What Are Treatments for Multiple Myeloma?

Multiple myeloma is a type of blood cancer that affects plasma cells, a type of white blood cell that produces antibodies. Treatment depends on various factors, such as the risk classification of the cancer, the patient’s age, overall health, and whether the myeloma is newly diagnosed or has recurred (relapsed).

Below are the main therapy classes for multiple myeloma. Treatment often involves a combination of these therapies tailored to the individual patient’s needs. It's important for patients to discuss all treatment options with their healthcare team to make the best decision for their unique situation.

Chemotherapy

The primary purpose of chemotherapy, also known as alkylating agents, is to kill or stop cancer cells from growing. However, chemotherapy can be very harsh on the body and destroy healthy, beneficial cells along with the mutated cancer cells.

Chemotherapy drugs used to be the standard of care for myeloma due to the lack of other options. Over the past two decades, the myeloma landscape has evolved only to include chemotherapy when it is the best option or appropriate for a specific circumstance, such as melphalan during a stem cell transplant or cyclophosphamide as a starting therapy for those with significant kidney involvement.

Chemotherapy can be administered orally or intravenously (through an IV).

For a list of chemotherapies used to treat multiple myeloma, search here: Alkylating Agents (Chemotherapies)

Targeted Therapy

These multiple myeloma treatments target specific parts of cancer cells, like proteins or genes, to stop or destroy their growth. By targeting the cancer cells, the treatment negatively affects fewer healthy cells.

Several classes of drugs fall into this category, such as immunomodulators (IMiDs), proteasome inhibitors (PIs), or monoclonal antibodies.

Common targeted therapies are:

IMiDs: lenalidomide (Revlimid, Bristol Myers Squibb), pomalidomide (Pomalyst, Bristol Myers Squibb)
Proteasome Inhibitors: bortezomib (Velcade, Takeda Oncology), carfilzomib (Kyprolis, Amgen), ixazomib (Ninlaro, Takeda)

Immunotherapy

These treatments enhance the immune system's ability to recognize and attack myeloma cells, strengthening the body's natural defenses against cancer. They have shown higher response rates than previous therapies and are becoming key components of combination treatments. However, their mechanisms of action can lead to increased infection rates.

Immunotherapies frequently used in myeloma treatment are:

Monoclonal Antibodies: daratumumab (Darzalex/Darzalex Faspro, Johnson and Johnson), isatuximab (Sarclisa, Sanofi), elotuzumab (Empliciti, Bristol Myers Squibb)
CAR-T: ciltacabtagene autoleucel (CARVYKTI, Johnson and Johnson, Legend Biotech), idecabtagene vicleucel (Abecma, Bristol Myers Squibb)
Bispecific Antibodies (BsAb): teclistamab (TECVAYLI, Johnson and Johnson), talquetamab (TALVEY, Johnson and Johnson), elranatamab (AbbVie).

Corticosteroids

Corticosteroids like dexamethasone help reduce inflammation and work against myeloma cells. They are often used in combination with other treatments. Corticosteroids are known to ease the side effects of other treatments and increase the working synergy of combination therapy.

For more information on dexamethasone and other corticosteroids, check out the following resources:

Stem Cell Transplant

As mentioned earlier, stem cell transplantation was the standard treatment for multiple myeloma. In the 2000s, it moved from being the only known successful therapy to an important part of a bigger myeloma treatment picture.

This procedure involves replacing diseased bone marrow with healthy bone marrow stem cells after a large dose of chemotherapy. Then, the patient receives new, healthy stem cells that can make new blood cells.

In myeloma, the readministered stem cells usually come from the patient themselves (known as an autologous transplant), but donor cells can also be used in certain cases (allogeneic transplant).

View our Complete Patient's Guide to Stem Cell Transplant for a comprehensive, supportive document for those considering, preparing for, experiencing, or recovering from a stem cell transplant.

Radiation Therapy

This treatment uses high-energy rays to kill cancer cells. It can be used to treat a specific area where myeloma cells have collected, such as in a bone or the spinal cord, or to help treat significant bone pain.

For more information on the purpose of radiation therapy in myeloma treatment, you can watch the following video: All About Radiation Therapy (HealthTree University)

Biphosphonates (Bone Stregtheners)

These treatments form new bone, strengthen bones, reduce the risk of fractures, and can also help with bone pain.

Common treatments are:

denosumab (Amgen or Prolia, Amgen)
zoledronic acid (Zometa, Novartis)

For more information on maintaining bone health, read the following article: Living Well with Myeloma: A Focus on Bone Health.

Clinical Trials

Multiple myeloma patients can participate in clinical trials to access new treatments being tested for safety and effectiveness. They may also want to participate in clinical trials to further multiple myeloma research.

Search for multiple myeloma clinical trials here: HealthTree Myeloma Clinical Trial Finder

Supportive Care

Supportive care can help manage the symptoms and side effects of multiple myeloma and its treatment. This can include pain management, physical therapy, nutritional, and psychological support.

The choice of treatment depends on several factors, including the stage of the disease, the patient's age and overall health, and personal preferences. It's important for patients to discuss all treatment options with their healthcare team to make the best decision for their individual situation.

Resources

If you want to learn more about multiple myeloma treatments, you can learn more with our HealthTree resources like: