Treatment plans are individualized and frequently adjusted based on the patient’s response to therapy and any side effects experienced. Regular monitoring and follow-up are crucial to assess the effectiveness of treatment and make necessary adjustments.
Treatment Options
Treatment for multiple myeloma aims to control the disease, alleviate symptoms, and improve the quality of life.
The choice of treatment depends on several factors, including the stage of the disease, the patient’s overall health, and the specific characteristics of the myeloma cells.
Here’s an overview of the main treatment options and guidelines:
Chemotherapy
Purpose: Uses drugs to kill or inhibit the growth of cancer cells.
Drugs: Commonly used drugs include melphalan, cyclophosphamide, and doxorubicin. These drugs can be administered orally or intravenously.
Side Effects: May include nausea, hair loss, increased risk of infections, and fatigue. Low blood counts may also occur. (Other treatments are available nowadays that can lessen some of these side-effects.)
Targeted Therapy
Purpose: Focuses on specific abnormalities (small molecules or pathways) involved in the growth and survival of myeloma cells.
Examples:
- Proteasome Inhibitors: Such as bortezomib and carfilzomib, which block the proteasome—a cell structure that helps regulate protein levels and is crucial for myeloma cell survival.
- Immunomodulatory Drugs: Such as lenalidomide and pomalidomide, which modify the immune response and have direct anti-myeloma effects.
Side Effects: Can include increased risk of blood clots, gastrointestinal issues and low blood counts. Peripheral neuropathy (numbness or tingling) is uncommon with newer immunomodulatory drugs. (Other treatments are available nowadays that can lessen some of these side-effects.)
Immunotherapy
Purpose: Harnesses the body’s immune system to target and destroy myeloma cells.
Examples:
- Monoclonal Antibodies: Such as daratumumab and isatuximab, which target specific proteins on myeloma cells.
- Bispecific T-cell engagers: Such as teclistamab, which targets both the myeloma cell and a normal immune cell (T-cell), bringing them together so the T-cell can directly kill the myeloma cell.
- CAR T-Cell Therapy: Involves modifying a patient’s own T cells to better recognize and attack myeloma cells.
Side Effects: Can include infusion reactions, immune-related side effects, and cytokine release syndrome (a severe reaction where the immune system releases too many inflammatory chemicals).
Stem Cell Transplant
Purpose: Replaces damaged bone marrow with healthy stem cells, which can be sourced from the patient (autologous) or a donor (allogeneic).
Procedure:
- Autologous Stem Cell Transplant: Involves collecting and freezing the patient’s own stem cells, giving high-dose chemotherapy to kill myeloma cells, and then reinfusing the thawed out stem cells to rebuild normal bone marrow.
- Allogeneic Stem Cell Transplant: Uses stem cells from a matched donor. This option is less common and generally used in specific cases due to its higher risks.
Side Effects: Can include increased risk of infections, graft-versus-host disease (in allogeneic transplants), and prolonged recovery.
Radiation Therapy
Purpose: Targets and kills myeloma cells in specific areas, often used to reduce pain or treat localized bone lesions.
Side Effects: May include skin irritation and fatigue.
Bisphosphonates
Purpose: Medications that help strengthen bones and reduce bone pain by inhibiting bone resorption. They are often used to manage bone-related complications.
Examples: Zoledronic acid and pamidronate.
Side Effects: Can include flu-like symptoms, kidney issues, and, rarely, osteonecrosis of the jaw.
Treatment Guidelines
Initial Therapy
Induction Therapy: A combination of drugs is often used to achieve the best response and reduce the amount of disease. This is usually followed by a period of assessment to determine if a stem cell transplant is appropriate.
Risk Assessment: Treatment is tailored based on risk factors such as age, overall health, and specific genetic features of the myeloma.
Maintenance Therapy
Purpose: To help prolong remission and prevent relapse after initial treatment, particularly after a stem cell transplant.
Approach: Often involves lower doses of the same drugs used in induction therapy or other targeted therapies.
Relapsed / Refractory Myeloma
Treatment Options: If the disease returns or does not respond to initial treatments, options may include newer therapies, clinical trials, or different combinations of drugs.
Supportive Care
Pain Management: Includes medications and therapies to manage bone pain and other symptoms. These can include preventative antibiotics, regular infusions of normal immunoglobulins (gamma globulin) and routine vaccinations.
Infection Prevention: Due to the increased risk of infections, preventive measures and treatments are important.
Blood Cell Support: May involve transfusions or medications to manage anemia or low platelet counts, or medications stimulate red blood cell or white blood cell production.