There are more treatment options for multiple myeloma than ever before. No matter what type of treatment you need, multiple myeloma specialists at Fred Hutchinson Cancer Center will work closely with you, your family and each other to get you back to health.
Smoldering, or indolent, myeloma doesn’t cause symptoms, and patients with this condition may not need treatment right away. People who have active, or symptomatic, myeloma will be treated by our experienced, compassionate team.
As you go through treatment, your needs may change. Your care team at Fred Hutch is with you each step of the way. For example, we will help you cope with any side effects you have. We may suggest adding a new therapy that was just approved. Even after your multiple myeloma treatment is done, we will keep seeing you to protect your health over the long term.
ON THIS PAGE
Treatment Plan | Treatment Process | Monitoring Your Health | Supportive Care Services | Continuing Care
Treatment Plan
Multiple myeloma treatment at Fred Hutch is highly customized for each patient’s needs.
How Do We Create Your Treatment Plan?
Your Fred Hutch hematologist-oncologist works with an entire group of multiple myeloma specialists. They include other hematologist-oncologists, radiation oncologists, pathologists, nephrologists, cardiologists, spine specialists, transplant specialists and researchers who are all looking for better ways to treat this disease.
Every week, this team gathers in a meeting to discuss their patients’ treatment plans. This meeting is called a tumor board. This approach means each patient benefits from the experience of the whole group.
With support from the larger team, your physician will:
- Decide if your disease needs treatment now, or if watchful waiting is best
- Talk about the standard therapies
- Check if any clinical trials match your needs, so you can think about joining them
Your hematologist-oncologist will walk you through the treatment plan that the tumor board has recommended for you. You will have a chance to share your personal preferences and options, and you will decide together what happens next.
Why Do Treatment Plans Differ?
The treatment plan we design for you depends on many things, including:
- If your multiple myeloma is asymptomatic (also called smoldering or indolent) or symptomatic
- If your multiple myeloma is high-risk or standard
- If you have had treatment for multiple myeloma in the past
- Your age and overall health
- Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial
What is the Standard Therapy for Multiple Myeloma?
Your treatment plan will be individual to you and your unique circumstances, but physicians often use a combination of chemotherapy, blood and marrow transplant, immunotherapy and radiation therapy to treat multiple myeloma.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.
Our patients can also choose to have promising new multiple myeloma therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.
Treatment Process
The main goal of multiple myeloma treatment is to get rid of or reduce the number of myeloma cells in your body. This lets us stop or slow down your disease, stop or reduce complications and help you feel better and live a longer, healthier life. We choose, combine and schedule your treatments based on what will work best for your unique case. Your care team will make sure you understand each type of treatment and all of your choices.
Chemotherapy
The most common treatment to control myeloma cells is chemotherapy. This is often followed by a blood or marrow transplant for younger patients and then long-term maintenance therapy in the form of low-dose chemotherapy.
Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow).
Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Usually, chemotherapy for multiple myeloma involves a combination of oral medications (that you take by mouth) and injections.
You will get infusions in a special area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will also watch over you during the treatment. They will deal with any medical issues that come up and help keep you comfortable.
Common forms of chemotherapy can be used alone or in combination with other medicines. They include dexamethasone (steroids), lenalidomide, bortezomib, carfilzomib, daratumumab, elotuzumab and cyclophosphamide.
Your physician may recommend high-dose chemotherapy with melphalan and an autologous stem cell transplant (using your own stem cells).
Blood or Marrow Transplant
A blood or marrow transplant resets your body’s ability to make healthy blood cells. Researchers right here at Fred Hutch pioneered this form of treatment.
Your physicians may recommend an autologous stem cell transplant after your first therapy for multiple myeloma. An autologous stem cell transplant is a transplant using blood-forming stem cells from your own body. This treatment can help patients live longer before a relapse happens, or before they need treatment for myeloma again.
In some cases, your team may recommend a transplant using stem cells from a donor. This is called an allogeneic transplant.
A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, physician assistant or advanced registered nurse practitioner, pharmacist, registered dietitian, team coordinator and social worker.
Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today, we continue to improve transplant techniques and to develop new options.
Immunotherapy
Immunotherapies are treatments that use the power of your immune system to fight your cancer. CAR T-cell therapy is one common example.
Today, there are two FDA-approved CAR T-cell therapies for multiple myeloma offered at Fred Hutch. Our physicians and scientists are also studying immunotherapy and bispecific antibodies for multiple myeloma in clinical trials.
One of our latest clinical trials is looking at the side effects and best dose of BCMA CAR T-cells in patients with multiple myeloma that is positive for B-cell maturation antigen (BCMA-positive multiple myeloma, or BCMA+ multiple myeloma) that has come back or does not respond to treatment.
Radiation Therapy
Your doctor may also recommend radiation therapy, which uses high-energy X-rays to kill cancer cells. It is highly effective and works well for most myeloma patients.
In multiple myeloma, radiation therapy is used to treat myeloma tumors or a plasmacytoma (a single area of myeloma activity), painful areas of bone damage that aren’t improving with other treatments, or areas where disease activity or damage is causing pressure on the spinal cord or a nerve.
Monitoring Your Health
While you are in active treatment, your multiple myeloma care team will see you regularly for exams and tests to check:
- How well your treatment is working
- If there is any reason to change your treatment
- If you need help with side effects or supportive care services, like nutrition care or mental health counseling
We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.
Supportive Therapies for Multiple Myeloma
Your care team may recommend bone-strengthening medications if you need them. Multiple myeloma can cause holes in the bones that can last even after the cancer is gone, so preventative bone strengthening can be helpful.
This may include: Bone-modifying agents: Zometa, Pamidronate, Denosumab
Possible Results of Treatment
Throughout treatment, your care team looks for signs that your multiple myeloma is responding to treatment. This is called the This is called the International Myeloma Working Group (IMWG) criteria. Unlike other cancer types that have separate stages, with myeloma, most patients will go through relapse at some point, so we think of your outcomes as falling somewhere in a range. The responses to chemotherapy include:
- Partial response
- Very good partial response
- Complete response
- Stringent complete response
- Minimal residual disease (MRD) negative stringent complete response
If you have a relapse, this is called disease progression. Along with relapse, you may also hear the word “refractory,” which means that the disease progression happened during your treatment or soon after treatment ended.
Classifications include:
- Partial response
- Very good partial response
- Complete response
- Stable disease
- Disease progression
- Relapsed/refractory
- Minimum residual disease
What about “cured”? Physicians do not think of myeloma as curable, but it is treatable. Most patients are either on active therapy or being closely monitored.
“We see the patient on the day that they're meant to start treatment. That would also allow us to educate them on potential side effects to look out for. Typically, they'll meet with one of our pharmacists on that day as well — again, just for another layer of support and information.”
— Christen N. Martino, ARNP, lymphoma survivor
Supportive Care Services
Along with treating your multiple myeloma, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.
From registered dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.
Learn more about Supportive Care
When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your multiple myeloma. They will check your overall health and look for signs that your cancer may have come back (signs of recurrence).
Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).