Treatment Options
There is no such thing as "one-treatment-fits-all" when it comes to treating myeloma. What works for one patient may not work for another, which is why each case must be assessed individually.
The choice of treatment depends on a number of factors, including:
- The results of physical exams and diagnostic testing (blood, urine and bone tests).
- The stage of the disease at the time of diagnosis.
- The prognostic indicators (i.e., factors on which doctors base their best estimate of how the myeloma will affect the patient and how it is likely to respond to treatment).
- The patient's age and overall state of health.
- The symptoms being experienced (for example, bone pain, fractures, etc.).
- Disease complications (for example, kidney disease, anemia, infections, etc.)
- Response to prior treatments (if applicable);
- New treatments that are becoming available through participation in clinical trials.
That said, all treatment options share similar goals, namely to help:
- Control the myeloma (i.e., prevent the production of abnormal plasma cells).
- Strengthen the bone and prevent fractures.
- Increase the red blood count and reduce fatigue.
- Reduce the risk of infections.
- Promote well-being and quality of life.
The standard therapies for myeloma in Canada may include the following:
- Observation
- Radiotherapy
- Corticosteroids such as dexamethazone or prednisone, often in combination with other myeloma drugs
- Chemotherapy such as melphalan or cyclophosphamide
- High-dose chemotherapy with stem cell transplantation
- Immunomodulatory agents (IMiDs) such as thalidomide (e.g., Thalomid), lenalidomide (e.g., Revlimid) and pomalidomide (e.g., Pomalyst)
- Proteasome inhibitors (PIs), such as bortezomib (e.g., Velcade) and carfilzomib (Kyprolis)
- Selective inhibitors of nuclear export (SINE), such as selinexor (Xpovio)
- Immunotherapy:
- Monoclonal antibodies (MoAbs) such as daratumumab (Darzalex) and isatuximab (Sarclisa)
- Chimeric antigen receptor (CAR) T-cell therapy. Note: Idecabtagene vicleucel (Ide-cel; Abecma) and ciltacabtagene autoleucel (Cilta-cel; Carvykti) have been approved for treatment of myeloma by Health Canada but are not yet available in Canada (last updated July 2023).
- New and emerging therapies being studied in clinical trials
Treatments or drugs are commonly used in different combinations, such as lenalidomide and dexamethasone or melphalan and prednisone with bortezomib. A number of new and emerging treatments are becoming available. For more information of new and emerging therapies, visit the Myeloma Research section.
Receiving a High-Dose Chemotherapy with Stem Cell Transplantation
It is normal to feel anxious about receiving a stem cell transplant. Watch the video below and hear other patients’ journey and learn about your options.
| The standard types of treatments for myeloma in Canada may include a combination of the following | |
|---|---|
| Observation |
|
| Radiotherapy |
|
| Chemotherapy |
|
| Steroids | Steroids may be used to help prevent inflammation, either alone or in combination with other drugs, such as chemotherapy drugs. |
| High-Dose Chemotherapy with Stem Cell Transplantation |
|
| Maintenance Therapy |
|
| Consolidation Therapy | Consolidation therapy involves a shorter course of treatment with the goal of deepening the patient's response to the initial therapy. |
| Clinical Trials |
|
| Supportive Treatments |
|