The newer treatments for myeloma include combinations of agents that include thalidomide, lenalidomide, or bortezomib.
Initial therapy depends on whether you are considered a candidate for an autologous stem cell transplant. Patients who are older and not considered candidates for transplant (typically those age 70 to 75 or older) may be treated with combinations such as melphalan/prednisone/thalidomide or melphalan/prednisone/bortezomib; younger patients may be treated with lenalidomide/dexamethasone or bortezomib/thalidomide/dexamethasone. Many patients also enroll on clinical trials available at our center (see below).
The response rates to these treatments are in the range of 70 percent to 80 percent or better. The medications may cause side effects in some patients. For thalidomide, these include fatigue, sleepiness, constipation, numbness or tingling of the hands and feet, and possible blood clots in the legs. For lenalidomide, side effects include lowering of blood counts and possible blood clots in the legs. Patients who might become pregnant or whose partners might become pregnant need to take special precautions when on thalidomide and lenalidomide. Bortezomib can cause numbness or tingling of the hands and feet, nausea, vomiting, diarrhea, constipation, fever, and lowering of blood counts. Patients usually do well dose reductions if they have side effects, or with medications that can improve the symptoms.
Whether you are starting treatment for the first time or have already had treatment for myeloma and need treatment again, you may be able to take part in studies of new treatments.