How is myeloma treated?

How is myeloma treated?

Treatment for myeloma is aimed at disease control by stopping the production of abnormal plasma cells –paraprotein/M band, relieving the complications and symptoms it causes, reducing risk of infection and promoting wellbeing and quality of life.and extending and improving the quality of patients’ lives. Myeloma treatment is almost always with a combination of drugs over periods of time known as cycles. Cycles may last from weeks to months.

Treatment combinations are usually made up of two or three different types of drugs which work well together and can include chemotherapy drugs (e.g Cyclophosphamide), steroids (e.g. dexamethasone and prednisolone), immunomodulatory agents to help normalize the immune system (e.g. Lenalidomide, Pomalidomide) and targeted therapy (e.g Bortezomib, Carfilzomib).d other types of anti-myeloma drugs (e.g. thalidomide, Velcade® and Revlimid®).

Initial treatment/Front line treatment

Commonly used initial treatment combinations for myeloma include:

  • Bortezomib ( Velcade), Lenalidomide, Dexamethasone (known as VRD)
  • Cyclophosphamide, Bortezomib, Dexamethasone (known as CyBorD)
  • Lenalidomide, Dexamethasone
  • Cyclophosphamide, thalidomide and dexamethasone (known as CTD)
  • Melphalan, prednisolone and thalidomide (known as MPT)
  • Velcade®, melphalan and prednisolone (known as VMP)
  • After receiving an initial course of treatment, you may be suitable to go on and have high-dose therapy and a stem cell transplant.

Supportive care

You may also be prescribed other treatment to help prevent or manage potential side-effects of treatment combinations and treat the symptoms and complications of myeloma.

These include:
Bisphosphonates to help minimise myeloma bone disease, hypercalcaemia and bone pain
Pain-killers
Radiotherapy for areas of localised bone disease and pain
Blood transfusions and/or erythropoietin (EPO) for anaemia
Vaccination for ‘flu
Anti viral medication / preventative antibiotics
Intravenous immune globulins

Maintenance

To sustain a response from initial or front-line treatment you may or may not be prescribed myeloma treatments for a period of time.

Examples of these treatments include:
Lenalidomide
pomalidomide
Bortezomib
Treatment for relapsed myeloma
Myeloma is highly treatable in the majority of cases but unfortunately it is currently incurable. This means that even after successful treatment has given you a period of remission or stable disease, your myeloma will return. This is called a relapse. There are a number of effective treatments available for relapsing myeloma. This is true regardless of whether it is your first relapse or if you have experienced one or more relapses previously.

Commonly used treatment combinations at relapse include:
Carfilzomib / Lenalidomide/Dexamethasone (KRD)
Ixazomib/Lenalidomide/dexamethasone (IRD)
Lenalidomide/Dexamethasone (LD)
Pomalidomide/Dexamethasone (PD)
Daratumumab Monotherapy
Borte and dexamethasone
Revlimid® and dexamethasone

There are also a number of novel treatments being investigated for use in clinical trials.

Source: myeloma.org.uk/ Irish cancer Society/NCCP

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