We recognize that a cancer diagnosis is a stressful time for you and your loved ones, and we dedicate as much time as you need to review information and options with you. Your team will create an individualized treatment plan for you based on:
- Your age, overall health, and medical history
- Specific genomic characteristics of the type of myeloma you have
- Your expectations, preferences, and health goals
We typically present several options and offer you the guidance and support of your entire care team in making a decision. Once you start treatment, we follow you closely to make sure you are responding to therapy. After treatment, we continue to follow you to make sure there is no residual disease.
We work closely with the Columbia University Bone and Marrow Transplant Program to give you state-of-the art treatment and follow-up.
Induction and consolidation therapies use medications.
Multiple myeloma is mainly treated with chemotherapy and immunotherapy. Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. Multiple myeloma often spreads throughout your body, so systemic medicine helps control the disease no matter where it started.
This action is why chemotherapy causes side effects like hair loss. You’ll either get chemotherapy through an IV in our infusion center or perhaps through a pill, depending on the medication.
These agents are divided into several groups based upon how they work. The most commonly used groups and drugs are:
- Immunomodulatory drugs. Lenalidomide (Revlimid®), pomalidomide (Pomalyst®), thalidomide (Thalomid®)
- Proteasome inhibitors. Bortezomib (Velcade®), carfilzomib (Kyprolis®), ixazomib (Ninalro®)
- DNA-damaging chemotherapy agents. Cyclophosphamide, bendamustine, melphalan, vincristine, doxorubicin, carmustine, etoposide, cisplatin
- Immunotherapies. Monoclonal antibodies, bispecific antibodies, and CAR T-cell therapies: daratumumab (Darzalex®), elotuzumab (Empliciti®), teclistamab (Tecvyali), Ide-cel (Abecma), and Cilta-cel (Carvykti)
- Corticosteroids. Dexamethasone, prednisone
Usually, the drugs above are used in combination, and treatment regimens contain two or three drugs at a given time. In addition to chemotherapy and immunotherapy, patients may choose to undergo stem cell transplant during their treatment course.
Stem Cell Transplant
Multiple myeloma is caused by a malfunction in the cells produced by your bone marrow.
Stem cells are part of your bone marrow. They can become any type of blood cell your body needs—red blood cells, white blood cells, or platelets. A stem cell transplant regenerates your bone marrow’s ability to create healthy cells.
Many factors go into your decision to have a stem cell transplant. Your experienced care team will walk you through the pros and cons of this decision based on your specific situation.
Stem cell transplants use autologous treatment—using your own cells. Our experts harvest stems cells from your blood before you have high-dose chemotherapy called the "conditioning regimen.” Harvesting is similar to giving blood. You might have to do it multiple times to get enough stem cells. After the conditioning regimen, which wipes out your bone marrow, your noncancerous stem cells will be given back to you.
Stem cell transplants can have serious side effects including graft versus host disease. Your care team is highly experienced in treating this illness and others. We’re also at the forefront of science to develop new therapies.
You might have radiation therapy if multiple myeloma is weakening the bones in your back. As your bones weaken, they may collapse and start pressing on your nerves and spinal cord. Radiation therapy can prevent paralysis.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy. For brain and spine tumors, you might have a version called image-guided radiation therapy (IGRT) or intensity-modulated radiation therapy (IMRT).
You’ll have radiation therapy on a schedule your radiation oncologist sets—daily, weekly, every other day, or a single treatment.
We encourage patients to consider clinical trials, as they offer promising new treatments that may be more effective than current standard options. When discussing treatment, we present available clinical trials alongside standard treatments.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of colorectal cancer patients. The HICCC offers several multiple myeloma cancer clinical trials. You can talk to your care team about whether a clinical trial is an option for you.
Patients with multiple myeloma may receive additional treatments that are not chemotherapy or immunotherapy but that also help treat their myeloma. These include:
- Radiation therapy
- Pain management
- Medications to prevent infection
- Medications to prevent blood clots
Additionally, we cannot stress the importance of patient support—whether through advocacy programs, support groups, or psychological counseling—on the recovery of patients and their loved ones.