If you don’t have symptoms, your doctor may choose to watch you closely rather than start treatment right away.
If you do have symptoms, your doctor will work with you to come up with a treatment plan. It will aim to improve your quality of life by easing your symptoms and helping you get good nutrition.
People who are considered high-risk might want to look into a clinical trial for an existing or new treatment. Research is ongoing, including clinical trials to find more effective drugs and combinations.
Which drugs your doctor chooses depends on your age and how aggressive your cancer is.
Chemotherapy: Chemo drugs are most often used in combinations. The ones that treat multiple myeloma are:
- Bendamustine (Treanda)
- Cyclophosphamide (Cytoxan)
- Doxorubicin (Adriamycin)
- Etoposide (VP-16)
- Liposomal doxorubicin (Doxil)
- Melphalan (Alkeran, Evomela)
- Vincristine (Oncovin)
Corticosteroids: These drugs can help other treatments work. When you’re getting chemo, the doctor might prescribe dexamethasone or prednisone to ease side effects.
Targeted therapies: These medications target proteins, genes, or tissues and prevent cancer from growing.
Immunomodulatory drugs strengthen your immune cells to help them attack cancer cells. They also help starve the myeloma cells in your bone marrow by preventing new blood vessels from forming:
- Lenalidomide (Revlimid)
- Pomalidomide (Pomalyst)
- Thalidomide (Thalomid)
Monoclonal antibodies help your immune system spot and destroy myeloma cells. You might hear your doctor call this immunotherapy:
- Daratumumab (Darzalex)
- Elotuzumab (Empliciti)
If you don’t have symptoms, your doctor might start you on one of these drugs to prevent myeloma from getting to a point where you need further treatment.
Proteasome inhibitors stop the process that eats up extra proteins in cells. Myeloma cells make lots of proteins. When they build up, the cells die:
- Bortezomib (Velcade)
- Carfilzomib (Kyprolis)
- Ixazomib (Ninlaro)
HDAC inhibitors, like panobinostat (Farydak), affect which genes are active inside cells. Your doctor may prescribe one if you’ve already tried bortezomib and an immunomodulatory drug.
Interferon: Bone marrow cells and some white blood cells release this hormone-like substance. When it’s used as a drug, it can slow the growth of myeloma cells. You might take interferon to help keep myeloma that’s been successfully treated in remission.