What to Know About Chemotherapy for Multiple Myeloma
Chemotherapy is the use of drugs to kill cancer cells. For this treatment, you will see a medical oncologist. This is a doctor who specializes in using drugs to treat cancer. For multiple myeloma, your doctor is likely to give you more than one drug. This is called combination chemotherapy.
You may take these drugs by an IV into a vein, as a subcutaneous injection (shot), or by a pill. Either way, chemotherapy is a systemic treatment because the drugs travel all through the body in the bloodstream. Most people with multiple myeloma have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. In some cases, depending on your health or the drugs you take, you may need to stay in the hospital during treatment.
Chemotherapy is given in cycles. This means you will be treated for a period of time with chemotherapy and then have a rest period. Each treatment and rest period make up one cycle. You'll likely have more than one cycle of treatment. Your doctor will explain what your treatment plan will be and what you can expect. The length of each treatment period differs depending on the types of drug you take. With many types of chemotherapy, monthly treatments are common. Sometimes you will get chemotherapy more often.
Common chemotherapy drug combinations
For multiple myeloma, traditional chemotherapy drugs are often combined with newer types of drugs, such as immunomodulating agents (like thalidomide or lenalidomide), proteasome inhibitors (like bortezomib or carfilzomib), and/or with corticosteroid drugs such as dexamethasone or prednisone. Treatment options often depend on whether or not a person may be eligible for a stem cell transplant. Some of the more commonly used combinations of drugs include:
Melphalan and prednisone (MP), with or without thalidomide or bortezomib. If a stem cell transplant is planned, melphalan should not be used because it can damage the bone marrow.
Vincristine, doxorubicin, and dexamethasone (called VAD), or a variant of it called DVD (liposomal doxorubicin, vincristine, dexamethasone)
Thalidomide or lenalidomide, plus dexamethasone
Bortezomib and dexamethasone, with or without doxorubicin or thalidomide
There are new drugs approved for patients who have already received both lenalidomide and bortezomib, including carfilzomib and pomalidomide
Potential side effects from chemotherapy
Chemotherapy affects both normal cells and cancer cells. Side effects depend on the type and amount of drugs you take. Here are some common side effects that people with multiple myeloma have when they take chemotherapy. Ask your doctor which ones are the most likely to happen to you:
Serious side effects such as bleeding or infection may also occur. Drugs, such as doxorubicin and liposomal doxorubicin, may also affect the heart, so your doctor may monitor your heart function closely during treatment.
If you take corticosteroid drugs such as prednisone or dexamethasone, you could have these side effects:
Some of the newer drugs used to treat multiple myeloma are not standard chemotherapy drugs, and they can have their own side effects.
Thalidomide and lenalidomide may cause nerve damage (leading to burning or tingling sensations in the hands and feet), drowsiness, dizziness, skin rash, blood clots, constipation, and low blood cell counts. These drugs can also cause severe birth defects if used by pregnant women.
Bortezomib and carfilzomib can cause fatigue, nausea and vomiting, fever, diarrhea or constipation, loss of appetite, low blood cell counts, and nerve damage (leading to numbness or tingling in the hands and feet).
Carfilzomib has been associated with shortness of breath (dyspnea).
Ask your doctor or nurse for tips on easing these side effects. Many may go away when treatment ends.