Multiple Myeloma

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Information written by:
John Garton, MD

Multiple Myeloma

TREATMENT ALTERNATIVES

Unlike certain malignancies the rationale for therapy of multiple myeloma is based upon the signs, symptoms and laboratory results found at the time of diagnosis more so than simply making the diagnosis. Although timing of treatment for multiple myeloma may be variable, and dependent upon the strategy agreed upon between the patient and treating physicians, the principal form of therapy utilized in this disease is chemotherapy. As in most malignancies there have been a variety of treatment programs which have been utilized and studied in attempts to improve the overall response and survival in this disease process. The determination of treatment is usually based upon age, underlying health, specific laboratory results and symptoms. The treatment may include what one could consider standard oral treatment with Melphalan and Prednisone, or move to an aggressive form of therapy such as/or including bone marrow transplantation. A number of cooperative cancer study groups throughout the world are continuing to try to develop improved treatment programs.

When determining the appropriate treatment for multiple myeloma your hematologist/oncologist will likely have reviewed the concerns regarding treatment of smoldering myeloma, indolent myeloma versus active disease. By close monitoring of the disease process appropriate therapy can be determined and initiated at the proper time. As one would expect different drug regimens may have different side effects or concerns and are better reviewed in a more specific drug related discussion.

Radiation therapy can be an important part of the treatment program available for multiple myeloma patients. The role of radiation therapy may include those instances of solitary plasmacytoma of bone, osteosclerotic myeloma, relief of spinal cord or nerve root compression, prevention of pathologic fractures, and palliation of pain due to localized tumor growth. In each of these instances radiation can be provided in such a way as to effectively eradicate the disease at the site of radiation, but may not have significant impact upon the systemic process requiring chemotherapy. In treatment programs utilizing aggressive types of therapy such as stem cell treatment or bone marrow transplantation more sophisticated and systemic radiation therapy may be utilized. Side effects of the radiation tend to be limited, especially because of the localized nature of most of the therapeutic programs. Blood counts may be affected in patients receiving radiation therapy, even if they are not receiving chemotherapy at the same time. Close observation may be indicated depending upon the circumstances of therapy.

Summary

Multiple myeloma is a relatively rare malignancy which results in systemic symptoms and frequently local bone disease. As a general statement, active multiple myeloma is best treated with systemic chemotherapy programs but may be benefitted by the addition of radiation therapy in circumstances as noted above. Your hematologist/oncologist or radiation oncologist will be able to give more specific information in regard to treatment programs, side effects and response.