Chemotherapy for Multiple Myeloma

Chemotherapy for Multiple Myeloma

If you have myeloma, your doctor will likely recommend chemotherapy, or treatment with anti-cancer drugs. These medicines are distributed throughout the body through the bloodstream. They can help kill myeloma cells in the bone marrow and blood, as well as those that may have spread to other areas.

Selecting a Chemotherapy Regimen

There are several chemotherapy drugs and combinations of drugs available for treating myeloma. It may be easier or harder to tolerate the side effects of some compared to others. Some tend to work more quickly or slowly than others. These issues may influence what plan your doctor recommends.

Another important consideration is that some chemotherapy drugs are more likely to damage your stem cells. If you have these drugs, a stem cell transplant will not be as good an option for you in the future. So before deciding about your chemotherapy, you and your doctor will want to discuss whether you are a good candidate for a transplant. If you are, your doctor will most likely recommend having a transplant, and this will affect the doctor’s recommendations about chemotherapy. If you are not a good candidate for a transplant, your doctor will likely recommend chemotherapy alone, or chemotherapy with radiation therapy, if appropriate.

Some patients who intend to have chemotherapy without a transplant may arrange to have their stem cells removed and stored before they begin chemotherapy so they might have the option to use these cells in a transplant in the future. This is an option you can discuss with your doctor to see if it makes sense in your situation.

Whatever your circumstances, your doctor will recommend a certain type of chemotherapy based on your needs and will talk with you about the reasons. Ask your doctor to explain his or her recommendation and any other options you can consider.

Common Forms of Chemotherapy

Here are several common forms of chemotherapy for myeloma:

  • Melphalan (Alkeran) and prednisone (Prednisolone) (a combination also called MP
  • Cyclophosphamide (Cytoxan) and prednisone (a combination called CP)
  • Vincristine (Oncovin), doxorubicin (Adriamycin) and dexamethasone (Decadron) (a combination also called VAD)
  • Thalidomide (Thalomid) and dexamethasone (a combination also called Thal-Dex or TD
  • Lenalidomide (Revlimid) and dexamethasone (a combination also called Rev-Dex or RD or, when low-dose dexamethasone is given, Revlodex or Rd)
  • Bortezomib (Velcade) alone or with other drugs
  • Dexamethasone alone or with other drugs
  • Doxil (a form of doxorubicin) with other drugs

Your doctor may recommend another combination of these drugs or additional drugs, depending on your situation.

Seattle Cancer Care Alliance patients who have myeloma receive chemotherapy at the SCCA clinic.

Side Effects

Side effects are an important concern for many people receiving chemotherapy. Besides killing cancer cells, chemotherapy can damage healthy tissue and cause side effects like fatigue, hair loss, digestive problems, mouth sores, skin irritation, and low levels of healthy blood cells. Your doctor will talk with you about the specific side effects you might develop and what to watch for. We will help you take the best possible care of yourself to prevent, minimize, or relieve side effects so you can focus your energy on your recovery.