What are the treatments for multiple myeloma?

The treatment of multiple myeloma is complex and often requires a combination of therapies tailored to the individual patient. The primary goals of treatment are to control the disease, alleviate symptoms, and prolong survival. Here are the main treatment options for multiple myeloma:

1. Chemotherapy

• Purpose: To kill rapidly dividing myeloma cells.

• Drugs Used: Melphalan, Cyclophosphamide, Doxorubicin, and Vincristine.

• Administration: Can be given orally or intravenously.

2. Targeted Therapy

• Purpose: To specifically target the cancer cells with minimal damage to normal cells.

• Drugs Used:

• Proteasome Inhibitors: Bortezomib (Velcade), Carfilzomib (Kyprolis).

• Immunomodulatory Drugs (IMiDs): Thalidomide (Thalomid), Lenalidomide (Revlimid), Pomalidomide (Pomalyst).

• Mechanism: These drugs interfere with the cancer cells’ ability to grow and survive.

3. Immunotherapy

• Purpose: To enhance the body’s immune response against myeloma cells.

• Drugs Used:
• Monoclonal Antibodies: Daratumumab (Darzalex), Elotuzumab (Empliciti), Isatuximab (Sarclisa).

• Mechanism: These antibodies attach to specific proteins on myeloma cells, marking them for destruction by the immune system.

4. Stem Cell Transplant (Bone Marrow Transplant)

• Purpose: To replace diseased bone marrow with healthy stem cells.

• Types:
• Autologous Stem Cell Transplant: Uses the patient’s own stem cells.

• Allogeneic Stem Cell Transplant: Uses stem cells from a donor.

• Process: High-dose chemotherapy is used to kill myeloma cells, followed by infusion of healthy stem cells to restore bone marrow function.

5. Radiation Therapy

• Purpose: To target and kill myeloma cells in specific areas, particularly to relieve bone pain or treat spinal cord compression.

• Administration: External beam radiation.

6. Corticosteroids

• Purpose: To reduce inflammation and kill myeloma cells.

• Drugs Used: Dexamethasone, Prednisone.

• Mechanism: These drugs are often used in combination with other treatments.

7. Surgery

• Purpose: Generally used to relieve pain or repair fractures caused by bone lesions.

• Use: Not a primary treatment for myeloma but can be necessary in certain circumstances.

8. Bisphosphonates

• Purpose: To strengthen bones and reduce bone pain and fractures.

• Drugs Used: Zoledronic acid (Zometa), Pamidronate (Aredia).

• Mechanism: These drugs slow down the bone damage caused by myeloma cells.

9. CAR T-Cell Therapy

• Purpose: To reprogram a patient’s own T cells to attack myeloma cells.

• Drugs Used: Idecabtagene vicleucel (Abecma), Ciltacabtagene autoleucel (Carvykti).

• Mechanism: T cells are extracted, modified to target myeloma cells, and then reintroduced into the patient’s body.

10. Supportive Care

• Purpose: To manage symptoms and improve quality of life.

• Includes:
• Pain management.
• Treatment of infections.
• Blood transfusions for anemia.
• Physical therapy and rehabilitation.

Monitoring and Follow-up

Patients with multiple myeloma require ongoing monitoring to assess the effectiveness of treatment, manage side effects, and detect any signs of relapse. This includes regular blood tests, imaging studies, and bone marrow examinations.

Clinical Trials

Patients may also have the option to participate in clinical trials, which can provide access to new and emerging treatments.

Treatment plans are often individualized based on the patient’s overall health, age, stage of the disease, and specific characteristics of the myeloma. It is essential for patients to work closely with their healthcare team to determine the most appropriate treatment strategy.