Sandbox: treatment
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Multiple myeloma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Sandbox: treatment On the Web |
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American Roentgen Ray Society Images of Sandbox: treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months. Whereas patients with active (symptomatic) multiple myeloma are treated with a combination of steroids, immune modulator therapy and chemotherapy. The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation. Patients who are candidates for bone marrow transplantation are treated by a combination of dexamethasone and lenalidomide/bortezomib in advance to their transplantation. Alkylating agents are not recommended among transplant eligible patients, as the toxicity of such agents makes it difficult to harvest bone marrow stem cell later for transplant. Other pharmacological regimes used to treat active multiple myeloma patients eligible for bone marrow transplant may include either thalidomide, carfilzomib, cyclophosphamide, vincristine, or doxorubicin. In addition to the aforementioned agents, pharmacological regimes for active multiple myeloma patients not eligible for bone marrow transplantation may include either melphalan or prednisone.
Medical Therapy
Smoldering multiple myeloma
- Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months.
- Follow up studies for such patients include complete blood count, blood chemistry, serum and urine electrophoresis,
- Treatment should be deffered
Treatment for multiple myeloma is focused on disease containment and suppression. If the disease is completely asymptomatic (i.e. there is a paraprotein and an abnormal bone marrow population but no end-organ damage), treatment may be deferred. Such patients need to be treated when they develop symptoms such as anemia, hypercalcemia, progressive lytic lesions, renal dysfunction, rise in serum M component or Bence Jones protein. Those with solitary bone plasmacytomas and extramedullary plasmacytomas can be treated with a local radiation therapy of about 40 Gy.[1]