Initial treatments for myeloma

Will I need treatment immediately?

Not everyone diagnosed with myeloma will need to start treatment immediately. The timing of treatment will depend on the results from various tests and investigations, together with any symptoms you have.

What will treatment involve?

Treatment for myeloma is almost always with a combination of drugs. It’s usually given over a number of weeks, which may or may not be followed by a rest period. This pattern constitutes one cycle of treatment, and a series of treatment cycles is referred to as a course of treatment.

Your doctor may refer to all of your treatment as “chemo” or “chemotherapy” to keep things simple. In fact, treatment combinations are usually made up of two or three different types of drugs which work well together. These can include myeloma chemotherapy drugs, steroids and other types of anti-myeloma drugs.

Haematologist Dr Yasmin Reyal explains how chemotherapy treatment is used in myeloma:

What treatment will I have?

Your myeloma treatment will be co-ordinated by your specialist doctor (haematologist). They’ll discuss all your options with you and together you’ll decide what’s most appropriate for you.

Here are some of the most commonly used initial treatment combinations:

• Daratumumab (Darzalex®), bortezomib (Velcade®), thalidomide and dexamethasone (known as DVTD)
• Bortezomib (Velcade®), thalidomide and dexamethasone (known as VTD)
• Bortezomib (Velcade®), cyclophosphamide and dexamethasone (known as VCD)
• Lenalidomide (Revlimid®) and dexamethasone
• Melphalan, prednisolone and thalidomide (known as MPT)
• Cyclophosphamide, thalidomide and dexamethasone (known as CTD)
• A different combination, via a clinical trial. Find out more about clinical trials and novel drugs

The initial course of treatment tends to last four to six months. After this, some patients may be suitable to go on and have high-dose therapy and stem cell transplantation.

What is high-dose therapy and stem cell transplantation?

For younger and/or fitter myeloma patients, a stem cell transplant may be recommended after their initial course of treatment. A stem cell transplant is a more intensive treatment that involves several steps.

The process uses a higher than normal dose of chemotherapy to remove as many myeloma cells from your bone marrow as possible. Unfortunately, this has the side effect of destroying healthy cells too, so to restore your bone marrow, stem cells are given to you, which multiply and build up the bone marrow again.

Usually, you will have your own stem cells collected before the high-dose chemotherapy is given and then returned afterwards. Find out more about what a stem cell transplant is by reading our High-dose therapy and autologous stem cell transplant Infoguide.

For a small number of younger patients, an allogeneic stem cell transplant using stem cells from a donor may be considered. Learn more in our Infosheet.

Supportive treatments

You may also be prescribed other treatment to help prevent or manage potential side effects of your treatment. You might also be given other treatment to help with the symptoms and complications of myeloma. 

How will you know if treatment is working?

Tests will be carried out on a regular basis to determine how you are responding to treatment. These will vary, but generally will include regular blood and/or urine tests, and occasional imaging tests or bone marrow investigations.

The signs that treatment is working include:

• A fall in the paraprotein or light chain level
• An improvement in symptoms and/or complications such as bone pain, anaemia and kidney function
• A reduction in the number of myeloma cells in the bone marrow
• An improvement in general health

What happens if treatment doesn’t work?

Not every patient responds well to the same treatment. Refractory myeloma is myeloma that has not responded to treatment.

There are, however, a number of different treatment options for myeloma. Many of the drugs used to treat myeloma work in different ways, so even if a patient does not respond well to one treatment combination this does not necessarily mean they won’t respond to a different combination. Find out about treatment for relapsed myeloma.