptoms of multiple myeloma reappear after a period of improvement, this is called a relapse. Treatments for relapses or tumors that do not respond to therapies are similar to initial treatments.

Doctors may administer the same drugs a person had before or apply a combination of drugs sequentially when relapse happens 1 year or more after therapy.

Treatment for multiple myeloma relapse may include:

  • monoclonal antibodies
  • proteasome inhibitors
  • immunomodulatory agents
  • chemotherapy
  • CAR T cell therapy
  • corticosteroids

Some people with multiple myeloma have no symptoms. Other people have common symptoms, such as:

  • bone pain, particularly in the spine, ribs, or hips
  • nausea
  • loss of appetite
  • weight loss
  • constipation
  • fatigue
  • confusion
  • breathlessness
  • weakness in the legs and feet
  • excessive thirst
  • frequent infections

There is no cure for multiple myeloma, but remission can occur. This can last months to years.

According to the National Cancer Institute’s SEER program, the overall 5-year survival rate for myeloma from 2012–2018 was 57.9%.

Multiple myeloma is a cancer of plasma cells. It may cause the destruction of the bones in the body, elevated calcium levels, anemia, or kidney failure.

Doctors determine the most suitable treatment and medication dosage depending on several factors involving a person’s health and the aggressiveness of the disease.

Treatment for multiple myeloma may include a combination of chemotherapy, corticosteroids, and more.

Treatment for multiple myeloma relapse is similar to initial treatment. Doctors may use the same drugs or try new drug combinations.