A team led by a consultant haematology specialist takes care of you if you are a multiple myeloma patient. The team discusses your situation and suggests the best treatment for you, but you will finally decide.
It may be paramount to compile a list of questions which you will ask the specialist before going to the hospital to analyze your alternative treatment. For instance, you would want to inquire about the merits and demerits of a certain treatment.
Multiple myeloma treatment goals are:
- Myeloma control
- Myeloma problems (e.g. anemia and bone pain) prevention and treatment
Myeloma is incurable, but the treatment can control it and make life better. Therefore, more treatment is required when the cancer recurs.
The treatment for myeloma also depends on the stage of its progression. But broadly, the treatment consists of non-chemotherapy drugs, chemotherapy, corticosteroids, and transplanting bone marrow. If myeloma does not seem to get into remission, treatment is given to control the symptoms either through chemotherapy or radiotherapy. Bisphosphonates can prevent bone damage and blood transfusions are done to treat anemia.
Myeloma cells are killed by chemotherapy medicines. Melphalan and cyclophosphamide are the common types of myeloma treatment. Good results are seen in most cases where the symptoms are partially controlled. Total remission is also seen in most cases.
The treatments are commonly administered in tablet form. They have mild side effects which may include:
- Higher risk of severe infections
- Sick feeling
- Loss of hair
In the course of your treatment, your clinician will advise and inform you about the possibility of getting severe infections, and advise on the remedies.
Radio therapy, X-ray therapy and irradiation are some of the methods. In this method, high-energy particles or rays are used to damage the cancer cells. Normal cells too may be affected by it, but they recover fully after some time. Only the fast growing cancer cells in the bone marrow are damaged. Usually, low dose radiation therapy is used to target bone tumors in people with multiple myeloma.
Steroid medications (Corticosteroids) make chemotherapy more effective by assisting in the myeloma cells destruction. Dexamethasone and prednisolone are the most popular types of myeloma treatment.
Steroids are taken by mouth after a meal. Heartburn, indigestion, mood changes, increased appetite, and insomnia are the possible negative effects.
Thalidomide can assist in destroying myeloma cells. You can take its tablet in the evening to help you sleep. Thalidomide is given in combination with other drugs like Bortezomib and Dexamethasone to patients having kidney problems.
Other usual negative effects include:
Pregnant women shouldn't take Thalidomide because it causes birth defects. Therefore, a genuine method of contraception is vital during treatment.
You may be given blood clot prevention medication which is thalidomide’s possible risk. Contact your care team as soon as you develop blood clot symptoms, such as painful or swelling leg(s), or chest pain and breathlessness.
Lenalidomide and Pomalidomide
Lenalidomide and Pomalidomide, which are the same as thalidomide, are both orally taken and can cause some effect on the bone marrow cells, which can later result in:
- Higher risks of getting an infection
- Bruising and bleeding
They also make you vulnerable to causing a clot in the blood and go through other thalidomide-like side effects.
By making protein build-up inside them, Bortezomib (Velcade) can assist in killing myeloma cells. Your care team member will discuss with you the Bortezomib’s limitations. The medication is administered with injection, normally under the skin.
Possible negative effects are:
Stem cell transplant
People treated intensively are given a higher chemotherapy dose medication than inpatients to assist in destroying many myeloma cells after initial therapy with primarily outpatient-based treatments. The goal of this is to get a lengthy remission.
Transplantation of stem cell will be required to assist the bone marrow to fill since these huge amounts of doses interfere with normal, healthy cells in the bone marrow.
In the case that myeloma returns, further medication is required and is similar to the earlier treatment. However, non-intensive medication is recommended to continued intensive treatment.
The treatment for people who have been in remission for more than 18 months is the same as that they were given before. But if the relapse occurs within a year, the treatment will be different.
There can be an addition of more drugs like pomalidomide, lenalidomide, and some chemotherapy drugs but they are only limited to hematologist’s recommendation.
Treating Complications and Symptoms of Myeloma
Multiple myeloma causes many serious complications like anemia and thickening of the blood. Multiple myeloma associated problems may as well require treatment to assist in relieving them in addition to the disease's main treatments.
- Painkillers for pain relief
- Bisphosphonate tablet/injection medication
- Erythropoietin medication or blood transfusions - When people have a low red blood cell count, or anemia, they may require blood transfusions. Erythropoietin(EPO),a substance secreted by the kidneys, helps in boosting the production of red blood cells in the bone marrow. Now EPO is manufactured in laboratories and given by injections to the anemic person. This increases the hemoglobin levels in the body making the person less anemic. The need for blood transfusion then becomes less urgent.
- Surgery - Myeloma patients who have bone damage may need surgery to repair the fracture and help control pain. Surgery can also restore movement to the affected part.
- Plasma exchange - In rare cases, people suffering from multiple myeloma experience hyperviscocity syndrome, which is thickening of blood as the plasma in their blood produces antibodies that affect the immune system. Such cases are treated by plasmapheresis. It is a method of blood filtration that removes the root cause of blood thickening. In this process, a machine removes the plasma portion of the blood which contains the antibodies and returns or exchanges blood plasma or components thereof from and to the blood circulation. This process is like that of Dialysis.
Ensure you analyze the probable risks and advantages with your treatment team first before the treatments commence because each of them has its side effects.