This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on June 6, 2022.
Multiple myeloma treatment generally depends on the stage of the cancer, whether you are a candidate for a stem cell transplant, and other factors, such as personal preferences and needs.
Treatments for multiple myeloma include chemotherapy, targeted therapy, immunotherapies, steroids and, more rarely, radiation and surgery. These treatments are typically used in combination, and sometimes with the addition of a stem cell transplant.
If you’re diagnosed with multiple myeloma, several treatment types may be used depending on the disease progression and prognosis, or the chance of recovery.
The type of treatment your doctor recommends depends on three factors:
Your treatment plan may have specific goals based on these factors. Goals may include removing the cancer, preventing additional damage from cancer, improving quality of life, relieving pain and other symptoms and side effects, or lowering the chance of recurrence.
Drugs to treat multiple myeloma, which is a common treatment approach, include:
Patients diagnosed with multiple myeloma are commonly prescribed drugs such as corticosteroids, which may shrink plasma cell tumors. Steroids kill multiple myeloma cells directly and decrease inflammation, subduing some symptoms and side effects of other treatments. They include dexamethasone and prednisone and are usually used in combination with other drugs.
Chemotherapy for the treatment of multiple myeloma may consist of a single agent or a combination of drugs. Because each medication destroys tumor cells in different ways, giving several drugs together may make the cells more responsive to treatment. When treatment for patients with multiple myeloma involves chemotherapy, the drugs are typically given orally (by mouth, in pill form) or intravenously (by injection into the vein).
Many multiple myeloma patients receive chemotherapy in combination with other drugs or treatments to fight the disease and prevent recurrence. A typical multiple myeloma treatment plan may include:
Throughout your treatment, we will conduct routine blood tests and other diagnostic evaluations to check for myeloma cells and make modifications to your treatment plan as needed.
Chemotherapy drugs often used for multiple myeloma include:
As is the case with chemotherapy in general, this treatment can cause a number of side effects when used for multiple myeloma, including:
In addition, you may experience tingling and/or numbness in your feet or hands, low blood counts and/or problems with blood clotting.
The exact chemotherapy side effects you may experience vary based on which drug or combination of drugs are prescribed, along with other individual factors.
Interventional radiology allows doctors to visualize tumors and perform real-time, image-guided interventional procedures. At City of Hope, we deliver treatment directly to tumors and perform image-guided bone marrow biopsies, lymph node biopsies, and vascular catheter and port placements. We may also provide palliative treatment and vascular access for stem cell transplantation.
Kyphoplasty is an example of a minimally invasive procedure used to relieve pain from compression fractures of the spinal vertebrae caused by multiple myeloma.
Radiation therapy for multiple myeloma may be used to treat a specific area where bone has been damaged and myeloma cells growing in the bone marrow are causing pain. Also, radiation therapy is sometimes given in preparation for a stem cell transplant, to destroy as many myeloma cells as possible.
Radiation for multiple myeloma may cause side effects such as:
These radiation side effects tend to go away when treatment is completed.
A stem cell transplant, sometimes referred to as a bone marrow transplant, may be used to treat multiple myeloma by infusing bone marrow with healthy cells, which helps stimulate new bone marrow growth and restore the immune system. Typically, patients with advanced-stage multiple myeloma who are younger than 70 and in otherwise good health are candidates for a stem cell transplant.
Before a stem cell transplant for multiple myeloma, you may undergo a preparative conditioning regimen, which involves intensive treatment to destroy as many myeloma cells as possible. You may receive high doses of chemotherapy and, in some cases, radiation therapy.
During the transplant, you receive the stem cells intravenously, much like a blood transfusion. The procedure takes about an hour. After entering the bloodstream, stem cells travel to the bone marrow and start to make new blood cells in a process known as engraftment.
In the months following the transplant, your care team will monitor your blood counts. You may need transfusions of red blood cells and platelets. Sometimes, the intensive treatments you receive before stem cell transplantation for multiple myeloma may cause side effects, including infection. In this case, your doctor may administer intravenous (IV) antibiotics.
If you had an allogeneic stem cell transplant (using donor cells), your doctor may prescribe certain drugs to reduce the risk of graft-versus-host disease, a condition in which the donated cells attack the patient’s tissues.
Life-saving stem cell transplants for multiple myeloma carry some risks and side effects. Because of a stem cell transplant’s preparative conditioning regimen (chemotherapy and/or radiation), side effects may include:
Side effects vary based on the type of stem cell transplant. For example, an allogeneic transplant involves transplanting stem cells from a donor. This may cause graft-versus-host disease (GVHD), which occurs when the donor cells attack your tissues.
By contrast, an autologous transplant involves removing your own healthy stem cells and freezing and storing them while you undergo cancer treatment. Then, the stem cells are re-infused after you finish treatment.
Targeted therapy drugs are designed to attach themselves to specific protein receptors in or on the surface of cancer cells. For patients with multiple myeloma, targeted therapy may be used alone or in combination with other treatments, such as chemotherapy or radiation therapy.
Monoclonal antibody therapy is a type of targeted therapy that may be used to treat multiple myeloma. These drugs are made of antibodies engineered in a laboratory. Once injected into the body, monoclonal antibodies may target specific proteins found on cancer cells, killing them or preventing them from growing.
Among the targeted therapy drugs that may be used to treat multiple myeloma are proteasome inhibitors. Proteasomes are enzymes inside cells that break down old proteins so they can be recycled into new proteins. This process is necessary to prevent a toxic build-up of proteins inside the cell. Proteasome inhibitors are designed to stop the proteasomes from recycling proteins inside cancer cells, causing a toxic protein overload that may kill the cell.
Some of these treatments may include:
Unlike chemotherapy and radiation, which cast wide nets to kill all rapidly dividing cells in your body (including healthy and cancerous cells), targeted therapy is aimed at cancer cells only, sparing healthy ones. As a result, targeted therapy causes fewer side effects than chemotherapy and radiation.
Targeted therapy side effects vary based on the type of drug or drugs and the dose, along with other factors. Side effects may include:
Other risks may include low blood cell counts, infection, and cold or flu-like symptoms.
Immunotherapy turns your immune system against cancer. These are usually drugs that make the immune system stronger or direct it to fight off the cancer cells.
Immunotherapy side effects vary based on the type of drug or drugs that you’re taking to treat multiple myeloma. Common side effects that you may experience include:
Though rare for multiple myeloma, surgery may be recommended to remove single tumors called plasmacytomas or tumors causing symptoms. Your doctor may also recommend radiation or other drug treatments after surgery.
In most cases, multiple myeloma patients are prescribed a combination of treatments that work together for better end results and fewer side effects than any single treatment. These include:
This treatment uses high doses of chemotherapy drugs to destroy the body’s blood cells, but it also damages healthy bone marrow cells in the process. Radiation may also be used to ensure all of the cancerous cells have been destroyed.
Those damaged cells are replaced with stem cells found in the blood (peripheral blood stem cells), through a stem cell transplant. These stem cells then repopulate the bone marrow, build the tissue back up and create new blood cells. The stem cells come from two possible sources:
Multiple drugs are usually combined to treat multiple myeloma. Instead of just one or two, your care team may recommend a custom combination of chemotherapy drugs, immunotherapy, targeted treatment and a steroid for personalized treatment options based on your test results, cancer stage, symptoms, co-occurring conditions, and other health information such as your age and general health.
Supportive care services are also helpful in addressing side effects of treatment or the cancer itself, such as anemia, infections, blood clots, kidney failure, bone disease, pain or depression.
End-of-life and supportive care for patients with advanced multiple myeloma that hasn’t responded to treatment may include hospice care. In hospice, treatment is focused on improving the quality of the patient’s life, not extending lifespan. Hospice care focuses on pain relief and symptom management and may happen at home or in an inpatient facility.
Chimeric antigen receptor T-cell therapy, or CAR T-cell therapy, is a cancer treatment that falls under immunotherapy. Immunotherapy is an approach to treating cancer that harnesses the power of your body’s immune system by using treatments that boost or improve the body’s defenses.
During CAR T-cell therapy, cells that naturally exist in your body, called T cells, are extracted from a blood sample and sent to a laboratory. There, scientists alter the DNA of these cells, giving them new receptors that latch on to myeloma cells. Then, these modified T cells are reintroduced into your blood, and they travel through the body locating cancer cells. By latching on to cancer cells, the new T cells improve your immune system’s ability to fight the cancer.
So far, one type of CAR T-cell therapy has been approved to treat multiple myeloma: Abecma® (idecabtagene vicleucel).
This treatment option alters T cells so that they attach to a protein called BCMA. The BCMA protein is located on the surface of myeloma cells. The altered T cells that latch on to this protein may boost the immune system’s ability to find and attack myeloma cells.
Abecma® is generally an option for myeloma patients who have exhausted other treatments. Most patients who receive this treatment have already undergone at least four other treatments.
The treatment starts with a procedure called leukapheresis, which involves two intravenous (IV) lines that remove blood from your body and circulate some of it back in. As blood leaves the body, it’s sent through a specialized machine that separates T cells from the blood. Then, the rest of the blood is delivered back to your body via the second IV line. The procedure may take two to three hours. You may be in a seated position or lying down during the process.
Once the collection of T cells has concluded, they’re transferred to a laboratory. The process of altering the T cells may take weeks to complete, so treatment doesn’t begin immediately after leukapheresis.
Before you’re able to start treatment, you’ll receive a short round of chemotherapy, lasting a couple of days. The chemotherapy equips the body to respond to CAR T-cell therapy.
Once the cells have been successfully altered and the chemotherapy is complete, the T cells are introduced into the bloodstream via a vein.
CAR T-cell therapy is a very specialized approach that requires expert knowledge. It’s important to receive treatment with CAR T-cell therapy under the supervision of doctors who have significant experience with this approach.
The potential side effects of this treatment may be severe and include:
Following treatment, your care team will continue to monitor you to ensure that your multiple myeloma has not relapsed.
Clinical trials provide an opportunity for cancer patients to gain access to novel cancer treatments that may prove to be more beneficial than standard treatments. For cancer treatment to continue to advance, clinical trials are essential, as they allow doctors to study new approaches and patients to benefit from new treatments.
City of Hope runs many clinical trials for patients seeking innovative treatment options. Enrolling in a clinical trial may be beneficial for any person with cancer, but it’s an especially promising option for those who have exhausted standard-of-care approaches.
Before moving forward with a treatment plan, consider asking your doctor if enrolling in a clinical trial is a good option for you. Your doctor may be able to explain which clinical trials you may be eligible to join, how to join them, and what to expect.
Next topic: What are the facts about multiple myeloma?