Although the patient's primary care doctor helps to manage the patient's care, the specialists involved often include an oncologist, hematology pathologist, radiologist, stem cell transplant specialist, and occasionally a surgeon (orthopedist and/or spine surgeon).
What are the stages of multiple myeloma?
- Smoldering: multiple myeloma with no symptoms
- Stage I: early disease with little anemia, relatively small amount of M protein and no bone damage
- Stage II: more anemia and M protein as well as bone damage
- Stage III: still more M protein, anemia, as well as signs of kidney damage
What is the medical treatment for multiple myeloma?
There is no known medical treatment that cures multiple myeloma. However, there are methods to decrease the occurrence and severity of symptoms and prolong life. The therapy is decided based upon the patient's condition and the cancer management team, made with the patient's input. The team will likely involve both a medical specialist in the treatment of myeloma called a medical oncologist, as well as a radiation oncologist and other consultants as appropriate. Oncology trained nurses and other personnel will likely be important members of the treatment team.
The choices for treatment(s) often include combinations of drugs, some of which are given as pills and others by intravenous injection. These include drugs which affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations. There may be a role for high-dose chemotherapy followed by the administration of bone marrow stem cells called a stem cell transplant or autotransplantation. Numerous factors come into play in determining whether or not to do such a transplant. Further information may be obtained from the National Comprehensive Cancer Network Guidelines (NCCN.org), which are updated at least yearly. Other medical treatments may include steroids, bisphosphonate therapy, blood or platelet transfusions, autotransplantation and/or plasmapheresis, and other combination therapy depending on the individual patient's disease stage.
Painful areas of bone damage may be treated with radiation therapy. Broken bones can be surgically repaired in many cases.
There are many drugs used to treat multiple myeloma. The following drugs are used often in combination with dexamethasone, sometimes orally or by IV, depending on the patient's individual disease status:
- Dexamethasone (Decadron) -- immune cell modulation
- Bortezomib (Velcade) -- protease inhibitor
- Lenalidomide (Revlimid) -- immune cell modulation
- Pamidronic acid (Aredia) -- inhibits bone resorption
- Zoledronic acid (Zometa) -- inhibits bone resorption
- Melphalan (Alkeran) -- alkylating agent that is toxic to myeloma cells
- Carfilzomib (Kyprolis) -- protease inhibitor that is FDA approved usually for patients who have failed a previous treatment
What are lifestyle and diet tips for people with multiple myeloma?
To stay healthy, lifestyle changes can help individuals with multiple myeloma. Giving up tobacco, reducing alcohol intake, eating better, and getting more exercise is recommended. Eating better may be difficult because of changes in your diet and tastes. After multiple myeloma treatments, it can be helpful to eat small meals about two to three hours apart until you feel as if you can eat a larger meal. During treatment, fitness or endurance and muscle strength can decline. For exercise, start slowly by taking short walks or getting involved with an exercise program that gradually increases without pushing the body too hard.
What is the prognosis for multiple myeloma? What is the survival rate for multiple myeloma?
The prognosis of multiple myeloma is variable, depending on the approximate stage and response to therapy. Though there is no cure for the disease, today's treatments are more effective and less toxic (have fewer side effects) than did many in the past. Multiple myeloma is a focus of active ongoing research. The median survival rate, beginning at the point of first treatment according to the American Cancer Society (ACS), according to stage of the disease is as follows:
- Stage I, 62 months
- Stage II, 44 months
- Stage III, 29 months
Complications of multiple myeloma may include kidney insufficiency, bleeding disorders, bone problems like pathological fractures, hypercalcemia, and neurological problems (for example, spinal cord compression, intracranial plasmacytomas, and others).
Is it possible to prevent multiple myeloma?
Because the risk factors for multiple myeloma are not fully understood, it is not a preventable disease. Currently, there is no cure for the disease. Even some individuals who recommend herbal home remedies like cayenne peppers suggest the herbals are used with drugs. Individuals should discuss the use of home remedies with their doctor before use.
What support systems are available for multiple myeloma?
The International Myeloma Foundation (IMF) can provide caregivers and patients information about many aspects of this disease. IMF's phone number is 1-800-452-2873. There are local, state, and national support groups for multiple myeloma and for palliative care.
What is the latest research on multiple myeloma?
Experimental studies on multiple myeloma have shown that if stem cells from patients with multiple myeloma are grown in cell culture, patients can improve but could also relapse because the stem cells often were contaminated with a few multiple myeloma cells. However, myxoma virus kills human multiple myeloma cells but not stem cells. Consequently, if stem cells for multiple myeloma patients are treated with myxoma viruses, the patient's stem cells are not contaminated multiple myeloma cells. Researchers have used this method to provide multiple myeloma patients with uncontaminated stem cells successfully preventing relapse of multiple myeloma due to contaminated stem cell cultures.
Myxoma viruses exclusively infect rabbit's cells and are not infectious to humans, so the researchers tried another method. In a mouse model of multiple myeloma, the mice were injected with the myxoma viruses and impressively, according to the researchers, 25% of mice had a complete eradication of multiple myeloma and no evidence of relapse. Researchers plan to try to improve this technique in humans and improve the remission rate.