How multiple myeloma is treated

When multiple myeloma is diagnosed, it is the doctor who decides with the patient what treatment is best for the specific case. The decision is not easy, and treatment may be different for each individual.
It is not always necessary to start treatment when multiple myeloma is diagnosed. The decision about whether to start treatment immediately depends on the results of your bone marrow examination, imaging tests and blood tests, as well as whether at least one of the so-called CRAB criteria is met.
The CRAB criteria are generally met if multiple myeloma is already causing symptoms. If this is the case, the doctor will begin treatment immediately.

High-dose chemotherapy and autologous stem cell transplantation

A long period of remission from multiple myeloma can be achieved by using high-dose chemotherapy, followed by an autologous stem cell transplant. The goal of such therapy is to destroy as many myeloma cells as possible. Because chemotherapy also affects healthy bone marrow cells, the patient will subsequently receive an infusion of healthy cells that will have been taken from his or her own blood on a previous occasion. This process is called autologous stem cell transplantation.
However, this type of treatment is best suited for younger, fitter patients up to the age of about 65-70, because they often tolerate side effects better than older patients. For this reason, high-dose chemotherapy followed by stem cell transplantation is often not an option in older or less fit patients.

When high-dose chemotherapy followed by stem cell transplantation is not possible, other medications are currently available.

Alternative therapeutic measures

In recent years, tremendous progress has been made in the treatment of multiple myeloma.

As a result of intensive research, more than twice the number of drugs are now available than 10 years ago, and more are in development. This has significantly improved the outlook and quality of life for those affected.

The drugs mainly used are corticosteroids, immunomodulators (lenalidomide, thalidomide, pomalidomide), proteasome inhibitors (bortezomib and analogs), monoclonal antibodies (daratumumab and elotuzumab).

Supportive therapies for multiple myeloma

Moreover, support therapies are fundamental in the treatment of multiple myeloma, useful, regardless of the treatment of the disease, to improve the quality of life, often severely compromised since the diagnosis.

Hypercalcemia
If the side effect is mild, the doctor may recommend to increase hydration or prescribe steroids.

Kidney failure
the doctor will avoid giving drugs that are toxic to the kidney, treat hypercalcemia, and in some cases may indicate dialysis to help the kidneys function better

Bone pain
in case of pain the doctor may prescribe the use of drugs that can relieve this symptom, there are many types and very effective

Peripheral neuropathy
Some drugs used to treat myeloma may cause symptoms such as altered sensitivity, pain, weakness, numbness in the hands and feet, the doctor has now many drugs available to alleviate these problems

Hyperuricemia
sometimes uric acid increases, in these cases specific drugs are administered to reduce its formation in the body and therefore the concentration in the blood, avoiding the onset of further problems such as kidneys

Bone disease
To treat bone disease, your doctor may prescribe bisphosphonates, such as zoledronic acid. Bisphosphonates counteract the loss of bone density.
 
Anemia
To increase the number of red blood cells, your doctor may prescribe the hormone darbepoetin alfa or recombinant erythropoietin (EPO). Both are artificially produced human erythropoietins that stimulate red blood cell production.
 
Severe granulocytopenia
If the concentration of white blood cells, called neutrophil granulocytes, becomes excessively low, the patient may be treated with a stimulating factor, granulocyte colony-stimulating factor (G-CSF). A low concentration of neutrophil granulocytes weakens the immune system. G-CSF stimulates the regeneration of neutrophil granulocytes.
 
Infections
Multiple myeloma and related treatments may increase your chances of getting an infection. Therefore, at the first sign of infection, your doctor may prescribe antibiotics.

Motor rehabilitation and psychological support are also important.