How is Multiple Myeloma Treated?

The treatment for multiple myeloma depends on various factors, such as your stage and classification risk, your age, your overall health, and whether the myeloma is newly diagnosed or has come back. 

Treatment often involves a combination of therapies tailored to your individual needs. It's important for patients to discuss all treatment options with their healthcare team to make the best decisions for their unique situation.

If possible, you should seek treatment from a specialist who has experience treating multiple myeloma. 

Find a multiple myeloma specialist in your area

After your diagnosis, it is normal to get a second opinion. During a second opinion, another oncologist will look at your biopsy results and other tests you had during your diagnosis. They will offer their opinion on your treatment. 

How is newly diagnosed multiple myeloma treated?

The standard of care treatment for newly diagnosed multiple myeloma is an autologous stem cell transplant (ASCT) followed by maintenance therapy. About half of all people with multiple myeloma will be treated with an ASCT. 

An ASCT is when your own healthy stem cells are collected, stored, and then returned to your body after intensive treatment. This is also known as high-dose therapy with stem cell rescue. 

Induction therapy

Before the transplant, induction therapy treats the multiple myeloma without damaging your stem cells. There are two types of induction therapy regimens: triplet therapy and quadruplet therapy. 

Induction therapy takes place over 3 to 6 cycles. Each cycle is between 3 to 4 weeks. There are different induction therapy combinations. Your care team will make a recommendation based on your specific needs. 

Triplet induction therapy

Triplet induction therapy combinations include an immunomodulatory drug, a proteasome inhibitor, and a steroid. 

Triplet therapies include:

• Carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone, a combination called KRd
• Bortezomib (Velcade), lenalidomide, and dexamethasone, a combination called VRd

Quadruplet induction therapy

Quadruplet induction therapies include an immunomodulatory drug, a proteasome inhibitor, an anti-CD38 monoclonal antibody, and a steroid..

Quadruplet therapies include: 

• Daratumumab with hyaluronidase-fihj (Darzalex Faspro) plus KRd (DKRd)
• Daratumumab with hyaluronidase-fihj plus VRd (DVRd)
• Isatuximab (Sarclisa) plus KRd (Isa-KRd)
• Isatuxiumab plus VRd (Isa-VRd)

New induction therapy combinations are being studied for newly diagnosed multiple myeloma. Learn more about clinical trials. 

Stem cell collection

After induction therapy, your healthy stem cells will be collected from your blood. Those cells will be frozen and stored until they are needed.

Conditioning therapy with high-dose chemotherapy

After your healthy stem cells are collected, treatment begins with high-dose chemotherapy. Typically, it is melphalan. This type of chemotherapy is called an alkylating agent. This step is called conditioning.

High-dose chemotherapy targets all cells that divide rapidly. This targets the myeloma cells, but it also attacks some healthy cells. This can cause side effects including: 

• Nausea
• Vomiting
• Mouth sores
• Hair loss
• Rash
• Itching
• Infertility
• Infection
• Inability to make new blood cells

ASCT

After conditioning therapy, the collected and frozen stem cells are thawed and infused into your body. 

Maintenance therapy

After the ASCT, you will have ongoing maintenance therapy. This keeps the myeloma from returning. Options for maintenance therapy include: 

• Lenalidomide (Revlimid)
• Bortezomib (Velcade)
• Ixazomib (Ninlaro)

Learn more about getting an ASCT, including side effects.  

Treating newly diagnosed multiple myeloma without a stem cell transplant

Not everyone can get a stem cell transplant. It is a highly intensive treatment, and your care team may recommend that you do not get a stem cell transplant because of your overall health. If you cannot have an ASCT, you will continue induction therapy with a triplet or quadruplet therapy instead of getting the high-dose chemotherapy. 

How is relapsed or refractory multiple myeloma treated?

Relapsed multiple myeloma is myeloma that comes back after treatment ends. Refractory multiple myeloma is when treatment does not work to control the disease. If you have relapsed or refractory multiple myeloma, your care team will help you decide which treatment options to consider.

There are different kinds of medications used to treat multiple myeloma. They include: 

Proteasome inhibitors

Proteasome inhibitors target proteasomes, which help cells survive. They are especially helpful to treat multiple myeloma because of the amount of protein in myeloma cells. There are currently three proteasome inhibitors approved to treat multiple myeloma: 

• Bortezomib (Velcade)
• Carfilzomib (Kyprolis)
• Ixazomib (Ninlaro)

Immunomodulatory drugs

These medications help immune cells work to destroy myeloma cells and stop them from growing. Immunomodulatory drugs approved to treat multiple myeloma include: 

• Lenalidomide (Revlimid)
• Pomalidomide (Pomalyst)
• Thalidomide (Thalomid)

Monoclonal antibodies

Monoclonal antibodies also help immune cells work. These include: 

• Daratumumab (Darzalex) 
• Elotuzumab (Empliciti)
• Isatuximab (Sarclisa)

Bispecific antibodies

Bispecific antibodies are a type of immunotherapy. Approved bispecific antibodies used to treat myeloma include: 

• Elranatamab (Elrexfio)
• Linvoseltamab (Lynozific)
• Talquetamab (Talvey)
• Teclistamab (Tecvayli)

Learn More About Bispecific Antibodies

CAR T-cell therapy

CAR T-cell therapy is chimeric antigen receptor (CAR) T-cell therapy. During this treatment, your own white blood cells are removed from your body and enhanced in a lab. They are then reinfused into your body to fight myeloma. Currently there are two different types of CAR T-cell therapy approved for multiple myeloma: 

• Ciltacabtagene autoleucel (Cilta-cel, Carvykti)
• Idecabtagene vicleucel (Ide-cel, Abecma)

Learn more about CAR T-cell therapy.

Antibody drug conjugates

Antibody drug conjugates (ADC) combine two treatments: a monoclonal antibody and a powerful chemotherapy. The monoclonal antibody targets and attaches to cancer cells. The chemotherapy can then destroy the cancer cells directly. 

Currently, the only ADC approved to treat multiple myeloma is belantamab mafodotin (Blenrep). 

Other medications used to treat multiple myeloma

Selective inhibitors of nuclear export (SINE). There is currently one SINE approved to treat multiple myeloma: selinexor (Xpovio). 

Chemotherapy. Traditional chemotherapy may also be used to treat relapsed/refractory multiple myeloma.

Steroids. Steroids are often used in the treatment of multiple myeloma. They can help kill myeloma cells. They can also be used as supportive care, to help reduce pain, improve inflammation, and help improve nausea and vomiting.

What’s Next: The next page in this guide is Understanding Multiple Myeloma Lab Results. If you would like to read another page in this guide, return to the Understanding Multiple Myeloma page or choose another page from the menu.

SOURCES: 

Multiple Myeloma Research Foundation. Treatments for Multiple Myeloma. https://themmrf.org/diagnosis-and-treatment/treatment-options/

International Myeloma Foundation. Multiple Myeloma Frontline Treatment Options. https://www.myeloma.org/frontline-treatment-options

International Myeloma Foundation. Role of Transplant. https://www.myeloma.org/autologous-stem-cell-transplant

Cancer Today. The Case for Waiting. https://www.cancertodaymag.org/winter-2025-2026/the-case-for-waiting/

International Myeloma Foundation. Melphalan (Alkeran). https://www.myeloma.org/treatment/multiple-myeloma-medications/melphalan-alkeran

Proteasome Inhibitors: Structure and Function. https://pmc.ncbi.nlm.nih.gov/articles/PMC6020165/