Hematologic Malignancies Program

Patient and Family Education

Multiple Myeloma

Stages and Treatments

After multiple myeloma is diagnosed, the doctor will do more tests to find out the extent and characteristics of the myeloma cells. This process, called staging, helps the doctor plan the best treatment. Chromosome studies should be done on the bone marrow sample taken during the bone marrow aspiration.

Other important tests that help to evaluate patients with multiple myeloma include tests of b2 microglobulin, C-reactive protein, blood count, calcium level, kidney function, and type of abnormal myeloma protein.

The following stages are used for multiple myeloma:

Stage I: Relatively few cancer cells have spread throughout the body. The number of red blood cells and the amount of calcium in the blood are normal. No tumors (plasmacytomas) are found in the bone. The amount of M-protein in the blood or urine is very low. There may be no symptoms of disease.

Stage II: A moderate number of cancer cells have spread throughout the body.

Stage III: A relatively large number of cancer cells have spread throughout the body. There may be one or more of the following:

A decrease in the number of red blood cells, causing anemia
Large amounts of calcium in the blood because the bones are being damaged
More than three bone tumors (plasmacytomas)
High levels of M-protein in the blood or urine

Treatments Options

There are three primary treatments for patients with multiple myeloma:

chemotherapy
radiation therapy
biological therapy

Bone marrow transplantation, surgery, and plasmapheresis may also be used in certain cases.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs for multiple myeloma are usually given by mouth, but they can be injected into a vein or muscle. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

There are several different types of chemotherapy drugs, and the choice of which to use is usually based on the patient's age, the stage of the cancer, and the patient's tolerance for treatment. (Younger patients are better able to tolerate high doses of chemotherapy.) The most common chemotherapy drugs used to treat multiple myeloma are melphalan and prednisone, and they are usually given together. Other chemotherapy drugs used for multiple myeloma include vincristine, carmustine, cyclophosphamide, doxorubicin, and dexamethasone.

Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

(top)

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for multiple myeloma usually comes from a machine outside the body (external-beam radiation therapy). It is usually used when myeloma has not responded to chemotherapy and the patient is experiencing serious symptoms caused by damage to the bones.

(top)

Biological Therapy

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. Two immunotherapy drugs sometimes used for multiple myeloma are thalidomide and interferon. Thalidomide inhibits the growth of blood vessels to tumor cells, thus slowing the growth of the cells. Interferon is used to prolong the remission of myeloma by slowing the growth of myeloma cells.

(top)

Bone Marrow Transplant

A bone marrow transplant is a treatment in which a patient's diseased bone marrow is replaced with healthy bone marrow. It is often used in combination with high doses of chemotherapy. After chemotherapy is given, healthy stem cells are transplanted into the patient to replace the marrow destroyed by the chemotherapy drugs.

A bone marrow transplant using marrow from a relative or person not related to the patient is called an allogeneic bone marrow transplant. The transplant includes the following steps:

First, all of the bone marrow in the patient's body is destroyed with high doses of chemotherapy with or without radiation therapy.
Healthy marrow is then taken from another person (a donor) whose tissue is the same or almost the same as that of the patient. The donor may be a twin (the best match), a brother or sister, or a person who is not related.
The healthy marrow from the donor is then given to the patient through a needle in the vein, and the new marrow replaces the original marrow that was destroyed.

Another type of bone marrow transplant, called an autologous bone marrow transplant, is conducted in the following steps:

First, bone marrow is taken from the patient and treated with drugs to kill any cancer cells.
The treated marrow taken from the patient is then frozen and saved
Next, high-dose chemotherapy is given to the patient with or without radiation therapy to destroy all of the remaining marrow.
The frozen, treated marrow is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.

Another type of autologous transplant is called a peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns the blood to the patient. This procedure is called leukapheresis and usually takes three or four hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to the patient. This procedure may be done alone or with an autologous bone marrow transplant.

Patients have a greater chance of recovery if they are treated in a hospital that does more than five bone marrow transplants a year.

(top)

Surgery

Surgery is not usually considered an effective treatment for multiple myeloma. However, it may be used in emergencies to relieve pressure on the spinal cord and can also be used for the insertion of metal rods to help support weakened bones. In addition, if the spleen is swollen, a doctor may take out the spleen in an operation called a splenectomy.

(top)

Plasmapheresis

If too many M-proteins build up in the blood, causing the blood to become too thick, the patient's blood may need to be filtered through a special machine in a process called plasmapheresis. The patient's blood is transfused, and blood plasma is removed, discarded, and replaced with donated blood proteins. The procedure relieves symptoms but does not kill the cancer cells.

(top)

This page was last updated on: October 7, 2009.