Treatments and Medications for Multiple Myeloma

Once myeloma reaches stage II, treatment is needed to alleviate symptoms and reduce the number of myeloma cells. There's no standard protocol: most patients will receive several different kinds of drugs at different stages of the disease, depending on their age, symptoms, general physical condition, risk category, and treatment preferences.

If you're ages 65 to 70 and don't have other serious illnesses, such as diabetes or major organ damage, a stem-cell transplant will usually be recommended. (See "What's a stem-cell transplant?"). If you're not a candidate for stem-cell transplant, you'll start with drug therapy and continue on it until the disease is in complete remission (no sign of myeloma) or until the myeloma plateaus at a very low level. (See "Medications used to treat multiple myeloma.") After the initial treatment, you'll be monitored for disease recurrence or progression.

For recurrence, several treatment options are available. A second stem-cell transplant may be effective in certain patients. Drugs or drug combinations used the first time may work well a second time, so combinations can be revisited or new ones explored. Today there are many clinical studies testing new myeloma drugs that are in line for FDA approval. (To find out about clinical trials in your area, go to www.clinicaltrials.gov.)

Additional therapies may be needed to counteract the effects of both the disease and the drug treatment. Most people with myeloma receive a bisphosphonate to slow bone resorption, and many take blood thinners to prevent clots. Bone pain can be treated with radiation therapy; anemia can be treated with epoetin (Epogen, Procrit), which stimulates the production of red blood cells and decreases the need for blood transfusions.