Multiple myeloma

Treatment

Seattle Cancer Care Alliance (SCCA) is an internationally recognized center for multiple myeloma. We offer comprehensive care, including advanced treatments and new options available only through clinical studies. 

People with smoldering, or indolent, myeloma — which doesn’t cause symptoms — don’t need immediate treatment. But regular exams are important to check whether the condition is getting worse. 

Those who develop active, or symptomatic, myeloma can live full lives for years or decades using the many treatment options available today. With individualized care, many enter remission, a period in which most or all signs and symptoms disappear.

A diagnosis of cancer can feel overwhelming. SCCA has an experienced, compassionate team ready to help. 

Multiple myeloma expertise at SCCA

Everything you need is here

We have expert hematologist-oncologists, radiation oncologists and pathologists; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Innovative multiple myeloma therapies

SCCA is a world leader in multiple myeloma research. Our doctors and scientists pioneered bone marrow transplant, an enduring pillar of myeloma treatment, and we advance new approaches, like CAR T-cell therapy, every day. 

Multiple myeloma treatment tailored to you

We view multiple myeloma treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a treatment plan based on the stage and effects of your myeloma and many other factors, including your overall health and lifestyle. 

Team-based approach

Your personal team includes a hematologist-oncologist, nurse case manager and, if needed, a radiation oncologist. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a palliative care professional, social worker, physical therapist or dietitian.

Learn More About Supportive Care Services

Ongoing care and support

Throughout your treatment, your team provides follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as a multiple myeloma survivor.

Deciding on your treatment plan

The main goal of myeloma treatment is to eliminate or reduce the number of myeloma cells in your body in order to:

  • Stop or slow the disease.
  • Stop or reduce complications (like bone breakdown, high blood calcium, kidney damage and low blood counts).
  • Help you feel better and live a healthier, longer life.

There is no single standard treatment plan. 

  • Your SCCA myeloma team will recommend a combination of treatments for you based on up-to-the-minute research as well as the stage of your myeloma and the effects on your body. 
  • Your treatment plan also depends on factors like your age, your overall health, your lifestyle and whether you’ve had treatment for myeloma in the past.

When you and your doctor are ready to talk about making treatment choices, you will probably discuss:

  • Whether there are disease processes, symptoms or complications that need to be addressed urgently, such as bone damage or compression of a nerve due to a bone fracture
  • Whether there are other longer-term issues and decisions that you can wait to address later on

Your doctor will talk with you about the timeline for making treatment decisions in your unique situation. 

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at SCCA. 

Chemotherapy

The most common treatment to control myeloma cells is chemotherapy, often followed by a bone marrow transplant and then long-term maintenance therapy in the form of low-dose chemo.

Deciding on chemotherapy

Several chemotherapy medicines and combinations are 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 the plan your doctor recommends.

Another important consideration is that some chemotherapy medicines are more likely to damage your stem cells. If you have these medicines, a 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 talk about a transplant. 

  • If you are a good candidate, your doctor will most likely recommend having a transplant, and this will affect their recommendations about chemotherapy. 
  • If you are not a good candidate for a transplant, your doctor will likely recommend chemotherapy alone or with radiation therapy.

Some people who intend to have chemotherapy without a transplant may arrange to have their stem cells removed and stored for a possible transplant in the future. Talk with your doctor to see if this makes sense in your situation.

Common forms of chemotherapy

Common forms of chemotherapy for myeloma include:

  • Dexamethasone (steroids) alone or with other medicines
  • Melphalan (Alkeran) and prednisone (a combination also called MP)
  • Cyclophosphamide (Cytoxan) and prednisone (a combination called CP)
  • Lenalidomide (Revlimid) and dexamethasone (a combination also called Rev-Dex or Rd)
  • Bortezomib (Velcade), alone or with other medicines
  • Carfilzomib (Kyprolis), alone or with other medicines
  • Panobinostat (Farydak) in combination with other medicines
  • Elotuzumab (Empliciti) in combination with other medicines
  • Daratumumab (Darzalex) in combination with other medicines

Your SCCA team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and connect you with medical and support resources throughout SCCA. Most people with multiple myeloma tolerate chemotherapy well and continue to work, raise their families or enjoy their retirement while on therapy.

Chemotherapy

The most common treatment to control myeloma cells is chemotherapy, often followed by a bone marrow transplant and then long-term maintenance therapy in the form of low-dose chemo.

Bone marrow transplant

Many people with myeloma benefit from high-dose chemotherapy followed by a bone marrow transplant (also called stem cell or hematopoietic cell transplant). If you are a candidate, a transplant will be a key component of your comprehensive treatment plan. 

Transplants are quite effective at slowing or stopping the disease and prolonging survival in good candidates. In general, good candidates are people up to their mid 70s who are in good physical condition and whose heart, lungs and kidneys work well. These factors are important because the chemotherapy you have before a transplant is challenging for your body.

Most transplant recipients with multiple myeloma have a transplant using their own stem cells (autologous transplant). 

  • First, your stem cells are collected, frozen and stored. 
  • Next, you receive strong chemotherapy to attack your cancer cells, destroy or suppress your immune system and prevent your body from forming new blood cells. 
  • Then, your stored stem cells are thawed and returned to your bloodstream to restart your body’s ability to form blood cells again.

Some people with myeloma may have a transplant using cells from a donor (allogeneic transplant). More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as:

  • Nonmyeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors

Learn more about the Fred Hutch Bone Marrow Transplant Program at SCCA, including the lifelong support you get through our Long-Term Follow-Up Program for transplant recipients.

Learn More About Bone Marrow Transplant

Bone marrow transplant

Many people with myeloma benefit from high-dose chemotherapy followed by a bone marrow transplant (also called stem cell or hematopoietic cell transplant). If you are a candidate, a transplant will be a key component of your comprehensive treatment plan. 

Immunotherapy

Immunotherapies are treatments that harness your immune system to fight your cancer. SCCA doctors and scientists are currently studying immunotherapy for multiple myeloma in clinical trials. 

One of our latest trials explores the side effects and best dose of BCMA CAR T cells in patients with multiple myeloma that’s positive for B-cell maturation antigen (BCMA-positive multiple myeloma, or BCMA+ multiple myeloma) that has come back or does not respond to treatment. Read about this study.

Learn More About Immunotherapy

Immunotherapy

Immunotherapies are treatments that harness your immune system to fight your cancer. SCCA doctors and scientists are currently studying immunotherapy for multiple myeloma in clinical trials. 

Radiation therapy

Doctors use external-beam radiation therapy to treat:

  • Specific myeloma tumors or a plasmacytoma (a single area of myeloma activity)
  • Painful areas of bone damage that aren’t getting better with other treatments
  • Areas where disease activity or damage is causing pressure on the spinal cord or a nerve

Radiation therapy, which uses high-energy X-rays to kill cancer cells, is highly effective and well tolerated by most myeloma patients.

Radiation therapy

Doctors may use external-beam radiation therapy.

Treating complications

Myeloma can affect your body in many ways. In addition to getting treatment to control the myeloma, you may also need treatment for complications of the disease, such as these:

  • Low blood counts leading to increased risk of infection (due to low white blood cells), anemia (due to low red blood cells) and blood-clotting problems (due to low platelets)
  • Lowered immune function because myeloma cells don’t make effective antibodies 
  • Weakened bones, and possibly pain and fractures, due to myeloma activity
  • High blood calcium (hypercalcemia) because of dissolving bone
  • Kidney damage from high blood calcium and from proteins released by myeloma cells
The most common treatments for myeloma complications:
  • Infection treatments — If your immune system is weak because your white blood cell levels are low, you may be prone to infections, like pneumonia. You may need antibiotics to fight an infection or another medicine, called filgrastim (Neupogen), to boost your white blood cells.
  • Erythropoietin — This medicine also goes by the brand names Procrit and Aranesp. It can be given to help boost your red blood cells if you have anemia. Anemia can make you feel weak and tired. For more severe anemia, you may need a transfusion (receiving red blood cells through an intravenous line).
  • Medicines to manage calcium levels — Medicines called bisphosphonates help reduce destruction of bone. Thus, they help reduce the calcium levels in your blood and stabilize your bones. They can also help relieve bone pain. (You can use pain medications to relieve bone pain, too.) Two bisphosphonates are approved for this purpose: zoledronate (Zometa) and pamidronate (Aredia). Another, nonbisphosphonate, medicine is also approved: denosumab (Xgeva).
  • Orthopedic surgery — Your doctor may suggest surgery to place metal rods or plates to repair or strengthen bones damaged by myeloma. If vertebrae in your spine are damaged, they may press on your spinal cord or the nerves that branch from your spinal cord to the rest of your body. In this case, you could need emergency surgery to take off the pressure.
  • Kyphoplasty — This is a procedure to inject special cement into a damaged vertebra to stop pain caused by a spinal fracture and stabilize the bone.
  • Hemodialysis — If your kidneys don’t work well, you may need hemodialysis. In this process, a tube connected to one of your veins drains blood from your body to a machine. The machine filters wastes from your blood. Then the blood is returned to your body through another tube in your vein. Diuretics, medicines that increase urination, can also help relieve the burden on your kidneys.