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Your Guide to Making Multiple Myeloma Treatment Decisions

From the NCCN Guidelines for Patients ™


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Experts in myeloma will help you consider all of your treatment options, balancing the risks and benefits of each with your age and overall health. For example, while high-dose chemotherapy and autologous stem cell transplant is considered a standard treatment for myeloma, not everyone can tolerate high-dose chemotherapy.

Additionally, while many people enjoy long periods of time when the myeloma is under control, autologous stem cell transplant is not considered curative because the disease typically relapses. An allogeneic transplant may offer a better chance for cure, but this treatment opportunity is limited since many people do not have an appropriate donor. Furthermore, it can be associated with significant side effects, including death.

Finally, myeloma is an area of active research with many new drugs and combinations of drugs under development. These factors mean that there are many options for people with myeloma and their physicians to consider together. Frequently asked questions include:

  • Is the person considered a candidate for high-dose chemotherapy and autologous stem cell transplant?
  • If two autologous transplants are considered, what is the optimal timing? For example, should the second one be planned in advance or deferred until the person relapses?
  • Is the person a candidate for an allogeneic stem cell transplant? If so, how should the family members be tested to see if their bone marrow matches that of the recipient?
  • Should the allogeneic transplant be the first transplant, or should this transplant only be performed when the disease relapses after a prior autologous transplant?
  • What are the risks of each of these strategies, both short term and long term?
  • What duration of disease control is associated with each of these strategies, and what is the likelihood of long-term control or even cure?
  • If the person is not a candidate for a stem cell transplant, what other options are available, including new drugs that may be under study?

You should not hesitate to discuss your symptoms or any other quality-of-life concerns with your cancer care team.

The goal of treatment is to destroy the malignant myeloma cells and treat the symptoms of myeloma. But it is important to realize that maintaining quality of life is also a very important goal. Enduring pain unnecessarily has no benefit. You should not hesitate to discuss your symptoms or any other quality-of-life concerns with your cancer care team, as there are effective and safe ways to treat pain and most of the side effects caused by myeloma or chemotherapy.

For example, bone pain can be treated with pain medication or radiation therapy to the site of the pain. When properly prescribed, drugs can effectively relieve pain without risk of addiction, dependence, or becoming too drowsy to continue most usual activities. Pain medication does not interfere with cancer treatments. Receiving effective pain relief can help some people to be more active and may, indirectly, help them live longer.

Getting a Second Opinion
The time during a cancer diagnosis is very stressful. Many people with cancer divide their lives into the period “before I got cancer” and “after the diagnosis.” Often, people with cancer just want to get it treated as soon as possible to reduce the chance of it spreading. It is important to know that while a cancer diagnosis cannot be ignored; there is time to evaluate the various treatment options for your cancer and to select the one that is best for you.

Once your doctor has provided you with your diagnosis and a treatment plan, you may wish to have another specialist review the plan. This is called getting a second opinion. Cancer is complicated and there is a tremendous amount of new information being published every week about which treatments are most effective and safe. While you may have complete confidence in your doctor and his or her judgment, it is sometimes helpful to u have a second expert opinion on the course of treatment that is right for you. Some people feel uncomfortable asking their doctor to help them obtain a second opinion; however, it is a normal part of oncology practice.

Some people feel uncomfortable asking their doctor to help them obtain a second opinion; however, it is a normal part of oncology practice.

Your doctor will need to help you by providing copies of your pathology report, test results, and scans to the second specialist. Some health plans even require a second opinion before surgery. If your health plan does not cover the cost of a second opinion, you have the choice of paying for it yourself.

Even most doctors, when faced with a cancer diagnosis for themselves or their loved ones, will consult with more than one physician before selecting a course of therapy. This is one of the most important decisions you will ever make, and it can have a significant impact on both the quality of your life going forward and the chances of a positive outcome.

Please note, there are few cancers that are so aggressive that you cannot take a few days or weeks to get a second opinion and select a treatment that is most likely to provide you with the best chance.

Other Things to Consider During and After Treatment
Every person’s reaction to a cancer diagnosis is different. Some people wish to defer entirely to the cancer care team and become minimally involved in treatment decisions. Others want their family members to be involved in treatment decisions, and still others want to take charge themselves. However, becoming actively involved in your own cancer treatment may improve cancer care and recovery. For example, if individuals are aware of the potential side effects of treatment, they can alert their cancer care team promptly if problems emerge.

Cancer treatment can be exhausting, both emotionally and physically, so it is important to get plenty of sleep at night. You can also assist in your own recovery by making healthy lifestyle choices, such as quitting smoking and adopting good nutritional habits, that can be beneficial both during and after treatment.

People often have many family and friends who are eager to help, and they should take advantage of these offers while ensuring that they still have plenty of opportunity during the day for rest and personal time. Some people may have special strengths, such as a history of excellent nutrition and physical activity, a strong family support system, or a deep faith, and these strengths can have a positive effect on their response to cancer treatment. If people with myeloma, friends, or family members have difficulty coping with the emotional aspects of the illness, there are many experienced professionals in mental health services, social work services, and pastoral services who can assist. Local support groups can be helpful with this as well. You should not hesitate to take advantage of every opportunity available to help you recover.

About Clinical Trials
Clinical trials are carefully controlled research studies in which people with cancer may participate. These studies may test whether a new treatment is safe and how well it works, or look at new ways to diagnose or prevent a disease. Clinical trials may also focus on refinements to existing standard therapies. Most of the advances in cancer therapy have resulted from the participation of patients in clinical trials. There are many decisions to make after a cancer diagnosis, and one of them may be whether or not to participate in a clinical trial. Myeloma is an area of active research, so many clinical trials are available.

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To view the full version of the NCCN Guidelines for Patients™: Multiple Myeloma, go to www.nccn.com.

Reproduced with permission from the NCCN Guidelines for Patients™: Multiple Myeloma. © 2011 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines for Patients™ and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines for Patients™, go online to NCCN.com. NATIONAL COMPREHENSIVE CANCER NETWORK ®, NCCN®, NCCN GUIDELINES™, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

This article was published in Coping® with Cancer magazine, March/April 2011.