Multiple Myeloma Treatment by Stage

Treating inactive myeloma (MGUS and Smoldering Myeloma)

Generally, myeloma is not treated until symptoms develop. Patients with smoldering myeloma, an inactive form of myeloma, who have bone loss (osteoporosis or osteopenia) may receive bisphosphonates, a bone supportive therapy, to reduce the risk of fractures, and other bone problems.

One study has shown that Revlimid in combination with dexamethasone prolonged the time to development of symptomatic myeloma in patients with high-risk smoldering multiple myeloma, an inactive form of myeloma that is likely to progress to active myeloma. However, this therapy is still considered experimental and at this time there is not sufficient information on its benefits and risks. A large Phase III study (the most advanced stage of drug development involving large numbers of patients) is underway to determine if Revlimid can delay disease progression and improve survival in this group of patients.

Other therapies are also being investigated for high risk smoldering myeloma.

Treating active (symptomatic) myeloma

Patients with symptomatic myeloma usually receive treatment aimed at attacking the myeloma cells. Patients should know that if one regimen stops working, another one can be used. There are many choices available today and treatments continue to improve.

The role of maintenance therapy

Since myeloma is not yet curable, it may recur even in patients who obtain a complete response. The goal of maintenance therapy is to maintain the response for as long as possible and hopefully improve survival.

There is increasing evidence supporting the role of maintenance therapy after the completion of initial therapy or after transplantation. While more data are needed to determine if there is a consistent survival benefit of maintenance therapy, results thus far have prompted many doctors to discuss the option of maintenance therapy with their patients based on consistent evidence that it significantly delays disease progress.

Options if you don’t respond to therapy or relapse

If myeloma does not respond to initial therapy or if relapse occurs soon after the completion of initial therapy, the myeloma is considered to be refractory, or resistant to the treatment. Therefore, the disease is not likely to respond to the same treatment by itself.

An additional drug may be added to the treatment regimen or a different combination of drugs may be used as second-line therapy. If relapse occurs after a period of response to initial therapy, the initial therapy may be repeated or another regimen may be given.

There are many treatments available for relapsed or refractory myeloma, and many new drugs are being studied as well. Even if patients are refractory to a particular therapy, they may respond if it is used in a different combination with other myeloma drugs.

Treatment options include:

  • Any myeloma drug that has not been previously used or a different combination of myeloma medications
  • Stem cell transplant (if possible)
  • Participation in a clinical trial