Multiple Myeloma (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Multiple myeloma facts
- What is multiple myeloma?
- What causes multiple myeloma?
- What are risk factors for multiple myeloma?
- What are multiple myeloma symptoms and signs?
- How do health-care professionals diagnose multiple myeloma?
- What types of specialists treat multiple myeloma?
- What are the stages of multiple myeloma?
- What is the treatment for multiple myeloma?
- What is the prognosis for multiple myeloma? What is the survival rate for multiple myeloma?
- Is it possible to prevent multiple myeloma?
- What support systems are available for multiple myeloma?
- Find a local Oncologist in your town
What are the stages of multiple myeloma?
There are four stages of multiple myeloma. While many doctors use different staging, these are various stages cited by many clinicians:
- Smoldering: multiple myeloma with no symptoms
- Stage I: early disease with little anemia, relatively small amount of M protein and no bone damage
- Stage II: more anemia and M protein as well as bone damage
- Stage III: still more M protein, anemia, as well as signs of kidney damage
Because staging criteria differ according to different groups, some clinicians simply define the individual's multiple myeloma without assigning a stage and simply estimate a prognosis (see below) for their patient. In 2013, an international group divided stages into three stages based on two criteria, the concentration of beta-2-microglobulin and serum albumin levels; over time this defined criteria may become widely accepted.
What is the treatment for multiple myeloma?
There is no known treatment that cures multiple myeloma. However, there are methods to decrease the occurrence and severity of symptoms and prolong life. The therapy is decided based upon the patient's condition and the cancer management team, made with the patient's input. The team will likely involve both a medical specialist in the treatment of myeloma called a medical oncologist, as well as a radiation oncologist and other consultants as appropriate. Oncology trained nurses and other personnel will likely be important members of the treatment team.
The choices for treatment(s) often include combinations of drugs, some of which are given as pills and others by intravenous injection. These include drugs which affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations. There may be a role for high-dose chemotherapy followed by the administration of bone marrow stem cells called a stem cell transplant or autotransplantation. Numerous factors come into play in determining whether or not to do such a transplant. Further information may be obtained from the National Comprehensive Cancer Network Guidelines (NCCN.org), which are updated at least yearly. Other treatments may include steroids, bisphosphonate therapy, blood/platelet transfusions, autotransplantation and/or plasmapheresis, and other combination therapy depending on the individual patient's disease stage.
Painful areas of bone damage may be treated with radiation therapy. Broken bones can be surgically repaired in many cases.
There are many drugs used to treat multiple myeloma. The following drugs are used often in combination with dexamethasone, sometimes orally or by IV, depending on the patient's individual disease status:
- Dexamethasone (Decadron) -- immune cell modulation
- Bortezomib (Velcade) -- protease inhibitor
- Lenalidomide (Revlimid) -- immune cell modulation
- Pamidronic acid (Aredia) -- inhibits bone resorption
- Zoledronic acid (Zometa) -- inhibits bone resorption
- Melphalan (Alkeran) -- alkylating agent that is toxic to myeloma cells
There are at least seven or eight other drugs that are occasionally used alone or in combination with others to aid patients. In addition, some patients with anemia can benefit from blood transfusions although the transfusion effects are temporary. Research is ongoing and newer drugs and drug combinations are being investigated and used for treatment with some frequency. Most doctors who specialize in cancer treatment are aware of the newest treatments for multiple myeloma (for example, Procrit, Revlimid, Kyprolis). In addition, your doctor can address the side effects (for example, nausea and vomiting with chemotherapy) that may occur with treatment.
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