Treatments for Multiple Myeloma

Oncologists tend to treat multiple myeloma, not as a cancer to be cured, but as a chronic condition that can be managed. With the right combination of therapies, many patients with multiple myeloma can continue to live productive lives.

Most myeloma patients will be treated with combinations of medications. These medications are very effective at controlling the disease.

However, because there are so many medications and options available for patients today, multiple myeloma has become an increasingly complex condition to treat. Oncologists must be highly adept at matching their patients to the right therapies at the right time in order to achieve success. That’s why it’s important for multiple myeloma patients to be treated by a specialist.

The Washington University oncologists at Siteman Cancer Center are the most prominent multiple myeloma experts in the region. They understand myeloma inside and out and will be able to manage your case at every stage.

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. Talk to your physicians about whether your condition could benefit from a clinical trial.

What treatments are used for multiple myeloma?

Patients with multiple myeloma generally receive one or more of the following forms of treatment:

  • Drug therapy
  • Stem cell transplant
  • CAR T-cell therapy
  • Radiation therapy
  • Surgery
  • Active surveillance

What is drug therapy for multiple myeloma?

Most patients with multiple myeloma are first treated with drug therapy – that is, combinations of medicines that kill myeloma cells and keep the disease in check. These medications will likely include proteasome inhibitors, immune-modulatory drugs, and corticosteroids as well.

Over the past 10 years, new immunotherapy drugs have begun to play a more prominent role in the treatment of multiple myeloma. At Siteman Cancer Center, you may receive immunotherapy as part of your prescribed course of treatment or as part of a clinical trial. Immunotherapies are a major area of research for the Washington University multiple myeloma specialists on our team.

Drug therapy can cause a number of side effects, including nausea, vomiting, fatigue, and low blood counts. Your care team will work to manage side effects as they arise.

What are proteasome inhibitors?

Proteasome inhibitors are the first line of treatment for multiple myeloma patients. They are medications that target proteasomes, enzyme complexes that help keep cells healthy by removing waste proteins. Multiple myeloma cells rely heavily on the proteasome as they develop and multiply. Stopping the proteasome from working causes the myeloma cells to die.

Proteasome inhibitors can be given as injections under the skin, IV infusions, or pills.

What are immune-modulatory drugs?

Immune-modulatory drugs are taken as pills. They attack multiple myeloma cells in a number of different ways. Patients might receive immune-modulatory drugs in combination with other therapies to increase their effectiveness.

Chemotherapy for multiple myeloma

Chemotherapies are drugs that kill cancer cells. They are usually administered through an IV infusion, although some chemotherapies are now available as pills or injections.

Multiple myeloma patients typically receive chemotherapy alongside other types of drugs. Today, it is seldom used to treat myeloma on its own.

Immunotherapy for multiple myeloma

Immunotherapies help the immune system recognize and destroy cancer cells. They are a new class of drug, one of the most promising developments in cancer care in recent years.

There are several different types of immunotherapy. Patients with multiple myeloma are most often treated with monoclonal antibodies, which are lab-created antibodies that attach to cancer cells and prompt the immune system to attack them.

Trials at Siteman Cancer Center are exploring new immunotherapies for multiple myeloma. These include bi-specific T-cell engagers, which build bridges between cancer cells and immune cells, and natural killer cells.

When is surgery used to treat multiple myeloma?

Surgery is not a mainstay of treatment for multiple myeloma. If the myeloma has begun to affect any of the patient’s lymph nodes, they will be removed surgically.

In addition, some tumors caused by myeloma cells can also be removed. This happens most often in patients with a type of plasma cell neoplasm called plasmacytoma. Sometimes, removing the plasmacytoma tumor is enough to cure the patient.

When do patients with multiple myeloma receive radiation therapy?

Multiple myeloma patients primarily receive radiation therapy to reduce pain and prevent bone fractures.

If your oncologists decide that radiation therapy could be helpful for your condition, you will be treated by specialist providers. They will ensure that you receive the minimum amount of radiation necessary to meet your needs, using CT simulations to keep the radiation beams directed at the target area and away from healthy tissue.

Stem cell transplant for multiple myeloma

Patients with multiple myeloma can benefit from a stem cell transplant. Also referred to as a bone marrow transplant, a stem cell transplant is a procedure that allows for the administration of intensive doses of chemotherapy to kill of more of the cancer cells. They are a mainstay of multiple myeloma treatment.

Stem cell transplants can help patients with multiple myeloma enter prolonged remissions.

CAR T-cell therapy

CAR T-cell therapy is a new form of treatment that modifies the patient’s immune system cells so they can attack cancer cells. It has been shown to put treatment-resistant multiple myeloma into remission.

At this time, CAR T-cell therapy has not been approved by the FDA for use in multiple myeloma patients. Approval is expected shortly. In the meantime, you may be able to access CAR T-cell therapy through a clinical trial at Siteman.

What is active surveillance for multiple myeloma?

 “Active surveillance” means waiting to treat a disease until it progresses or causes symptoms. Most often used in patients with other plasma cell neoplasms such as MGUS and smoldering myeloma, active surveillance may be recommended based on the stage of the disease and the patient’s age and state of health.

While it may be unsettling not to pursue treatment right away, studies have shown that sometimes patients can benefit from delaying treatment for as long as possible. Waiting to expose cancer cells to medications can keep them from becoming resistant to treatment too early. Patients who are able to wait before taking medications may be more responsive to their treatments when they ultimately begin them.

During the period of active surveillance, patients monitored closely to ensure that their condition is stable.