Chemotherapy was the first treatment used for patients with multiple myeloma. It works by killing the myeloma cells, but it also kills many normal cells along the way. Chemotherapeutic agents typically come with an array of side effects, including hair loss, nausea, loss of appetite, and low blood counts.
Over the years, the types of chemotherapy used have evolved. Listed below are the most common types of chemotherapy used to treat multiple myeloma.
Several chemotherapy drugs fall under this category, including melphalan and Cytoxan® (cyclophosphamide, Baxter). Alkylating agents work by destroying the DNA of the myeloma cells.
Melphalan was one of the first chemotherapies for multiple myeloma. It is often used in combination with the steroid prednisone. High-dose melphalan is also used prior to an autologous stem cell transplant to destroy myeloma cells in the bone marrow.
In 2016, a reformulated version of intravenous melphalan, Evomela™ (Spectrum Pharmaceuticals) was approved for the treatment of myeloma in patients receiving high-dose chemotherapy in preparation for a transplant, as well as in patients who are receiving melphalan as treatment mainly for symptom and pain relief and cannot take oral melphalan. Evomela differs from conventional melphalan in how it is prepared for administration. It also is stable at room temperature for a longer period time than conventional melphalan and can be refrigerated, which may improve patients’ ability to receive their full intended dose of melphalan.
Cytoxan is usually given by injection. Side effects include low blood counts, mouth sores, and diarrhea. The amount of the drug given can determine the degree of the side effects.
A drug called Treanda® (bendamustine, Cephalon/Teva) combines an alkylator structure with another mechanism, resulting in DNA damage. In the United States, Treanda has been approved for two other blood cancers, but not for multiple myeloma.
In Europe, however, bendamustine has been approved for patients with newly diagnosed multiple myeloma in combination with prednisone. Other combinations for patients with relapsed multiple myeloma are currently being studied in clinical trials.
Adriamycin® (doxorubicin) is an example of this type of chemotherapy. It works by blocking an enzyme that myeloma cells need to grow and divide. It is often used as part of traditional chemotherapy regimens. In the mid-1980s, the combination of vincristine, Adriamycin®, and dexamethasone, or VAD, was prescribed as an alternative to melphalan.
Adriamycin has since been reformulated as Doxil® (doxorubicin HCL liposome injection, Janssen).