Treating Multiple Myeloma
Since multiple myeloma is a systemic disease (it affects the entire body) one of the most commonly used treatment option is chemotherapy.
Overview of treatment drugs (from WebMD)
From Lifescript, page 6, examples of chemotherapy drugs used for multiple myeloma include:
Melphalan and prednisone
Vincristine, doxorubicin, and dexamethasone
Usually given as an injection.
Understanding Velcade (Bortezomib)
(Velcade) including side effects
Understanding Velcade Subcutaneous (from the IMF) (8:25 minutes)
Understanding your treatment: Velcade therapy (24:02 minutes)
Velcade Animation with Narration (1:40 minutes)
"The mental side effects dexamethsone can cause is fairly long and includes depression, emotional instability, euphoria, headache, intracranial pressure increased, insomnia, malaise, mood swings, neuritis, personality changes, pseudotumor cerebri (usually following discontinuation), psychic disorders, seizure, vertigo... (from the Myeloma Beacon)
Dexamethasone can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had.
Do not stop using dexamethasone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.
Drink 6-8 cups of fluids every day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
Dexamethasone (from UPMC)
Dexamethasone for Myeloma Treatment
Side effects and more information about Dexamethasone and steroids
Dexamethasone Forum From brain cancer forum, with stories of the effects of Dexamethasone
Revlimid is used as a common treatment for multiple myeloma. It is an expensive drug and the patient needs to answer telephone questions about the safe practice of using Revlimid. The phone number to call to answer the questions is: 1-888-423-5436
Information about the Celgene Risk Management
Information from Celgene on Revlimid
Lenalidomide (Revlimid) information and side effects
Revlimid Side Effects Center (with a Revlimid / placebo comparison chart)
Lenalidomide and the
Risk for Second Cancers in Myeloma (after using melphalan)
Understanding your treatment: Revlimid therapy (24:16 minutes)
Revlimid an overview (1:29 minutes)
Cytoxan is a commonly used drug for treating multiple myeloma.
Acyclovir is used to prevent shingles during chemotherapy treatment.
Acyclovir (from WebMD)
What Is Acyclovir (Zovirax)?
Daratumumab / lenalidomide / dexamethasone
Immunotherapy Benefits Patients with Drug-Resistant Multiple Myeloma, from Cancer Connect
Dr. Torben Plesner on daratumumab/lenalidomide/dexamethasone in RRMM (ASH 2014) (IMF) (4:21 minutes)
Often drugs are administrated in combination for greater effectiveness. These are given abbreviations that reflect the combination, such as:
for Cytoxan with Bortezomib (Velcade) and Dexamethasone
for Revlimid and Dexamethasone
Newer drug treatments for patients that have had at least one other treatment
information and side effects
What is Ninlaro? (From the Multiple Myeloma Research Foundation - see detailed links on the left of their Web page)
Ninlaro clinical trials (From the Multiple Myeloma Research Foundation)
Ninlaro (From drugs.com)
Kyprolis is used for relapsed multiple myeloma
Delivered by an intravenous infusion (IV)
Information about Kyprolis and side effects (kyprolis.com)
There are a number of side effects when using kyprolis and the patient should be aware of them
Kyprolis from drugs.com, dosage, side effects
from the Multiple Myeloma Research Foundation
Delivered by an intravenous infusion (IV)
FDA Approves Empliciti for Multiple Myeloma (from Cure)
Clinical trial results (from the Myeloma Beacon)
Empliciti from drugs.com
Managing Side Effects
Managing Side Effects from the International Myeloma Foundation (39.42 minutes)
Auto Stem Cell Transplant or autologous stem cell transplant
Auto Stem Cell Transplant or autologous stem cell transplant using a patient's own stem cells
1. Harvesting stem cells
Neupogen (filgrastim) is a man-made form of a protein that stimulates the growth of white blood cells in your body
Inject Neupogen (Filgrastim)
White cell count goes from about 5 million to 50 million
Since it is a soft bone, you may feel pain in the sternum or breastbone is a long flat bone shaped like a necktie located in the center of the chest. This may appear as a heart attack. Call your hospital or clinic if you are concerned.
The patient is connected to a centrifuge, non-dominant arm is usually used to take blood out, and cannot be moved once the procedure starts
Blood is put back into the other arm, which may be moved, use to control a music player or remote, etc.
If you feel cold, may need to turn on a blood warmer on the machine, or get a blanket.
- Takes a number of hours, often 4-5
- If you have to eliminate, a bed pan is used
- Afterward may be tired, even though laying for a number of hours
- Can usually drive yourself home
- Usually harvest enough stem cells for 2 (maximum) transplants
- Takes two or more sessions to harvest the quantity of stem cells
- Stem cells are frozen until needed
2. Transplant process
Uses Melphalan to kill the cells in the bone marrow, including the myeloma
Then the patient's stem cells are infused back into the patient’s blood.
Some doctors recommend a tandem transplant of 2 autologous transplants, 6 to 12 months apart. This approach is called a tandem transplant.
A patient may be on maintenance drugs after the transplant, but not everyone is on maintenance drugs
A patient may feel weak for a number of months
Secondary Cancers after Melphalan
Revlimid And Secondary Cancers: Melphalan May Be The Culprit
BMT (Blood & Marrow Transplant) Information Network
Blogs and Links
Dexamethasone Support Group from drugs.com)
Treto (general, not specific to multiple myeloma)