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What are the best treatments for Multiple Myeloma?

Medically reviewed by Kristianne Hannemann, PharmD. Last updated on June 9, 2025.

Official Answer by Drugs.com

Multiple myeloma is a cancer of plasma cells, which are white blood cells responsible for producing antibodies. While not yet curable, advancements in therapy have transformed it into a manageable condition with treatments that can achieve long-term disease control and improved quality of life.

First-Line Treatment: Induction Therapy

Initial treatment typically involves induction therapy to rapidly reduce cancer cells. Common regimens include:

Transplant eligibility influences therapy choices. Patients eligible for autologous stem cell transplant (ASCT) often receive 3–4 cycles of induction first.

Role of Stem Cell Transplant

Stem cell transplant (SCT), also known as hematopoietic stem cell transplant, plays a significant role in the treatment of multiple myeloma, particularly for younger and healthier individuals. It's often used to allow for higher doses of chemotherapy, which can more effectively kill myeloma cells.

The primary reason for a stem cell transplant in multiple myeloma is to "rescue" the bone marrow from the damage caused by high-dose chemotherapy. While high-dose chemotherapy is very effective at killing myeloma cells, it also destroys the healthy blood-forming stem cells in the bone marrow. The transplant replenishes these stem cells, allowing the bone marrow to recover and produce new, healthy blood cells.

A stem cell transplant typically involves:

Post-transplant maintenance therapy with lenalidomide prolongs remission and improves survival.

Relapsed/Refractory Treatment Options

Sometimes, myeloma does not respond to treatment (called refractory disease). Additionally, most patients with myeloma will experience relapse (return of cancer). Treatment for refractory or relapsed myeloma depends on many factors, but options include:

Supportive Treatments and Symptom Management

For patients with multiple myeloma, treatment extends beyond targeting the cancer itself. Supportive treatments and symptom management strategies are an important part of comprehensive care.

Bone Health

Multiple myeloma can significantly impact bone health, leading to pain, weakness, and fractures. Several treatments are available to protect and strengthen bones:

Related questions

Anemia and Fatigue

A common symptom of multiple myeloma is anemia, a deficiency of red blood cells, which leads to persistent fatigue and weakness. Management strategies include:

Preventing and Managing Infections

Multiple myeloma and its treatments can weaken the immune system, making patients more susceptible to infections. There are several measures that can help reduce the risk of infection and related complications:

Summary and Clinical Considerations

Treatment plans for multiple myeloma are highly individualized, factoring in age, genetic risk, and comorbidities. Early referral to a hematologist/oncologist ensures access to cutting-edge therapies and clinical trials, which continue to redefine outcomes. With novel agents like bispecific antibodies and CAR T-cells, patients now have more options than ever to achieve durable remissions.

References
  1. Albagoush, S. A., et. al. Updated 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Accessed on June 9, 2025 at https://www.ncbi.nlm.nih.gov/books/NBK534764/
  2. American Cancer Society. 2025. Signs and Symptoms of Multiple Myeloma. Accessed on June 9, 2025 at https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/signs-symptoms.html
  3. American Cancer Society. 2025. Stem Cell Transplant for Multiple Myeloma. Accessed on June 9, 2025 at https://www.cancer.org/cancer/types/multiple-myeloma/treating/stem-cell-transplant.html
  4. American Cancer Society. 2025. Supportive Treatments for People with Multiple Myeloma. Accessed on June 9, 2025 at https://www.cancer.org/cancer/types/multiple-myeloma/treating/supportive.html
  5. American Cancer Society. 2025. Surgery for Multiple Myeloma. Accessed on June 9, 2025 at https://www.cancer.org/cancer/types/multiple-myeloma/treating/surgery.html
  6. Devarakonda, S., et. al. 2021. Role of Stem Cell Transplantation in Multiple Myeloma. Cancers, 13(4), 863. https://doi.org/10.3390/cancers13040863
  7. Leukemia and Lymphoma Society. Myeloma. Accessed on June 9, 2025 at https://www.lls.org/myeloma/treatment
  8. Multiple Myeloma Research Foundation. n.d. Treatments for Multiple Myeloma. Accessed on June 9, 2025 at https://themmrf.org/diagnosis-and-treatment/treatment-options/
  9. National Cancer Institute. 2025. CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers. Accessed on June 9, 2025 at https://www.cancer.gov/about-cancer/treatment/research/car-t-cells
  10. National Comprehensive Cancer Network. 2025. NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma. Accessed on June 9, 2025 at https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf

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