Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 9/24/2021
Doctor's Notes on Multiple Myeloma
Multiple myeloma is type of cancer that affects a specific kind of white blood cell. White blood cells are part of the immune system and they help fight infections in the body. They are produced in the bone marrow within the bones. In multiple myeloma, the bone marrow makes too many of a specific type of white blood cell, which can invade tissues and organs causing local and remote organ dysfunction.
Symptoms of multiple myeloma depend on the stage and spread of the disease.
- An early symptom can include osteoporosis.
- The most common symptom of multiple myeloma is bone pain resulting from bone lesions.
- In advanced myeloma, symptoms of
- tingling,
- numbness,
- burning sensation,
- loss of function of a limb or joint, or even paralysis may occur.
- Multiple myeloma may cause kidney damage and symptoms including
- fatigue,
- nausea,
- vomiting,
- loss of appetite,
- muscle weakness,
- constipation,
- decreased urine production,
- dehydration and increased thirst,
- restlessness,
- difficulty in thinking or concentrating, and
- confusion.
- Anemia may occur with symptoms such as
- fatigue,
- paleness, and
- mild shortness of breath.
- Other symptoms caused by multiple myeloma include
- spontaneous bruising or bleeding,
- visual problems,
- neurologic problems (lethargy, confusion, sleepiness, headache, problems with sensation or movement in one area of the body, stroke),
- shortness of breath or chest pain (due to congestive heart failure),
- frequent infections,
- tiny red spots on the skin,
- undetected bleeding in the brain or digestive tract,
- increased sensitivity to cold and/or pain and numbness in the fingers and toes during cold weather,
- heart failure,
- liver failure,
- kidney failure, and
- blood vessel damage.
What Is the Treatment for Multiple Myeloma?
There are numerous treatments for multiple myeloma. Some treatments are directed at the cancer cells in the body and some treatments are directed at the effects of the cancer cells and provide symptomatic relief.
Chemotherapy, monoclonal antibodies, and proteasome inhibitor drugs are common treatments for multiple myeloma and reach cancer cells throughout the body. In the U.S., the most commonly used induction therapy for healthy, transplant-eligible patients is called VRd, which is a combination of bortezomib (Velcade), lenalidomide (Revlimid), and low-dose dexamethasone.
Other common drug therapies used to treat multiple myeloma include (or combinations of these listed below):
- Proteasome inhibitors
- Bortezomib (Velcade)
- Carfilzomib (Kyprolis)
- Ixazomib (Ninlaro)
- Immunomodulating drugs
- Lenalidomide (Revlimid)
- Pomalidomide (Pomalyst)
- Thalidomide (Thalomid)
- Steroids such as dexamethasone and prednisone
- May be used alone or combined with other drugs
- Also used to help decrease nausea and vomiting caused by chemotherapy
- Histone deacetylase (HDAC) inhibitors
- Panobinostat (Farydak)
- Monoclonal antibodies
- Elotuzumab (Empliciti)
- Daratumumab (Darzalex) or a newer form of the drug, called daratumumab and hyaluronidase (Darzalex Faspro)
- Isatuximab (Sarclisa)
- Antibody-drug conjugate: Belantamab mafodotin-blmf (Blenrep)
- Chimeric antigen receptor (CAR) T-cell therapy: idecabtagene vicleucel (Abecma)
- Chemotherapy
- Cyclophosphamide (Cytoxan)
- Etoposide (VP-16)
- Doxorubicin (Adriamycin)
- Liposomal doxorubicin (Doxil)
- Melphalan flufenamide, also called melflufen (Pepaxto)
- Melphalan (Evomela)
- Bendamustine (Treanda)
- Vincristine (Oncovin)
- Nuclear export inhibitor
- Selinexor (Xpovio)
Other types of drugs used to treat multiple myeloma symptoms include:
- Bisphosphonates for bone disease
- Pamidronate (Aredia)
- Zoledronic acid (Zometa)
- Denosumab (Xgeva, Prolia)
Other systemic treatments that are used in multiple myeloma treatment include:
- Stem cell transplant
- Supportive treatments
- Surgery
- Used to repair damage from the cancer or remove individual tumors
- Radiation therapy
- May be used to treat areas of bone damaged by myeloma that have not responded to chemotherapy and/or other drugs
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What Is the Most Common Treatment for Multiple Myeloma?
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REFERENCE:
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.