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Standard first-line (primary) therapy for myeloma involves corticosteroid therapy, with or without chemotherapy. Supportive care is frequently given in conjunction with treatment. However, current investigations may eventually change the approach to first-line treatment of myeloma to nonchemotherapeutic approaches. Sometimes radiation therapy is added for people with significant bone damage.

Chemotherapy

Chemotherapy is the use of powerful drugs to kill cancer cells. Chemotherapy is a systemic therapy, meaning that it circulates through the bloodstream and affects almost all parts of the body. Ideally, chemotherapy can find and kill cancer cells throughout the body.

Unfortunately, chemotherapy also affects healthy cells, which accounts for its well-known side effects.

• The side effects of chemotherapy depend partly on the drugs used and the doses.
• Some people, due to variability in drug metabolism, tolerate chemotherapy better than others.
• The most common general side effects of chemotherapy include fatigue, increased susceptibility to infections, nausea and vomiting, loss of appetite, hair loss, sores in the mouth and digestive tract, muscle aches, and easy bruising or bleeding. Specific drugs may confer other specific side effects.
• Medications and other treatments are available to help people tolerate these side effects, which can be severe and, rarely, life-threatening, especially in the elderly.
• It is important that a patient review the expected outcomes and potential side effects of therapy with their health care provider prior to embarking on their selected course of treatment.

Clinical Trials

New therapies and novel ways to administer known therapies are continually under investigation for the treatment of multiple myeloma. These novel therapies come about as a result of favorable performance in earlier, monitored, national multi-institutional studies. Usually, a clinical trial is offered to patients in order to extend and confirm the earlier results of such studies. In order to receive such new therapies, a patient would have to agree to treatment by enrolling in a clinical trial.

Ideally, the treating hematologist/oncologist will belong to a clinical trial network that provides up-to-date therapy and instant analysis of ongoing data. Patient enrollment in any clinical trial involves agreeing to a particular treatment plan that is exquisitely detailed by the physician and other members of the treatment team. A written protocol is provided to the patient and includes a fully detailed/informed written consent document.

The protocol, and its associated consent form, details the medications, all known side effects, and alternatives to treatment should there be failures in therapy or patient refusal to participate. As noted, the patient is fully apprised of the potential benefits and risks associated with such treatment, and consent is obtained in the presence of the treating physician and very likely other members of the treatment team.

Alternatively, a hematologist-oncologist may refer a patient to another institution to receive investigational treatment or intensive treatment, which may be otherwise unavailable at the current institution, such as stem cell transplantation.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body involved by myeloma. A radiation oncologist plans and supervises therapy.

• In myeloma, radiation is used primarily to treat solitary plasma cell tumors, larger tumors, or to prevent a pathologic fracture in a myeloma-compromised bone.
• In people with extensive disease, radiation may be applied to a larger area to kill off multiple sites of myeloma.
• Radiation may be used to relieve pain and other symptoms related to a small area of particularly severe bone damage.
• Total body irradiation (TBI), which involves the entire body, is administered only for people undergoing stem-cell transplantation.
• Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue, loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of underlying bone and the marrow within the bone may result in suppression of the blood counts.
• The schedule for radiation treatments depends on the dose and the treatment goals. Radiation is often administered in short bursts over several days or weeks in order to minimize side effects without losing therapeutic efficiency.

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