If you are diagnosed with multiple myeloma, you are likely to be treated with a combination of drugs that work in different ways to target the myeloma cells in your body.

The standard treatment is a TRIPLET THERAPY involving a combination of three medicines 

A proteasome inhibitor (disposes damaged proteins)

An immunotherapy drug (boosts the immune system)

A corticosteroid (has anti-cancer effects)

Some patients may also receive four treatments or may be eligible for a stem cell transplant.

You may also receive treatments to help relieve some of the symptoms of myeloma and side effects associated with treatment.

Some of these treatment options specifically target abnormal proteins or certain growth signals that are responsible for the growth of the myeloma cells and are called TARGETED THERAPIES.

There are many different types of targeted therapies. For example:

PROTEASOME INHIBITOR

These are drugs that target proteosomes which are complexes that dispose old and damaged proteins. They cause myeloma cells to die by preventing them from removing damaged proteins.

STEROIDS

Some steroids have anti-cancer effects and are often used in combination with other targeted therapies.

Immunotherapy drugs

These drugs help to boost the body’s immune system. Depending on the proteins they activate/inhibit they are categorised as:

IMMUNOMODULATORS

These activate certain immune cells or prevent growth signals to myeloma cells

HDAC INHIBITORS

These block the action of certain enzymes which help in growth and survival of myeloma cells

MONOCLONAL ANTIBODIES

These are man-made antibodies that target specific proteins on the surface of myeloma cells

NUCLEAR EXPORT INHIBITORS

These prevent proteins from leaving the nucleus of a myeloma cell, thereby stopping it from functioning

Chemotherapy drugs or referred simply as “chemo” sometimes are non-specific unlike targeted therapy.

• Chemotherapy can be very good at getting rid of cancer cells in the body. They work by killing cells that are “fast-growing” within the body, those that are in the process of dividing rapidly. Cancer cells normally grow faster than normal healthy cells. The downside is some normal cells can get affected too. That is why you experience side effects. But these are largely manageable.
• Chemotherapy is often combined with targeted therapies or steroids. It is also commonly used in preparation for a stem cell transplant.
• If you do not have access to standard targeted triple therapy, experience side effects (peripheral neuropathy) from targeted therapy regimens or if you have impaired renal function your doctor may replace one of the drugs with chemotherapy.

Radiation therapy or irradiation is a type of local therapy. It is opted when cancer cells are localized in one area of the body.

• Radiation therapy uses high-energy particles or rays to destroy cancer cells and prevent them from growing, much in the same way as chemotherapy drugs work. Low-dose local irradiation is often used to treat bone lesions or a single group of myeloma cells, to relieve uncontrolled pain and prevent or treat bone fractures.

Stem cell transplant (SCT) or bone marrow transplant is an alternative treatment for multiple myeloma.
SCT aims to replace the harmful myeloma cells with healthy blood-forming stem cells. These stem cells are specialized cells that are able to make many different types of blood cells. 
The stem cells can help replace the red blood cells, white blood cells and platelets in the bone marrow, which are being crowded out by myeloma cells.

You may receive stem cells extracted from your own body (autologous SCT) or from an another donor (allogenic SCT). Before receiving a stem cell transplant, a high-dose of chemotherapy is used to kill as many myeloma cells as possible.

All of the treatment options for multiple myeloma have some side effects, for example, fatigue, weakness and drowsiness.

These depend on the drug, the dosage and the person’s response to the medications

Some side effects can be very serious, while others are uncomfortable but not serious.

Most of the side effects will disappear when treatment is stopped, while some may be long-term or even appear several years later.

Talk to your doctor to understand what side effects to expect and how they can be managed.

Most common side effects and how to manage them