If you’re looking for a standard treatment for multiple myeloma—a cancer that’s more likely to affect you if you’re African American, older than 65 and have a family history of the disease—stop. There’s no such thing. But understanding more about the factors that influence treatment options may help you make a more informed discussion with your doctor about what’s right for you.
After diagnosis, your doctor will do certain tests, including a blood test and a bone marrow biopsy. Your doctor will determine the right treatment options for you based on your results and taking into account these factors:
- Your risk of disease progression. Multiple myeloma varies between people. In some, it progresses slowly with few symptoms. In others, it can be more aggressive, progressing quickly and keeping doctors scrambling for the best therapy. The more aggressive the disease, the higher the risk it will progress. Your doctor will analyze a sample of your bone marrow. Depending on which DNA sequences are found in the sample, you’ll be classified as having high, intermediate or standard risk.
- Your suitability for a stem cell transplant. Your doctor also will order tests to determine whether or not you’re a candidate for a stem cell transplant, a procedure to replace your diseased bone marrow with healthy bone marrow. If you’re considered a good candidate, your doctor will discuss the procedure and its risks with you.
How do doctors determine your eligibility for a transplant? They take into account these factors:
- Age. A stem cell transplant usually isn’t recommended if you’re 75 or older. But some older adults in very good health may be offered a reduced-intensity stem cell transplant, which uses lower doses of chemotherapy.
- Other medical conditions. If you have chronic health problems, such as serious heart, kidney, liver or lung disease, you may not be eligible for a stem cell transplant.
- Previous treatments. If you haven’t had a lot of treatment for your multiple myeloma, you have a better chance of responding positively to a stem cell transplant.
If you’re a go for a stem cell transplant, understand that while it won’t cure your disease, it can increase the success of your treatment. The typical approach is:
Initial therapy. If you have a standard risk of your multiple myeloma progressing, your doctor will probably recommend treatment with an initial therapy—a combination of chemotherapy, biological therapy, targeted therapy and corticosteroids—for two to four months. The goal is to reduce the number of cancer cells and ease your symptoms before the transplant.
Stem cell transplant. After initial therapy, stem cells will be harvested from your bone marrow or blood. After enough stem cells are collected and stored, it’s recommended you have the transplant immediately after recovering from the harvesting procedure.
You may be able to delay stem cell transplantation if you have a standard risk for disease progression. But if your risk of progression is intermediate or high, delaying the procedure will likely not be an option.
If you’re not approved for a stem cell transplant, your doctor will choose one or more of the following options:
- Initial therapy. In this case, initial therapy is given for up to a year and isn’t followed by a stem cell transplant. Corticosteroids are often combined with chemotherapy to reduce side effects. And interferon, a hormone-like drug that can help keep the condition in remission after chemo, often is included, too.
- Immunotherapy. When antibodies are used to attack cancer cells, it is called immunotherapy. This is usually reserved for patients who have not had success with other treatments.
- Radiation therapy. In this treatment, a beam is directed from a machine to a bone or other affected part of the body. The beam’s rays kill plasma cells, easing pain and strengthening weakened bone.
- Clinical trials. Since we’re still searching for the best treatment for multiple myeloma, new drugs are being tested in clinical trials. Talk to your doctor about participating in a clinical trial for access to these new therapies.
Some treatments for multiple myeloma may be more suitable than others. Talk with your doctor about what options are best based on the factors that apply to you.