Clarence Sarkodee-Adoo, MD
Numerous chemotherapy and biological drug combinations have been used for multiple myeloma. Which type and combination of therapy depends on many factors, including the type and stage of myeloma, the ability to tolerate chemotherapy side effects, and if any previous treatment was rendered or if further treatment is planned, such as stem-cell transplantation. Hematologists/oncologists often work together regionally to decide which combination of chemotherapy and biological drugs are currently working best for their patients. Because of this regional collaboration, the drug combinations often vary and are able to change rapidly when improved results occur.
- Combinations of different chemotherapy drugs seem to
be more effective than single agents. Several drugs with different
mechanisms of action, when given together at lower doses, will likely increase
the effectiveness of treatment, while reducing the likelihood of intolerable
- Several different standard combinations are used as
induction therapy in myeloma, but the most widely used is the combination of
vincristine (Oncovin), doxorubicin (Adriamycin), and the corticosteroid,
dexamethasone (Decadron). This combination of drugs is referred to as "VAD".
Another widely used combination is oral melphalan (Alkeran) with the
corticosteroid prednisone. Which combination a person is given depends on the
treatment plan and the experiences of the specialist and the medical center
where treatment is received. For example, if a stem-cell transplant is part of
a treatment plan, melphalan may not be given, since it can lower stem cell
- Recently, a new drug that interferes with cancer cell
proteins (proteasome inhibitor), called bortezomib (Velcade) has been approved
for second-line therapy. Studies are underway to determine its effect in
first-line treatment and in combination with chemotherapy (see New drug
- The combinations of drugs are usually given according
to a set schedule that must be followed strictly.
- In some situations, chemotherapy can be given in the hematologist-oncologist's office. In other situations, the person may need to stay in the hospital.
Chemotherapy is given in cycles.
- One cycle includes the period of actual treatment
(usually several days) followed by a period of rest and recovery (usually a
- Standard treatment typically includes a set number of cycles, such as 4 or 6. Spacing out the chemotherapy this way allows a higher cumulative dose to be given while improving the person's ability to tolerate the side effects.
Chemotherapy may be given in pill form, but usually is in liquid form to be infused directly into the bloodstream through a vein (intravenous).
- Certain drugs widely used against myeloma-namely, melphalan, prednisone,
dexamethasone, and new time-release forms of doxorubicin-are in pill form.
- Most people who receive intravenous (IV) chemotherapy will have a semi-permanent device placed in a vein, usually in the chest or upper arm. This device allows a person's medical team quick and easy access to blood vessels, both for administering medications and for collecting blood samples. These devices come in several types, usually referred to as "catheter," "port," or "central line."
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