Medical Therapy for Multiple Myeloma

The medications your doctor prescribes may vary throughout the course of your treatment, but are likely to include some combination of the following.

Immunomodulating Medications

These medications affect how the immune system functions and make it difficult for cancerous plasma cells to survive, reproduce, and produce proteins that cause symptoms. Immunomodulating medications, which include thalidomide, lenalidomide, and pomalidomide, are taken by mouth and are often paired with a corticosteroid.

Proteasome Inhibitors

Proteasome inhibitors block the breakdown of proteins in cancer cells, leading to an accumulation of toxic material that prevents multiple myeloma from growing. These medications may be injected into a vein through intravenous (IV) infusion or given under the skin. Proteasome inhibitors used to treat multiple myeloma include bortezomib and carfilzomib.

Corticosteroids

These steroids are taken by mouth or given through an IV infusion. Corticosteroids, which can include prednisone and dexamethasone, help the other medications you are taking work more effectively. They may also help relieve the nausea and vomiting caused by other medications.

Bisphosphonates

Multiple myeloma can cause bone damage as cancerous plasma cells multiply. Your doctor may prescribe bisphosphonates to help prevent bone destruction by the myeloma cells and to heal bone tissue, which can also relieve pain. These medications, which may include zoledronic acid or pamidronate, are injected into a vein through IV infusion. Other available medications can be taken by mouth.

Chemotherapy

Your doctor may add chemotherapy, a combination of drugs used to kill cancerous plasma cells throughout the body, to the other medications. These drugs are usually given through an IV infusion, though they are being used less often to treat multiple myeloma because of the effectiveness of other drugs.

Some of the more commonly used chemotherapy drugs for multiple myeloma include melphalan, vincristine, cyclophosphamide, and etoposide.

NYU Langone doctors usually prescribe medications for multiple myeloma in three phases.

Induction

The initial phase of medical therapy, known as induction, generally lasts about four to six months. The goal is to reduce the number of cancerous plasma cells in the body.

Consolidation

In the consolidation phase, your doctor may prescribe high-dose chemotherapy for one month to help kill any remaining cancer cells after induction, and on recovery of the normal bone marrow, stem cells are harvested generally from the blood. The stem cells are stored in a frozen state until required.

Sometimes, stem cell transplantation is the next treatment used. In this procedure, a dose of chemotherapy meant to kill all the remaining malignant plasma cells is given, but this dose also permanently destroys the normal bone marrow cells. Then, the harvested stem cells collected earlier are reinfused into your body through a catheter to help restore bone marrow and the production of healthy blood cells.

If the multiple myeloma responds well to the high-dose chemotherapy given during consolidation, our doctors may delay stem cell transplantation unless the cancer returns or worsens. People who delay transplantation often still undergo stem cell collection so that stem cell transplantation can be performed in the future if needed.

Advances in the medications used to treat multiple myeloma mean that the cancer may respond well during induction. If so, NYU Langone doctors may prescribe lower doses of the induction-phase medications (or different medications) during the consolidation phase to further destroy cancer cells and to prevent the disease from worsening. Lower doses can help you avoid the side effects of this treatment, which may include nausea, vomiting, low blood cell levels, and infection.

Maintenance

During the maintenance phase, which may occur after induction or consolidation, medications are prescribed to help keep the number of abnormal plasma cells in the body low and to prevent you from experiencing symptoms of multiple myeloma.

Maintenance may last for several years. Because it’s likely the disease may continue to grow or progress, your doctor continues to see you periodically during maintenance to help you manage the condition, ensure you receive the supportive services you need, and determine if you are a candidate for a clinical trial.

At NYU Langone, conducting clinical trials of new therapies is an important part of caring for people with multiple myeloma, no matter how early or advanced the condition is.

For example, monoclonal antibody drugs, a form of targeted therapy, are available through clinical trials at NYU Langone. These drugs consist of antibodies that attach to proteins found on the surface of cancer cells, interfering with their ability to function. Because monoclonal antibodies target cancer cells and not healthy tissue, they may cause fewer side effects than traditional medications. Also, new oral forms of proteasome inhibitors are being tested.

You and your doctor can discuss the requirements of enrolling in a clinical trial and whether one might be the right option for you.