blood disorders
Multiple Myeloma
Treatment of Multiple Myeloma
Some combination of different types of drugs (for example, corticosteroids with one of the immunomodulatory agentsthalidomide,lenalidomideorpomalidomide, and/or proteasome inhibitorsbortezomib,carfilzomib, orixazomib, or the nuclear export inhibitorselinexor). In addition, traditional chemotherapy drugs may be also be used in combination with these types of drugs. Monoclonal antibodies (for example,elotuzumab,isatuximab, anddaratumumab) most commonly combined with steroids and an immunomodulatory agent or proteasome inhibitor Possibly stem cell transplantation Possibly radiation therapy to treat bone pain Treatment of complications Multiple myeloma remains incurable despite recent remarkable advances in therapy. Treatment is aimed at preventing or relieving symptoms and complications, destroying abnormal plasma cells and slowing progression of the disorder. Treatment usually does not begin until the person develops symptoms or complications, although certain patients with high-risk features who are asymptomatic and have no obvious complications may also be required to start treatment. These high-risk features include greater extent of disease, blood levels of certain proteins, and specific genetic abnormalities in the tumor cells. Several different drugs are usually used to slow the progression of multiple myeloma by killing the abnormal plasma cells. Doctors use different combinations of drugs depending on characteristics of the myeloma and whether or not people are eligible for stem cell transplantation. Combinations may include drugs from more than one or each of the following: An immunomodulatory agent (thalidomide,lenalidomide, orpomalidomide), and/or proteasome inhibitor (bortezomib,carfilzomib, orixazomib), plus corticosteroids (such asdexamethasone,prednisone, ormethylprednisolone) More traditional chemotherapy drugs The monoclonal antibodieselotuzumab,isatuximab, anddaratumumab Some other, newer drugs being used that target B cells or other white blood cells includeidecabtagene vicleucel,ciltacabtagene autoleucel, andteclistamab; although they can be effective, they can increase the risk of severe infections.Venetoclaxis effective for people who have a specific gene abnormality. Traditional chemotherapy drugs include an alkylating agent (melphalan,cyclophosphamide, orbendamustine) or anthracycline (doxorubicinor its pegylated liposomal formulation). Because chemotherapy kills normal cells as well as abnormal ones, the person's blood cell counts are monitored and the dose is adjusted if the number of normal white blood cells and platelets decreases too much. Sometimes doctors recommend Stem Cell Transplantation for people who have good underlying health and in whom the myeloma has responded to several cycles of drug treatment. Stem cells (unspecialized cells that transform into immature blood cells, which eventually mature to become red blood cells, white blood cells, and platelets) are collected from the person's blood before high-dose chemotherapy is given. These stem cells are then returned (transplanted) to the person after the high-dose treatment. Generally, this procedure is reserved for people who are younger than 70. However, many of the newer drug combinations are highly effective, so stem cell transplantation is now being used less often. Strong analgesics and radiation therapy directed at the affected bones can help relieve bone pain, which can be severe. Radiation therapy may also prevent the development of fractures. However, radiation therapy may damage bone marrow function, which can impact the ability of the patient to be treated with antimyeloma drugs. Monthly intravenous administration ofpamidronate(a bisphosphonate—a drug that slows loss of bone density) or the more potent drugzoledronic acidcan reduce the development of bone complications, and most people with multiple myeloma receive these drugs as part of their treatment forever. Monthlydenosumabmay be an option for patients who do not toleratezoledronic acidor have poor renal function. People are encouraged to take calcium andvitamin Dsupplements to help reduce bone loss as long as they do not have high levels of calcium in their blood, and doctors encourage them to stay active because these actions help prevent bone loss. Prolonged bed rest tends to accelerate bone loss and makes the bones more vulnerable to fractures. Most people can enjoy a normal lifestyle that includes most activities. Drinking plenty of fluids dilutes the urine and helps prevent dehydration, which can make kidney failure more likely. People who do develop kidney problems may benefit from Plasma exchange . People who have signs of infection—fever, chills, cough productive of sputum, or reddened areas of the skin—should seek medical attention promptly because they may need antibiotics. People also may be at risk of infections with the Shingles , especially when they are treated with specific antimyeloma drugs such as any of the proteasome inhibitors (including People who have severe Overview of Anemia may need transfusions of red blood cells. Erythropoietin or darbepoietin, drugs that stimulate red blood cell formation, may adequately treat the anemia in some people. Some people with anemia also may benefit from being given iron supplements. High levels of calcium in the blood can be treated with intravenous fluids and often require intravenous bisphosphonates. Avoidingvitamin Dand calcium-containing foods also is helpful to reduce elevated calcium levels. People who have high levels of uric acid in the blood or widespread disease may benefit fromallopurinol, a drug that blocks the body's production of uric acid, which can damage the kidneys. 