Treatment

Treatments

Multiple Myeloma belongs to a class of conditions called plasma cell (white blood cells that produce antibodies) neoplasms, abnormal growths of tissue that form a mass or tumor, some of which are benign and some cancerous. Abnormal plasma cells build up in the bone marrow. These tumors can prevent the bone marrow from making healthy blood cells: red cells to carry oxygen, white cells to fight infection, and platelets to prevent bleeding. It can damage the bone and make it more prone to breaking. They have a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our physicians are principal investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

Different types of plasma cell neoplasms respond to different treatments, so depending on your type, treatments will vary:

  1. Chemotherapy: These drugs stop the growth of cancer cells and may be administered by mouth, intravenously (systemically), or under the skin (subcutaneously) — depending on the stage and location of the cancer.
  2. Other drug therapy: Steroids have antitumor effects on multiple myeloma. Other drugs act to stimulate the immune system to attack the disease.
  3. Targeted therapy: These are drugs that identify and attack specific aspects of cancer and may include monoclonal antibody therapy.
  4. High-dose chemotherapy with stem cell transplant
  5. Radiation therapy: High energy radiation sources can be given either externally or internally via implants or seeds to kill cancer cells, depending on the type and stage of cancer.
  6. Surgery can remove specific tumors like plasmacytomas and is usually followed by radiation.
  7. Active surveillance: In conditions like MGUS or smoldering myeloma, the condition can be observed for any changes that might require treatment.

New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other facilities may have access to them.

Medical Treatment

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Recently, several new drugs have increased the options for physicians treating patients with multiple myeloma. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given by itself, or as part of a bone marrow and stem cell transplant.

Intravenous forms of treatment may require the placement of a Port-a-Cath. The catheter and port are inserted under the skin into the internal jugular vein right around the collar bone in a patient who will be getting multiple chemotherapy treatments. This allows for giving treatments without damaging the veins or increasing the risk of the medicine leaking out of the vein. It can also be used to draw blood samples to monitor therapy. The port into the catheter lies just under the skin and isn’t noticeable from the outside. When the nurse wants to give chemotherapy, the skin is cleaned and the needle is inserted through the skin into the port to deliver the medicine. It stays in place for the duration of treatment.

Targeted therapy: These drugs target certain parts of the cell and the signals that are needed for a cancer to develop and keep growing. These drugs are often grouped by how they work or what part of the cell they target. Monoclonal antibody drugs are man-made versions of large immune system proteins (called antibodies) that are designed to attack a very specific target on cancer cells.

Surgery

Surgery for blood cancers usually involves surgical removal of lymph nodes that have become affected. While in other blood cancers the spleen may become large and press on other organs requiring its removal, this is rarely the case in plasma cell neoplasms.

When a tumor is concentrated in one place, as with plasmacytomas, it may be possible to surgically remove the tumor for a cure.

Radiation therapy

Radiation oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. No one should be over or undertreated. Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.

External beam radiation: Ninety-five percent of radiation treatment at Siteman is external beam from outside the body. Siteman fine-tunes the radiation planning with intensity modulated therapy, using a large-bore CT simulator for 3D or full positioning to precisely target therapy. Our team was the first in the world to have the ability to do external radiation with MRI guidance, and the first to treat patients with that technology. For plasma cell neoplasms, radiation is most often used for pain control and prevention of fractures.