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Myeloma (cont.)

Myeloma Medical Treatment

Standard first-line (primary) therapy for myeloma involves combinations of corticosteroid therapy and immunomodulatory agents, with or without chemotherapy drugs. Supportive care medication is frequently given in conjunction with such treatment. 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 can result in 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 professional prior to embarking on their selected course of treatment.

Immunomodulatory drugs such as thalidomide and lenalidomide can cause some other side effects. These include:

  • Increased tendency to form blood clots in various places in the body
  • Dizziness and sleepiness
  • Constipation
  • Numbness and tingling in the hands and feet
  • Low blood counts
  • Rare problems with blood in urine, abnormal liver blood tests

A person taking thalidomide or lenalidomide must observe strict precautions about the risk of these agents to a person who may become pregnant as they can cause severe birth defects.

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 reduce pain and hopefully prevent a pathologic fracture in a myeloma-compromised bone.
  • Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue, loss of appetite, nausea, diarrhea, urgency of urination, and skin problems. 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 daily over several days or weeks in order to minimize side effects without losing therapeutic efficiency.
Medically Reviewed by a Doctor on 8/16/2013
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