Myeloma (cont.)

Myeloma Treatment

Primary health care providerswill usually referpeople with myeloma to a hematologist or oncologist.

• Although medical treatments are fairly standardized, different doctors have different philosophies and practices in caring for their patients.
  
  
• Apersonmay want to consultwith more than onespecialist before selecting the hematologist-oncologist.
  
  
• Family members, friends, and health care providers are goodresources to get referrals. Many communities, medical societies, and cancer centers offer telephone or Internet referral services.

During a consultation with a hematologist-oncologist, theperson will have an opportunity to ask questions and to discuss the treatments available.

• The doctor will present each type of treatment, give the pros and cons, and make recommendations based on published treatment guidelines and the doctor's experience.
  
  
• Treatment for myeloma depends on the stage. Factors such as age, overall health, and recurrence of myeloma are included in the treatment decision-making process.
  
  
• The decision of which treatment to pursue is made between the person's hematologist-oncologist (with input from other members ofthe care team) and family members, but the decision ultimately rests with the patient.
  
  
• For optimal treatment results, a person should be certain to understand exactly what will be done and why, and whatto expect from the treatmentsthat have been decided upon.

Like all cancers, myeloma is most likely manageablewhen it isdiagnosed early and treated promptly.

• Atreatment plan is individualized for a specific situation.
  
  
• The most widely used therapies are chemotherapy, corticosteroids, and/or radiation therapy.
  
  
• Newer medications that are active against myeloma may be offered, either as single therapy or together with chemotherapy.
  
  
• Supportive care is given to treat complications and symptoms. Some potential supportive care medications include growth factors for anemia and medications to treat bone disease.
  
  
• Some patients may be referred for additional treatment, such asstem cell transplantation.

In addition to a hematologist-oncologist, a person's medical team may include a specialist in radiation therapy (radiation oncologist). The team will also include one or more nurses, a dietitian, a social worker, and other professionals as needed.

There is no cure for myeloma. The goal of medical therapy is complete remission. This means that there is no detectable monoclonal protein and the number of plasma cells in the bone marrow is normal (less than 5%) after treatment. Remission is not the same as cure. In remission, small numbers of myeloma cells may remain in the body, but they are undetectable using currently available technology and cause no symptoms.

• The objectives in achieving complete remission are preventing myeloma-related damage to bones, kidneys, and other organs;prolonging life;relieving symptoms; andpreserving a good quality of life for as long as possible.
  
  
• Most patients in remission will eventually experience recurrent disease.
  
  
• The duration of remission depends on the stage of myeloma and varies by disease characteristics. Remission may be quite variable, lasting for a few months, or for many decades. Remission that lasts a long time is called durable remission, which is the goal of therapy. The duration of remission is a good indicator of the aggressiveness of the myeloma. Remission can also be considered partial. A partial remission (also called partial response) means that the level of monoclonal protein decreases after treatment to less than half its level before treatment. A very good partialresponse means that the level of monoclonal protein decreases by at least 90% from its level before treatment.

Other terms used to describe the myeloma's response to treatment include the following:

• Minor response: The level of monoclonal protein decreases but is still greater than halfthe original level.
  
  
• Stable disease/plateau phase: The level of monoclonal protein stays the same.
  
  
• Progression: The level of monoclonal protein worsens with treatment. This includes recurrent or refractory myeloma.
  
  
• Refractory myeloma: The disease is resistant to the treatment.

A hematologist-oncologist may use the following terms to refer tomyeloma therapy:

• The first line of therapy given for myeloma is often referred to as "induction therapy" because it is designed to induce a remission.
  
  
• If this treatment does not induce a complete remission, the person will probably be given a different treatment regimen. This is sometimes called "second-line therapy," or occasionally, "salvage therapy."
  
  
• Once the disease is controlled,the personmay be given yet more treatment tomaintain control. This is called "maintenance therapy."
  
  
• Some patients may have sufficiently aggressive myeloma to be considered candidates for stem cell transplantation, which is an intensive, high-dose chemotherapy regimen, followed by infusion of normal donor matched cells (in the form of an allogeneic stem cell transfusion, or followed by the reinfusion of the patient's stem cells, in the form of an autologous transplant). This form of treatment is often referred to as "consolidation therapy."