Multiple myeloma, a kind of blood cancer, begins from plasma cells in the bone marrow. There, abnormal plasma cells proliferate rapidly, which arrests the production of healthy blood cells by the bone marrow.

It causes anemia or low count of red blood cells, infections, bone fractures, and damage to the kidney due to abnormal proliferation of plasma cells. The goals of multiple myeloma treatment are controlling symptoms, avoiding complications, and prolonging life. Several drugs and a stem cell transplant are common forms of treatment. But it is rarely treatable.

An oncologist is a type of physician who specializes in cancer. They will use a number of blood and imaging tests to determine if you have active myeloma or smoldering multiple myeloma (SMM) or monoclonal gammopathy of unknown significance, two conditions that may lay the groundwork for it:.

If you have MGUS or SMM, your physician likely would recommend watchful waiting over aggressive treatment. It could take decades for multiple myeloma to become symptomatic as this often progresses slowly. For that reason, unless your illness evolves into active myeloma-or some other condition-you will likely not need treatment.

Induction Treatment

Your doctor will most likely start you on a combination medication regimen right away if you are diagnosed initially with active multiple myeloma. We call this type of treatment plan induction therapy. Its goal is to reduce the number of myeloma cells in your body as quickly as possible.

Three or four different drugs are administered in multiple cycles of a few weeks each as part of an induction therapy regimen. So, for example, you might receive a combination of four drugs in three rounds of four weeks each.

Some of the key variables influencing the drugs of choice for induction therapy include; your distinct myeloma type, a function of how your myeloma cells produces a distinct type of protein as well as your risk score and how advanced your diseases is now. However the following classes of drugs often are part of induction therapies:

• Immunomodulatory drugs: These drugs enhance the immune system to help your body to fight against cancer. Two are pomalyst (pomalidomide) and Revlimid (lenalidomide).

• Proteasome inhibitors: These drugs block an enzyme from breaking proteins in the cancer cells. This builds up proteins in cancer cells leading to cell death. A few examples include Velcade (bortezomib), Ninlaro (ixazomib), and Kyprolis (carfilzomib).

• Often called steroids, corticosteroids are drugs that help to decrease inflammation within the body. One of these is Decadron, dexamethasone.

An anti-CD38 monoclonal antibody may also be included in a four-drug combination. This medication helps the immune system to be able to target specific chemicals present on the surface of myeloma cells. There are Sarclisa, or isatuximab, and Darzalex, or daratumumab.

Transplanting Stem Cells

After completing induction therapy, you may be eligible for a stem cell transplant. Most patients receive autologous stem cell transplants (ASCTs). This means that their own stem cells—rather than donor cells—are used. These are the steps involved in the transplant:

• Taking out and preserving your bone marrow stem cells
• Chemotherapy at high doses to kill myeloma cells
• Reinfusion of your bone marrow’s stem cells

Your healthy stem cells are protected from the toxic effects of the chemotherapy by being taken out first. Your stem cells can produce healthy plasma cells once they are reinfused.

Some days will be better than others, and recovery typically takes three to six months. Taste buds may be altered as a consequence of adverse effects. The results of stem cell transplants do not show an improvement in overall survival, but it does increase the progression-free survival rate.

Qualifications for Transplantation

A stem cell transplant is not for everyone. Prior to giving any kind of treatment, your health care team will consider your age, overall health, and individual preferences.

You may have more than one cycle of induction therapy if you are not a candidate for a stem cell transplant. In this case, some doctors recommend up to eight or twelve cycles. You will likely move on to maintenance therapy regardless of whether you receive a transplant.

Therapy for Maintenance

Preventive treatment of cancer cells’ growth after induction therapy and/or a stem cell transplant is what maintenance medication therapy does. A maintenance therapy may consist of one or more medications. Some of these drugs are Revlimid, Velcade, and Ninlaro.

Alternative Therapies

Your healthcare provider will consider several drug treatment options if your cancer is not responsive to treatment or if you have a recurrence after the treatments described above.

In deciding which drugs to administer, your doctor will consider your symptoms and your medical history. Some of the same drugs that were prescribed during your induction or maintenance periods may be prescribed by them, including

• Bispecific antibodies are another type of immunotherapy, similar to other types of monoclonal antibodies. Some examples of this include Elrexfio (elranatamab), Talvey (talquetamab), and Tecvayli (teclistamab).

• Another type of immunotherapy is CAR T-cell treatment. To identify and destroy cancer cells, they work using lab-altered T cells. Among others, Carvykti (ciltacabtagene autoleucel) and Abecma (idecabtagene vicleucel) are two, usually provided in a hospital.

• Selective inhibitors of nuclear export (SINE): This newer medication helps in inhibiting myeloma cell growth. This drug is primarily prescribed by physicians along with steroids. It is only meant for treatment in refractory myeloma patients. The only available medicine is Xpovio (selinexor).

• Conventional chemotherapy: High doses of chemotherapy prepare the body better for a stem cell transplant. It also helps in treating refractory or relapsed myeloma at lower doses. Two of the examples include Cytoxan (cyclophosphamide) and VP-16 (etoposide). Perhaps the best chemotherapy drug combinations that can stop the growth of tumors are combinations.

Expectancy of Life and Prognosis

Although not always, multiple myeloma typically progresses slowly. Your prognosis will depend on your age, overall health, and response to treatment. Your current stage, type of myeloma, and rate of tumor growth also play a role in determining your prognosis.

Five years after diagnosis, the relative survival rate for patients with multiple myeloma is at 61%. There is no cure; however, scientists are still conducting research on a number of new therapies. With the advancement of therapy, the life expectancy is increasing.

Issues

The following are some possible multiple myeloma issues that may affect your prognosis:

• MedlinePlus. Myeloma multiplex.
• Kidney failure and damage
• fractures of the bones

• Hypercalcemia (blood calcium accumulation)

• Infections

• Low red blood cell count, or anemia

Managing and Coping with Multiple Myeloma

Different issues and side effects may be experienced from the treatment of multiple myeloma. Before writing a prescription, your doctor will discuss the advantages and disadvantages of each treatment with you. The best course of action may take some trial and error.

The following are potential side effects of myeloma treatment:

• Greater risk of infection

• A greater chance of blood clots

• Digestive-related symptoms (constipation, diarrhea, vomiting, and nausea)

• Oral ulcers

• Hair loss
•  Painfulness
•  Extreme fatigue

• Low platelet, white blood, and red blood counts

• Damage to peripheral nerves; specifically in the hands, feet, arms, and legs
•  Dysomnia

CAR T-cell therapies and bispecific antibodies may have distinct toxicities such as neurotoxicity and cytokine release syndrome (CRS).

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Fever and hypotension are two CRS presenting symptoms. Neurotoxicity, often brought about by neurological symptoms ranging from convulsion to confusion, often bring patients into the hospital in states of confusion or sometimes of coma. Your doctor will follow you closely if you experienced adverse effects.