Recommendations for the treatment of multiple myeloma

This article provides recommendations for the treatment of multiple myeloma (MM).

MM is a type of blood cancer characterized by abnormal plasma cells. Plasma cells are a type of immune cell that antibodies to fight bacteria and viruses and stop infection and disease. In MM, abnormal plasma cells build up in the bone marrow and form tumors in many bones of the body.

These tumors may keep the bone marrow from making enough healthy blood cells. This leads to many side effects, such as frequent fever and infections. Kidney disease can also develop due to a high amount of antibodies in the blood, which are released by myeloma cells. This condition affects normal kidney function and can lead to kidney failure.

Imaging is used to detect tumors and lesions (areas of bone loss due to cancer) in bones. This is traditionally done with a series of X-rays. However, studies found that whole-body CT scans detect bone lesions better than X-rays. Advanced imaging such as CT scans, PET/CT scans, or MRI scans, is recommended instead of X-rays.

Combinations of anti-cancer drugs are also under investigation. Studies have shown that adding a third drug to 2-drug regimens can improve outcomes. In one study, adding dexamethasone (Decadron) to DR (daratumumab, lenalidomide) lowered the risk of cancer getting worse by 44%. Even for patients who are good candidates for a stem cell transplant (SCT), 3-drug regimens are recommended. For patients who are not good candidates for SCT, 2-drug regimens are recommended.

After SCT, maintenance therapy is usually recommended to help delay relapse (cancer recurrence). Maintenance therapy is a low-dose treatment given for an extended period. Typically, a single drug is used, with the most common one being lenalidomide (Revlimid). Ixazomib (Ninlaro) is another maintenance option.

20 to 50% of patients with MM develop kidney disease, a serious condition that can lead to kidney failure. The authors recommend that all patients with MM be tested for kidney disease. For patients with kidney disease,  bortezomib (Velcade) alone or with dexamethasone is recommended. Chemotherapy and stem cell transplants may also be recommended. These options are safe for patients who are on dialysis.

This article reviewed recommendations for treating multiple myeloma. These included using advanced imaging to screen for cancer in the bones, testing for kidney disease, and using combinations of multiple drugs.