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Treatment Options

There is no such thing as "one-treatment-fits-all" when it comes to treating myeloma. What works for one patient may not work for another, which is why each case must be assessed individually. 

The choice of treatment depends on a number of factors, including:

  • The results of physical exams and diagnostic testing (blood, urine and bone tests).
  • The stage of the disease at the time of diagnosis.
  • The prognostic indicators (i.e., factors on which doctors base their best estimate of how the myeloma will affect the patient and how it is likely to respond to treatment).
  • The patient's age and overall state of health.
  • The symptoms being experienced (for example, bone pain, fractures, etc.).
  • Disease complications (for example, kidney disease, anemia, infections, etc.)
  • Response to prior treatments (if applicable);
  • New treatments that are becoming available through participation in clinical trials.

That said, all treatment options share similar goals, namely to help:

  • Control the myeloma (i.e., prevent the production of abnormal plasma cells).
  • Strengthen the bone and prevent fractures.
  • Increase the red blood count and reduce fatigue.
  • Reduce the risk of infections.
  • Promote well-being and quality of life. 

The standard therapies for myeloma in Canada may include the following:

  • Observation
  • Radiotherapy
  • Chemotherapy such as melphalan (Alkeran ®), cyclophosphamide (Cytoxan®), doxorubicin (Adriamycin®), liposomal doxorubicin (Doxil®) and vincristine (Oncovin®)
  • High-dose chemotherapy with stem cell transplantation
  • Corticosteroids such as dexamethazone or prednisone, often in combination with chemotherapy
  • Immunomodulatory agents (IMiDs) such as thalidomide (Thalomid®), lenalidomide (Revlimid®) and pomalidomide (Pomalyst®)
  • Proteasome inhibitors (PIs), such as bortezomib (Velcade®), carfilzomib (Kyprolis®), and ixazomib (Ninlaro®)
  • Monoclonal antibodies (MoAbs) such as daratumumab (Darzalex®)

Treatments or drugs are commonly used in different combinations, such as lenalidomide and dexamethasone or melphalan and prednisone with bortezomib. A number of new and emerging treatments are becoming available. For more information of new and emerging therapies, visit the Myeloma Research section.

  The standard types of treatments for myeloma in Canada may include a combination of the following
Observation
  • Sometimes the best treatment is no treatment at all.
  • Monitoring the condition may be the best option:
    • For people who have MGUS (a precursor of myeloma)
    • In people with asymptomatic or smouldering myeloma (i.e., disease that is stable or not yet active)
Radiotherapy
  • High-energy radiation may be used to damage the myeloma cells and prevent them from growing.
  • Radiation therapy is typically used on specific parts of the body, usually in combination with chemotherapy.
Chemotherapy
  • A number of drugs are used (often in combination) to reduce the number of plasma cells in the bone marrow and the proteins they produce.
  • Chemotherapy does not cure myeloma, but can put the disease in remission.
  • Chemotherapy is tailored individually to each patient, and usually administered in cycles of alternating treatment and rest periods.  
Steroids Steroids may be used to help prevent inflammation, either alone or in combination with other drugs, such as chemotherapy drugs. 
High-Dose Chemotherapy with Stem Cell Transplantation
  • To prepare for the autologous stem cell transplant (ASCT), the number of myeloma cells needs to be reduced. This is often done with an induction regimen most often using bortezomib (Velcade®)-based combination such as CyBorD (cyclophosphamide, bortezomib and dexamethasone).
  • The stem cells are the collected, frozen and stored until it is time for them to be reinfused.
  • Before the transplantation, patients undergo a "conditioning regimen" consisting of high-dose chemotherapy with melphalan (Alkeran ®) to destroy cancer cells and blood-producing cells in the bone marrow, after which the transplanted stem cells can begin to produce new blood cells. 
  • There are several types of stem cell transplantation approaches that may be used to treat myeloma. For more information, downlaod the Multiple Myeloma Patient Handbook. Download it now
Maintenance Therapy
  • Maintenance therapy is a prolonged, and often low-dose, form of treatment given to myeloma patients after their initial therapy.
  • The goal is to prevent disease progression for as long as possible, while maintaining a good quality of life.
Consolidation Therapy Consolidation therapy involves a shorter course of treatment with the goal of deepening the patient's response to the initial therapy. 
Clinical Trials
  • Clinical trials are research studies involving people. Because people are involved, all clinical trials must be reviewed by Health Canada and shown to be safe.
  • Clinical trials must also be approved by the Ethics Committees of all participating hospitals. These review processes are in place to protect the safety of participants. Only those studies that pass these rigourous approval processes are allowed to recruit patients.
  • For more information on clinical trials, visit the Clinical Trials section.
Supportive Treatments
  • Patients may also be prescribed other supportive treatments to:
    • Help prevent or manage potential side effects of treatment combinations.
    • Treat the symptoms and complications of myeloma, such as pain, bone disease, anemia, etc. 
    • For more information, downlaod the Multiple Myeloma Patient Handbook. Download it now