Piecing Together Your Multiple Myeloma Treatment Options


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Multiple myeloma is a type of cancer that begins in plasma cells (white blood cells that produce antibodies) and is also called Kahler disease, myelomatosis, and plasma cell myeloma.

Different types of treatments are available for people with multiple myeloma and other plasma cell neoplasms. Some treatments are standard, and some are being tested in clinical trials. Nine types of standard treatment for multiple myeloma are currently used.

Chemotherapy
This is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy) . When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy) . The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other Drug Therapy
Other types of drug therapy include the following:

  • Corticosteroid therapy: Corticosteroids are steroids that have antitumor effects in lymphomas and lymphoid leukemias.
  • Thalidomide and lenalidomide: These drugs are called angiogenesis inhibitors. They prevent the growth of new blood vessels into a solid tumor.
  • Bortezomib: This type of drug is called a proteasome inhibitor. It targets certain proteins in cancer cells and may prevent the growth of tumors.

Before starting treatment, you may want to think about taking part in a clinical trial.

High-Dose Chemotherapy with Stem Cell Transplant
This treatment is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the person with cancer or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Biologic Therapy
This is a treatment that uses the person’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Monoclonal antibody therapy is one type of biologic therapy. It is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Radiation Therapy
This is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Surgery
Surgery to remove the tumor may be done, usually followed by radiation therapy. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Watchful Waiting
This option involves closely monitoring a person’s condition without giving any treatment until symptoms appear or change.

Plasmapheresis
This is a procedure in which blood is removed from the person with cancer and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells. That person’s plasma contains the unneeded antibodies and is not returned to him or her. The normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement. Plasmapheresis does not prevent new antibodies from forming.

Supportive Care
This therapy controls problems or side effects caused by the disease or its treatment, and improves quality of life. Supportive care is given to treat bone problems or amyloidosis related to multiple myeloma and other plasma cell neoplasms.

Clinical Trials
New types of treatment are being tested in clinical trials. Clinical trials are studying different combinations of biologic therapy, chemotherapy, steroid therapy, and drugs such as thalidomide or lenalidomide. Before starting treatment, you may want to think about taking part in a clinical trial. Information about clinical trials is available at cancer.gov/clinicaltrials.

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Source: National Cancer Institute, www.cancer.gov

This article was published in Coping® with Cancer magazine, May/June 2009.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.