Multiple MyelomaLast Updated: June 21, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/11 Overview
Myeloma is a cancer of the plasma cells in the bone marrow, the spongy tissue inside of bones. Myeloma begins when normal plasma cells change and grow uncontrollably. Plasma cells are a part of the body's immune system and produce antibodies that help the body fight infection. Abnormal plasma cells can suppress the growth of other cells in the bone marrow that produce red blood cells, white blood cells, and platelets. This suppression may result in anemia (from a shortage of red blood cells), excessive bleeding from cuts (from a shortage of platelets), and a decreased ability to fight infection (from a shortage of white blood cells and the body’s inability to respond to infection normally). Like regular plasma cells, myeloma cells can produce antibodies. However, as the myeloma cells grow uncontrollably, there is overproduction of antibodies, leading to an accumulation in the blood and urine that may cause damage to the kidneys and other organs. Myeloma often causes structural bone damage resulting in painful fractures. Myeloma is often called multiple myeloma because most people (90%) have multiple bone lesions at the time it is diagnosed. Solitary plasmacytoma is a mass of myeloma cells that involve only one site in the bone or other organs (most commonly the upper respiratory tract, including the nose and throat). Extramedullary plasmacytoma describes myeloma that started outside of the bone marrow, such as the lymph glands, sinuses, throat, liver, or under the skin. Find out more about basic cancer terms used in this section. Looking for More of an Overview? If you would like additional introductory information, explore these related items on Cancer.Net:
Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel located on the right side of your screen. Statistics
This year, an estimated 20,520 adults (11,400 men and 9,120 women) in the United States will be diagnosed with multiple myeloma. It is estimated that 10,610 deaths (5,770 men and 4,840 women) from this disease will occur this year. The five-year survival rate (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with multiple myeloma is about 39%. However, several factors affect an individual’s survival, such as the person’s age and overall health. For instance, it is known that survival rates are higher in younger people than in older people. That’s why cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with multiple myeloma. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. This is particularly true for myeloma because major improvements in treatment have occurred during the past decade. Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2011; Kumar, Shaji K., et al. “Improved survival in multiple myeloma and the impact of novel therapies,” Blood 2008 111: 2516-2520; and Hermann Brenner, et al. “Recent major improvement in long-term survival of younger patients with multiple myeloma.” Blood 2008 111: 2521-2526. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The causes of myeloma are not known or well understood, and there are currently no known ways to prevent it. There are also no strong risk factors for myeloma. Mutations in plasma cells are acquired, not inherited, so having a relative with the disease usually does not mean another family member is at higher risk for developing it. There appears to be a very slight increase in the incidence of the disease in first-degree relatives (parents or siblings) of people with multiple myeloma, but this link is not yet shown to be genetic. The following factors can raise a person's risk of developing myeloma: Age. Myeloma occurs most commonly in people over 60. The average age at diagnosis is 70. Only 2% of cases occur in people under 40. Race. Myeloma occurs twice as frequently in black people than in white people for unclear reasons. Exposure to radiation and chemicals. People who have been exposed to radiation or to asbestos, benzene, pesticides, and other chemicals used in rubber manufacturing may be at higher risk for developing myeloma. Individual history. People with a history of a solitary plasmacytoma are at greater risk for developing multiple myeloma. Monoclonal gammopathy of unknown significance (MGUS). A person with a low level of a certain antibody protein in his or her blood, called the M protein, have a 1% chance of developing myeloma or another blood-related cancer called lymphoma per year (See Staging for more information). Gender. Myeloma is slightly more common in men. Symptoms and Signs
People with multiple myeloma may experience the following symptoms and signs. Sometimes, people with multiple myeloma do not show any of these symptoms. For people with myeloma who have no symptoms, their cancer may be discovered by a blood test performed for some other reason, such as at an annual physical. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.
Your doctor will ask you questions about the symptoms you are experiencing, if any, to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Bone marrow biopsy and aspiration. These two procedures are similar and often done at the same time. Bone marrow has both a solid and a liquid part. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle, and it is important to making a diagnosis of myeloma. An aspiration removes a sample of fluid with a needle. The sample(s) are then analyzed by a pathologist. A common site for a bone marrow biopsy and aspiration is the pelvic bone, which is located in the lower back by the hip. The skin is usually numbed with medication beforehand, and other types of anesthesia may be used. In addition to a physical examination and biopsy, the following tests may be used to diagnose multiple myeloma: Blood and urine tests. Myeloma cells secrete an antibody known as the M protein (monoclonal immunoglobulin). Levels of the M protein in a patient's blood and urine are used to determine the extent of the disease and to monitor the effectiveness of treatment. Blood tests are also used to measure kidney function, calcium levels, and blood counts (for possible anemia). Fat pad aspirate. If M proteins accumulate in body tissues, it can cause organ dysfunction. This condition is called amyloidosis. If amyloidosis is a consideration, it may be necessary to take a sample of the abdominal fat pad (the collection of fat around a person's abdomen) for examination under a microscope, called a biopsy. X-ray. An x-ray is a way to create a picture of the structures inside of your body using a small amount of radiation. X-rays are typically the first step in evaluating bones when myeloma is suspected or diagnosed. Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can show replacement of normal bone marrow by myeloma cells or plasmacytoma (a plasma cell tumor growing in bone or soft tissue), especially in the skull, spine, and pelvis. The detailed images may also show compression fractures of the spine or a tumor pressing on nerve roots. A contrast medium (a special dye) may be injected into a patient’s vein to create a clearer picture. Computed tomography (CT or CAT) scan. A CT scan creates a detailed, cross-sectional view that shows any abnormalities or tumors in soft tissues. A computer then combines these images into a three-dimensional picture of the inside of the body. Sometimes, a contrast medium is injected into a patient’s vein to provide better detail, but it is used cautiously in patients with multiple myeloma because of a risk of kidney failure. Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that produce the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Integrated PET-CT scan. An integrated PET-CT scan combines the images from a positron emission tomography (PET) scan and a computed tomography (CT) scan, performed at the same time on the same machine. Together, the two scans create a more complete image than either test can offer alone. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. It is common to classify patients with newly diagnosed myeloma as being either symptomatic from the disease (having symptoms and signs) or asymptomatic (without any symptoms). Symptoms related to the myeloma include elevated blood Calcium, poor Renal or kidney function, Anemia, or Bone pain or bone lesions (CRAB). Patients without symptoms are generally watched closely without treatment which is called active surveillance (see Treatment). Patients with symptoms need treatment.
The Durie-Salmon system had traditionally been used for the staging of myeloma. This staging system is good for assessing the extent of the disease or size of the tumor. According to this system there are three stages; each stage is further subclassified into A or B depending on whether kidney function has been affected (with the subclassification B meaning there is significant kidney damage). However, another classification system called the International Staging System (ISS) is now used more commonly. It defines the factors that influence patient survival. The ISS is based on data collected from patients with multiple myeloma from around the world. The system has three stages based on the measurement of serum albumin (a blood protein made by the liver that is necessary for maintaining proper blood volume) and the levels of serum ß2-microglobulin (ß2-M) (a small protein that plays a role in immunologic defense). Recent efforts involve further classifying myeloma based upon patterns of gene expression in myeloma cells. Stage I Many patients with stage I myeloma show no symptoms because there are fewer cancer cells in the body. If the cancer has affected kidney function, the prognosis may be worse regardless of the stage. Factors characteristic of stage I include:
Stage II More cancer cells are present in the body in stage II. Again, if kidney function is affected, then the prognosis worsens regardless of the stage. Criteria for stage II are defined as those that fit neither stage I nor stage III. Stage III Many cancer cells are present in the body at stage III. Factors characteristic of this stage are:
Relapsed myeloma: This is myeloma that returns after a period of being in control after treatment. This is also called recurrent myeloma. If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above. Other classifications Some people have no symptoms of myeloma, but they may have abnormal plasma cells producing an abnormal protein (M protein). Doctors generally monitor these people closely and do not actively treat them unless this condition turns into symptomatic myeloma. Monoclonal gammopathy of unknown significance (MGUS) This condition occurs when people have a low level of M protein (meaning there are small quantities of abnormal plasma cells), but they do not have any other evidence of myeloma, such as bone damage, excessive plasma cells, or low numbers of red blood cells. People with MGUS have a 1% chance per year of developing myeloma or lymphoma. For this reason, doctors monitor the health of people with MGUS on a regular basis. Smoldering multiple myeloma (SMM) or asymptomatic myeloma People who are diagnosed with SMM have slightly higher levels of M protein and more plasma cells in the bone marrow than people with MGUS. There is still no evidence of symptoms or signs of myeloma, such as bone disease or anemia. Most people with SMM eventually develop myeloma. For this reason, doctors closely monitor the health of people with smoldering myeloma. Prognosis The International Staging System (ISS) of myeloma gives information about prognosis and predicts the person’s chance of recovery. Researchers are also looking at other ways to predict prognosis for patients with multiple myeloma. Some of these ways of evaluating prognosis include:
Treatment
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections. Treatment overview In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. The treatment of multiple myeloma depends on whether the patient is experiencing symptoms and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. The goals of treatment are to eliminate myeloma cells, control tumor growth, control pain, and allow patients to have a normal, active life. While there is no cure for multiple myeloma, the cancer can be managed successfully in many patients for years. Doctors help patients manage the symptoms of myeloma as if it were a chronic disease, so patients can lead an active life. Descriptions of the most common treatment options for multiple myeloma are listed below; they are divided into treatment options for people without symptoms (also called asymptomatic patients) and for people with symptoms. In addition, treatment options may depend on whether the patient is newly diagnosed with myeloma or is experiencing a recurrence of the disease. Learn more about making treatment decisions. Active surveillance, for patients without symptoms Patients with early-stage myeloma and no symptoms or MGUS may simply be closely monitored. This approach is called active surveillance or watchful waiting. If symptoms appear, then active treatment starts. Current research shows that starting active therapy for people with no symptoms does not result in longer survival as compared to those who have active surveillance. However, patients with asymptomatic myeloma may participate in clinical trials designed to prevent the disease from turning into symptomatic myeloma. Overview of treatment options, for patients with symptoms Treatment for patients with symptomatic myeloma includes both treatment for the disease as well as supportive therapy to improve a patient’s quality of life (such as by relieving symptoms and maintaining good nutrition). Disease-directed treatment typically includes drug therapy, such as targeted therapy or chemotherapy, with or without steroids. Stem cell transplant may be an option. Other types of treatments, such as radiation therapy and surgery, are used in specific circumstances. Each type of treatment is described below. Targeted therapies Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells, usually leading to fewer side effects than other cancer medications. Targeted therapy has proven in recent years to be quite successful in controlling myeloma, and researchers continue to investigate new and evolving drugs to treat this disease. Thalidomide (Thalomid) and lenalidomide (Revlimid) are drugs that stop growth of myeloma cells in the bone marrow. They starve the cancer cells by blocking new blood vessel formation, a process called angiogenesis. These drugs strengthen the immune cells to attack the cancer cells. Another targeted therapy drug, bortezomib (Velcade), is classified as a proteasome inhibitor, targeting specific enzymes called proteasomes that digest proteins in the cells. As myeloma cells produce a lot of proteins in the form of antibodies, they are particularly vulnerable to this drug. Lenalidomide and bortezomib are effective for treating recurrent myeloma; thalidomide, lenalidomide, and bortezomib may be used to treat newly diagnosed patients. Targeted therapies may also be used in combination with chemotherapy (see below), as certain combinations of drugs can sometimes have a better effect than a single drug. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Chemotherapy that has been used successfully for the treatment of myeloma include cyclophosphamide (Cytoxan, Neosar), doxorubicin (Adriamycin), melphalan (Alkeran), vincristine (Oncovin), etoposide (Toposar, VePesid), and cisplatin (Platinol). Often, more than one drug is used at a time. It may also be recommended to combine chemotherapy with other types of treatment, including targeted therapies or steroids. For instance, the combination of melphalan, prednisone (a steroid, see below), and a targeted therapy called bortezomib is approved by the U.S. Food and Drug Administration (FDA) for the initial treatment of multiple myeloma because it increases survival when compared with melphalan and prednisone. The combination of melphalan, prednisone, and the targeted therapy called thalidomide or lenalidomide also looks promising. Additional combinations of drugs are being evaluated in clinical trials. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. Other side effects include peripheral neuropathy (tingling or numbness in feet or hands), blood clotting problems, and low blood counts. These side effects usually go away once treatment is finished. The length of chemotherapy treatment varies from patient to patient and is usually given until the myeloma is well-controlled. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Other drug therapy Steroids, such as prednisone and dexamethasone (Decadron), may be given alone or at the same time as other drug therapy, such as targeted therapy or chemotherapy (see above). In addition, most patients with myeloma receive monthly infusions of bisphosphonate therapy, which are drugs that help to prevent bone disease from myeloma. Learn more about bisphosphonate therapy. Stem cell transplantation/bone marrow transplantation A stem cell transplant may be given after high-dose chemotherapy. In this procedure, bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the blood stem cells that are typically being transplanted, not the actual bone marrow tissue. Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health. There are two types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). AUTO is a standard treatment for myeloma, while ALLO is recommended only for patients with high-risk or recurrent disease. In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level; this testing is called HLA-typing. Most often, a patient’s brother or sister serves as the donor, although unrelated donors can serve as the donor, too. Millions of people worldwide have volunteered to donate stem cells for patients who do not have matched family members; your health care team will search a computer registry to look for a match. In addition, a donation of stem cells derived from umbilical cord blood is sometimes considered if family donors are not available. In an AUTO transplant, the patient’s own stem cells are used. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are then frozen until they are needed, usually after the high-dose treatment (explained below) is completed. In both types, the goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and allow replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system so that, in an ALLO transplant, the donor cells are not rejected by the body. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts from donor cells. Sometimes, ALLO transplants can also be performed after giving lower doses of chemotherapy and/or radiation therapy that are still sufficient to suppress the immune system and allow growth of the donor cells. These transplants, sometimes termed “mini-transplants” or reduced-intensity transplants, have less immediate side effects, allowing the procedure to be used for older patients. For both ALLO and AUTO transplant types, the replacement cells engraft (begin to make new blood cells) and turn into healthy, blood-producing tissue in 10 days to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune system is back to normal, patients may need antibiotics and blood transfusions, and they need to follow certain safety restrictions provided by the health care team to help avoid infections. In an ALLO transplant, another major risk is that the donor’s cells will recognize the patient’s body as foreign, causing graft-versus-host disease (GVHD). GVHD may be a serious complication of allogeneic transplants and can be fatal. Other side effects may include liver problems, diarrhea, infections, and rashes. However, GVHD can also be a benefit because the donor cells can recognize the cancer cells as foreign and destroy these cells, a mechanism that is one of the major reasons why ALLO transplantation generally works so well over the long term. The risk of GVHD can be reduced with exact HLA-type matching and the use of preventive drugs. In an AUTO transplant, there is little risk of GVHD because the replacement stem cells are the patient’s own cells. However, there is a risk in an autologous transplant that some of the cells that are put back into the patient could still be cancerous. Learn more about bone marrow and stem cell transplantation. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Doctors may recommend radiation therapy for patients with bone pain when chemotherapy is not effective or in an attempt to control pain. However, the use of radiation therapy should be a careful decision. In many instances, pain (especially back pain) is due to structural damage to the bone. Radiation therapy will not help this type of pain and may compromise the bone marrow's response to future treatment. Side effects of radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy. Surgery Because multiple myeloma is usually widespread and scattered at the time of diagnosis, surgery is not typically used to treat myeloma. However, it may be used to diagnose the disease or relieve pressure from a plasmacytoma on the spine or other organs. More recently, procedures such as kyphoplasty (inflating and injecting bone cement into the vertebra [back bones]) and vertebroplasty (injecting bone cement to stabilize fractures in the spine) have been considered to relieve pain, restore lost height from collapsing vertebra, and strengthen the spine. Relapsed myeloma Once your treatment is complete and there is a remission (absence of cancer symptoms), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. If the cancer does return after the original treatment, it is called relapsed myeloma. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the relapse. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, targeted therapy, and chemotherapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat relapsed myeloma. People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence. Refractory myeloma Refractory myeloma occurs when cancer has recurred on more than one occasion and the disease no longer responds to treatment. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects of cancer and cancer treatment. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. For people with myeloma, supportive therapies to reduce symptoms and complications may include:
A diagnosis of refractory myeloma is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with multiple myeloma. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating multiple myeloma. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with multiple myeloma. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for multiple myeloma, learn more in the Current Research section. Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with myeloma. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of myeloma is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team, who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
After active treatment for multiple myeloma ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests during the coming months and years. After successful control of the cancer with treatment, people with myeloma should have regular check-ups to watch for any recurrence of cancer. Your doctor may recommend maintenance therapy to prevent recurrence of cancer for a year or longer. All patients requiring treatment for systemic myeloma are also treated with intravenous monthly bisphosphonates; however, the development of kidney dysfunction or osteonecrosis (a small area of dead bone) of the jaw in a small fraction of patients after chronic use may modify recommendations for bisphosphonate use in the future (see Treatment). ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. People recovering from multiple myeloma are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
Doctors are working to learn more about myeloma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you. Expanded use of stem cell transplantation. While autologous (AUTO) stem cell transplantation with high-dose chemotherapy is a standard treatment for myeloma, researchers are studying the benefits of tandem (double) AUTO transplantations, ALLO transplantations, and tandem AUTO mini-allogeneic transplantations. Autologous means the stem cells are from the patient, and allogeneic means that the stem cells came from a donor. (For more information on transplantation, read the Treatment section.) New drugs. Rapid progress is being made in researching new treatments of myeloma. Several new drugs are being studied for the treatment of myeloma:
Myeloma represents a new treatment paradigm (a set of assumptions and practices) in cancer because the new drugs that target the tumor cell, tumor-bone marrow interaction, and bone marrow environment can overcome conventional drug resistance. Drugs are first tested in patients with advanced myeloma and then used to treat patients with earlier stage myeloma. Drug combinations. Most myeloma cells will eventually become resistant to standard chemotherapy, a condition called multidrug resistance. New drugs and combinations of approved drugs are being researched to provide more options for patients with myeloma. Several drug combinations are being studied:
Immunotherapy. This therapy, also called biologic therapy, helps to boost a person's immune system to fight cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. Vaccines are a type of immunotherapy being explored in the treatment of multiple myeloma. Learn more about immunotherapy. Cytogenetics. Cytogenetics (the study of genetic changes in cells) and molecular studies may be performed on the tissue sample removed during the biopsy to show how aggressive the cancer is. Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current myeloma treatments in order to improve patients’ comfort and quality of life. Learn more about common statistical terms used in cancer research. Looking for More about Current Research? If you would like additional information about the latest areas of research regarding myeloma, explore these related items:
Or, choose “Next” (below, right) to continue reading this detailed section. In this video, learn more about a doctor who received a grant from the Conquer Cancer Foundation and how his research led to a new drug to treat multiple myeloma. Questions to Ask the Doctor
Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
