Treatment Options

Active Myeloma

Treatment options for people with symptomatic myeloma include both treatment to control the cancer, as well as supportive care to improve quality of life and help manage symptoms. Myeloma can’t be cured, but there are many new treatments to help people control the disease and live with it over time. Most people receive more than one type of treatment and the treatment plan includes different phases:

• Primary Treatment (also known as Induction Therapy) is given to rapidly control cancer and help relieve symptoms and usually includes several treatments at the same time. The type of medicine chosen depends on whether a stem cell transplant is recommended and may include:
• Triplet Therapy - a combination of three or four drugs to attack and destroy myeloma cells
• Bone-building therapy - Used to strengthen bones and protect them from damage
• Adjunctive treatment and supportive care - treatment for the symptoms of myeloma and the side effects of myeloma treatment. A few treatments include: drugs, radiation therapy or surgery for bone pain, drugs for hypercalcemia, plasmapheresis for hyperviscosity, erythropoietin for anemia, vaccines/treatments for infections, blood thinners to prevent blood clots and/or IV fluids or plasmapheresis to reverse kidney damage
• Consolidation is the treatment given to keep cancer cells under control after primary treatment (e.g. chemotherapy or a bone marrow/stem cell transplant).
• Maintenance Therapy is treatment that's provided over a prolonged period to prevent cancer recurrence.

• Chemotherapy: Drugs that may be used in combination to destroy cancer cells through a specific number of cycles over a set period of time. These drugs include bendamustine (Bendeka, Treanda), carmustine (BiCNU), cisplatin (Platinol), cyclophosphamide (Cytoxan), doxorubicin hydrochloride (Adriamycin), doxorubicin hydrochloride liposome (Doxil), etoposide (Etopophos), melphalan (Alkeran), melphalan hydrochloride (Evomela).
• Targeted Therapy: Treatment that targets the cancer's specific genes or proteins by blocking growth and spread of cancer cells while limiting damage to healthy cells. Doctors can better match each patient with the most effective treatment by running tests on cancer cells to identify the unique genes, proteins, etc. Targeted therapy includes:
  • Proteasome Inhibitors target specific enzymes called proteasomes that digest proteins in the cells and include: bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro)
  • Monoclonal antibodies bind to myeloma cells and identify them for removal by a person’s own immune system and include: elotuzumab (Empliciti), daratumumab (Darzalex), daratumumab and hyaluronidase-fihj (Darzalex Faspro), isatuximab-irfc (Sarclisa) and teclistamab-cqyv (Tecvayli)
  • Small molecule inhibitors penetrate the inside of cancer cells and target proteins or other molecules that cause the cancer cell to die and include: venetoclax (Venclexta)
  • Nuclear export inhibitors work by blocking the XPO1 protein, which stops the cancer cells from functioning and includes selinexor (Xpovio)
  • Bispecific antibodies aim to engage two targets. These antibodies can attach to both a T cell and a myeloma cell at the same time, activating an immune attack on the cancer cells.
• Immunotherapy: Boosts the body’s natural defenses to fight cancer and is also called biologic therapy. Chimeric antigen receptor (CAR) T-cell therapy (chimeric antigen receptor) is a cell-based gene therapy that alters the genes inside certain immune cells to help them attack cancer and includes: ciltacabtagene autoleucel (Carvykti) and idecabtagene vicleucel (Abecma).
  • Immunomodulatory drugs: Drugs that stimulate the immune system and keep new blood vessels from feeding myeloma cells. These include: lenalidomide (Revlimid), pomalidomide (Pomalyst) and thalidomide (Thalomid).
• Steroids: Reduce burden of plasma cells temporarily and include prednisone (Deltasone), and dexamethasone (Decadron)
• Bone-modifying drugs: Help strengthen bones, reduce bone pain and risk of fractures. There are two types available and choices depend on your risk of side effects and overall health:
  • Bisphosphonates: Block osteoclasts, which are the cells that dissolve bone and include: pamidronate disodium (Aredia) and zoledronic acid (Zometa)
  • RANK ligand inhibitor: Osteoclast-targeted therapy: denosumab (Xgeva)
• Bone marrow/stem cell transplant: A procedure where bone marrow that contains cancer is replaced by healthy red blood cells. The two types of transplants are allogeneic (ALLO), which uses donated stem cells and autologous (AUTO), which is more common and uses the patient's own stem cells.
• Radiation therapy: Use of high-energy x-rays or other particles to destroy cancer cells or stop new cancer cells from being made in a specific area of the body. Radiation therapy usually requires a series of treatments over a set period of time. The most common type is external-beam radiation therapy, which is radiation given from a machine outside of the body.
• Surgery: May be used to relieve symptoms such as bone fractures.
• Clinical Trials: A care option across all types and stages of multiple myeloma

Learn more about the various types of treatment and the drugs approved for Multiple Myeloma.