Multiple Myeloma Treatment Options at Penn

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Different treatments are available for those with multiple myeloma. Some treatments are called standard. This means they are the currently used treatments. Some treatments are being tested in clinical trials. A treatment clinical trial is a study meant to help improve current treatments or obtain information on new treatments.

When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. You may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment, while others are available during or after treatment.

Treatment options vary depending on your situation including the stage of the cancer and other factors that may be present.

Talk with your team about the approach that is best for you.

Standard treatments for multiple myeloma offered at Penn

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other drug therapy

Corticosteroid therapy

Corticosteroids are steroids that have antitumor effects in lymphomas and lymphoid leukemias.

Thalidomide and lenalidomide

Thalidomide and lenalidomide are drugs called angiogenesis inhibitors that prevent the growth of new blood vessels into a solid tumor.

Bortezomib

Bortezomib is a type of drug called a proteasome inhibitor that targets certain proteins in cancer cells and may prevent the growth of tumors.

High-dose chemotherapy with stem cell transplant

This treatment is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Monoclonal antibody therapy is one type of biologic therapy. It is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Types of radiation therapy include:

• External radiation (or external beam radiation) comes from a machine outside the body. The machine directs high-energy rays at the cancer and some normal surrounding tissue. It is the most often used radiation treatment. The machine used to deliver the high-energy rays is called a linear accelerator.

• Three-dimensional (3-D) conformal radiation treatment is a type of external beam radiation. It uses computers to allow doctors to more precisely target a tumor with radiation beams (using width, height, and depth).

• Intensity-modulated radiation treatment (IMRT). IMRT is a type of 3-D conformal radiation treatment that uses radiation beams (usually x-rays) of
  various intensities to give different doses of radiation, at the same time, to small
  areas of tissue. This allows the delivery of higher doses of radiation to the tumor and lower doses to nearby healthy tissue.

• Internal radiation treatment, or brachytherapy, is given by placing an implant into or near the tumor. The implant is a small container that holds the
  radioactive source or material. Internal radiation treatment allows your doctor to give a higher total dose of radiation to a smaller area and in a shorter time than with external radiation treatment.

• Photodynamic therapy (PDT) combines a drug called a photosensitizer or photosensitizing agent with a specific type of light to kill cancer cells.
  Photosensitizers are drugs that when exposed to a specific wavelength of light,
  produce a form of oxygen that kills nearby cells. PDT can also work by
  shrinking or destroy tumors by damaging blood vessels in the tumor. This
  prevents the cancer from receiving nutrients. Also, PDT may activate the
  immune system to attack the tumor cells.

• Stereotactic radiosurgery is a a type of external radiation therapy that uses special equipment to position the patient and precisely give a single large dose of radiation to a tumor. It is used to treat brain tumors and other brain disorders that cannot be treated by regular surgery. It is also being studied in the treatment of other types of cancer. Also called radiation surgery, radiosurgery, and stereotaxic radiosurgery.

• Proton Therapy is the most precise form of radiation treatment for cancer possible, while minimizing damage to healthy tissue and surrounding organs.

Surgery

Surgery to remove the tumor may be done, usually followed by radiation therapy. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.

Plasmapheresis

Plasmapheresis is a procedure in which blood is removed from the patient and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells. The patient's plasma contains the unneeded antibodies and is not returned to the patient. The normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement. Plasmapheresis does not prevent new antibodies from forming.

Supportive care

This therapy controls problems or side effects caused by the disease or its treatment, and improves quality of life. Supportive care is given to treat bone problems or amyloidosis related to multiple myeloma and other plasma cell neoplasms.

New types of treatment are being tested in Clinical Trials at Penn.