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Treatment

How Is Multiple Myeloma Treated?

There are many treatment options for patients with multiple myeloma, including:

Watchful Waiting

Patients with early-stage myeloma (either smoldering or Stage I) who choose watchful waiting will be closely monitored but won't receive treatment until symptoms of the disease either appear or change.

Chemotherapy

Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, they destroy cancer cells. Chemotherapy is particularly useful for cancers that have metastasized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).

Bisphosphonates

Bisphosphonates are used to help bones stay strong by slowing down the rate at which they are being dissolved by myeloma cells. Jaw damage and infection are rare but serious side effects of being treated with bisphosphonates.

Radiation Therapy

Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT). Radiation may be used as a solitary treatment or with surgery and/or chemotherapy. The equipment used to deliver the radiation therapy is called a linear accelerator. The linear accelerator has a moveable arm, which enables the radiation to be focused on the part of your body where the cancer is located. Developments in EBRT equipment have enabled physicians to offer conformal radiation. With conformal radiation, computer software uses imaging scans to map the cancer three-dimensionally. The radiation beams are then shaped to conform, or match, the shape of the tumor.

Radiation works by breaking a portion of the DNA of a cancer cell, which prevents it from dividing and growing. Radiation therapy can be systemic, meaning it moves throughout your bloodstream. Systemic therapies are usually given as an injection into a blood vessel or are taken as a pill. Systemic treatments expose your entire body to cancer-fighting medication. Radiation therapy is typically given as a "local" treatment however, meaning it affects only the part of the body that needs therapy.

Surgery

Surgery is not commonly used to treat multiple myeloma. However, surgery may become necessary if the spinal cord is pinched. It can also be used to attach metal rods or plates to support weight-bearing bones and to treat existing fractures and prevent future ones.

Stem Cell Transplant

A stem cell transplant is a procedure that uses stem cells to replace blood cells in the bone marrow that have been damaged or destroyed by chemotherapy, radiation or disease. For patients receiving a stem cell transplant, the first step is to lower the amount of cancer present in the patient’s body by induction treatment. After induction treatment, stem cells are harvested from the patient’s blood or bone marrow. Once harvested, the cells are frozen. After the stem cells have been removed, the patient receives high-dose chemotherapy to kill any leftover myeloma cells. The treatment also kills all of the remaining normal bone marrow cells. The frozen stem cells are then thawed and given back to the patient through an intravenous line in a process similar to a blood transfusion. The stem cells travel to the bone marrow where they begin to make new blood cells.

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