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Chemotherapy uses drugs to destroy cancer cells. The drugs enter the bloodstream and travel through the body. Chemotherapy primarily affects cancer cells, but some healthy cells can also be damaged. The treatment plan and doses will be adjusted to provide the best effect against cancer with minimal side effects. Chemotherapy is the main treatment for multiple myeloma but, it is often used in combination with other treatments. Currently, there is no cure for myeloma, so treatment is designed to prolong life by reducing the effects of myeloma on bodily functions and reducing discomfort.

Three phases of chemotherapy are used to treat multiple myeloma:

  • Induction—To reduce the amount of myeloma cells.
  • Consolidation—To kill any remaining myeloma cells still in the body, which may be done before a bone marrow transplant
  • Maintenance—maintenance therapy may be used to extend a remission period and prolong survival time.
Chemotherapy Drugs and Delivery

There are a variety of chemotherapy drugs. Standard chemotherapy drugs may be combined with biologic and/or targeted therapies.

Biologic therapies (also called immunotherapy) help the body fight cancer cells using natural processes. It may help stimulate the immune system to better attack cancer cells, control the growth of cancer, or change cancer behavior. Medications include thalidomide, pomalidomide, lenalidomide, or interferon.

Targeted therapies attempt to interfere with the growth of the tumor by blocking the formation of new blood vessels around the tumor. Medications include brotezomib (with or without ponatinib) or carfilzomib.

The choice and combination of drugs is determined by the stage and type of the disease, as well as factors like your age, overall health, and kidney function. Drugs used to treat multiple myeloma include:

  • CTD—cyclophosphamide, thalidomide, dexamethasone
  • TAD—thalidomide, doxorubicin, dexamethasone
  • Bortezomib and dexamethasone
  • PAD—bortezomib, doxorubicin, desamethasone
  • Cyclophosphamide and prednisone
  • MP(T)—melphalan, prednisone (with or without thalidomide)
  • Vincristine, doxorubicin, and dexamethasone

Chemotherapy for multiple myeloma is usually given through an IV, but some forms can be given by mouth. It is delivered in cycles over a set period of time. A medical oncologist will determine how many cycles of chemotherapy are needed and what combination of drugs will work best. It is likely that a relapse will occur after treatment. If so, the combination of chemotherapy drugs be changed.

Side Effects and Management

Though the drugs are targeted to cancer cells, they can affect healthy cells as well. The death of cancer cells and impact on healthy cells can cause a range of side effects. A medical oncologist will work to find the best drug combination and dosage to have the most impact on the cancer cells and minimal side effects on healthy tissue. Side effects or complications from chemotherapy may include:

  • Nausea and vomiting
  • Fatigue or sleepiness
  • Hair loss
  • Fluid retention
  • Lightheadedness
  • Reduced blood cell counts, which can lead to anemia or problems with blood clotting
  • Bone marrow suppression and/or reduced white blood cell counts, which increases the risk of infection
  • Constipation
  • Diarrhea
  • Tingling, numbness, pain, or weakness—peripheral neuropathy
  • Muscle aches
  • Skin rash
  • Deep vein thrombosis (DVT)
  • Rarely, infertility and/or reproductive and sexual problems—If you plan on having children, talk to your doctor about options to preserve fertility before starting treatment.

A variety of treatments are available to help manage side effects including medication, lifestyle changes, and alternative treatments. In some cases, the chemotherapy regimen may be adjusted to reduce severe side effects. The earlier the side effects are addressed, the more likely they will be controlled with a minimum of discomfort. Long-term side effects can include damage to the heart, kidneys, lungs, other bone marrow cancers, and some cognitive dysfunction.

References:

Bortezomib. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T232918/Bortezomib. Updated September 6, 2016. Accessed October 6, 2016.

Cyclophosphamide. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T233062/Cyclophosphamide. Updated September 27, 2016. Accessed October 6, 2016.

Multiple myeloma. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003131-pdf.pdf. Accessed May 13, 2016.

Multiple myeloma. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116888/Multiple-myeloma. Updated August 16, 2016. Accessed October 6, 2016.

Multiple myeloma. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/multiple-myeloma. Updated August 2013. Accessed May 13, 2016.

Toxicities of chemotherapeutic agents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115935/Toxicities-of-chemotherapeutic-agents. Updated July 26, 2016. Accessed October 6, 2016.

Treatment options for plasma cell neoplasms. National Cancer Institute website. Available at: http://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq#section/_240. Updated October 1, 2015. Accessed May 13, 2016.



Last reviewed March 2016 by Mohei Abouzied, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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