Multiple Myeloma Treatments
Multiple myeloma is a type of blood cancer which is found in plasma cells within bone marrow. Like many cancers, it is the result of malformed cells, and because it affects many areas of the body it is called "multiple" myeloma.
Multiple myeloma mainly affects the longer bones in the body, including the spine, ribs, skull, leg and arm bones, and hips.
Symptoms of Multiple Myeloma
The main symptoms of multiple myeloma are bone pain and overwhelming tiredness or fatigue, which is caused by the resulting anemia. Another common symptom is that bones can fracture easily, and sometimes this is associated with kidney problems as a result of the abnormal protein cells produced by the cancer.
Recurrent infections may also be experienced due to the immune system being compromised. Other possible symptoms include constipation, loss of appetite, weight loss and being excessively thirsty. Peripheral neuropathy, which is a tingling or pain in the nerve endings of the fingers and toes, can also be experienced with multiple myeloma. Read more about the symptoms of multiple myeloma.
How Is Multiple Myeloma Diagnosed?
Multiple myeloma is diagnosed using a bone marrow biopsy. This is performed using a needle which takes a sample of bone marrow, and sometimes bone, under local anaesthetic. Other scans may have preceded this phase, including x-rays which look for bone damage, as well as CT and MRI scans.
The tissue taken during the biopsy is examined in the lab to see if cancer is present in the plasma cells.
What Treatments Are Available for Multiple Myeloma?
Although multiple myeloma can’t be cured, it is treatable. It’s a type of cancer which is often treated for a period of time and then treatment is paused to let the body recover. Often, the disease won’t cause any problems for a while but once symptoms are experienced again the treatment can be restarted.
The good news is that with advances in research during the past 10 years, and the availability of various multiple myeloma treatments, survival rates are among the fastest growing of all cancer types. A combination of drugs is often prescribed, alongside other medications to control side effects.
Older or less-fit patients are usually offered a less intensive drug regime when compared with younger or fitter patients.
Chemotherapy for Multiple Myeloma
Chemotherapy drugs are designed to kill or slow down the grow of the myeloma cells, but in doing so can also damage other cells. Chemotherapy side effects include low immunity, nausea, hair loss and nerve damage. Chemotherapy may be delivered in tablet form, or via an injection.
Steroid Treatment for Multiple Myeloma
As with many other cancers, chemotherapy can be accompanied by steroid treatments to improve its effectiveness. Steroid tablets are prescribed during the chemotherapy phase and have their own side effects which include insomnia, mood changes, weight gain as a result of having an increased appetite, heartburn and indigestion. Steroids are also useful in treating multiple myeloma because they prevent inflammation in the areas of the body which are experiencing pain.
Targeted Therapy for Multiple Myeloma
Various drugs can be prescribed for multiple myeloma which modify the body’s immune system and make it stronger. They are known as immunomodulatory drugs, or IMiDs for short. These drugs starve the cancer cells; slowing down the growth of myeloma cells and stopping them from multiplying.
Thalidomide: thalidomide is a type of biological therapy which uses the body’s own immunity to fight the cancer cells.
It is common to be prescribed a (proteasome inhibitor) targeted therapy such as bortezomib when treating multiple myeloma, as it is extremely effective at killing the diseased cells. Side effects of bortezomib include tiredness, diarrhea and peripheral neuropathy.
Stem Cell Transplant for Multiple Myeloma
When higher doses of chemotherapy are given to treat multiple myeloma, many healthy cells can be damaged too. The aim of this intensive treatment is to suppress the disease for longer, but healthy cells in the bone marrow are also affected. To replenish the healthy cells, stem cell treatment uses the patient’s own cells, which will have been collected prior to starting treatment. Otherwise known as a bone marrow transplant, this can involve a long stay in the hospital afterwards while the body recovers.
Remission, Relapse and Hope
When these multiple myeloma treatments are combined, a good response is often experienced, and the cancer can become stable. It could be that there is no evidence of any remaining active myeloma cells in the body, and that the patient feels much better. They will be monitored by checking levels of paraproteins and having regular blood and urine tests. X-rays are also often used to check the bones, and a biopsy of the bone marrow is used to detect and diagnose the presence of any new cancer cells.
Sometimes, though, the cancer returns — which is known as a relapse — but there are very effective treatments for this phase too. Further doses of the drugs mentioned above may be given, but there are also new options available. These include lenalidomide and pomalidomide, which are similar to thalidomide, but produce side effects such as anaemia, bruising, bleeding and low immunity. Carfilzomib is an intravenous injection which is a more intensive alternative to bortezomib. Daratumamab is another intravenous treatment which works by killing one of the proteins contained within multiple myeloma cells. And, finally, panobinostat is another new treatment which is given orally.
As research progresses, more treatments become available and sometimes patients may be offered to participate in a clinical trial to compare new therapies with existing ones. As one of the more treatable cancers, multiple myeloma can be very well managed to give patients an excellent quality of life and prognosis even if an ultimate cure is not possible.