Myeloma: The Basics
Our guide to myeloma includes a glossary of terms, question guides and details on what to expect during each stage of diagnosis, treatment, and follow-up care.
Download or order up to 50 copies today.
It's important that your doctor is experienced in treating patients with myeloma or works in consultation with a myeloma specialist. This type of specialist is called a hematologist-oncologist.
Finding the best treatment approach for myeloma
Myeloma is not curable, but it is treatable. The goals of myeloma treatment are to:
- Reduce symptoms
- Slow disease progression
- Provide long periods of remission (when there are no signs of myeloma or you feel well enough to carry on your daily activities)
- Lengthen survival while preserving quality of life
The treatment your doctor recommends is based on several factors:
- Extent and characteristics of your disease, such as chromosome abnormalities
- Rate of disease progression
- Presence of other conditions, such as heart or kidney disease, diabetes, or neuropathy
- Age and overall health.
As you develop a treatment plan with your doctor, be sure to discuss the following:
- Your treatment options and the results you can expect from treatment
- The possibility of participating in a clinical trial, where you'll have access to advanced medical treatment that may be more beneficial to you than standard treatment
- Potential side effects, including long-term and late effects of treatment
Getting a second opinion
People diagnosed with myeloma may want to consult a myeloma specialist, or a second myeloma specialist, before proceeding with a prescribed treatment plan to make sure they are getting the best therapy available. Many health insurance companies will authorize a second opinion.
Learn more about making blood cancer treatment decisions.
Other treatment considerations
If you are 60 or older, your treatment may vary from standard approaches. For instance, your body may not be able to tolerate toxic chemotherapy drugs, or you may have other ailments that are more common as we age. These factors, among others, may make choosing a treatment more complicated.
If your cancer has returned (relapsed) or it's still present after you finish standard therapy (refractory), you may have a different treatment approach than the first time around.
Read more about refractory and relapsed myeloma.
Types of myeloma treatment
Open each section below to learn more.
The main treatment for active myeloma is systemic drug therapy (meaning the drugs travel through the bloodstream to kill malignant cells). The initial therapy, or “induction therapy,” for myeloma usually includes a combination of targeted agents and/or standard chemotherapy. Common drugs combinations for people with newly diagnosed myeloma include:
- Dara-VRd: daratumumab, bortezomib, lenalidomide, dexamethasone
- Isa-VRd: isatuximab, bortezomib, lenalidomide, dexamethasone
- Dara-KRd: daratumumab, carfilzomib, lenalidomide, dexamethasone
- Dara-CyBorD: daratumumab, cyclophosphamide, bortezomib, dexamethasone
- Dara-Rd: daratumumab, lenalidomide, dexamethasone
- VRd: bortezomib, lenalidomide, dexamethasone
- KRd: carfilzomib, lenalidomide, dexamethasone
Induction therapy is often followed by stem cell transplantation in eligible patients.
These patients will have stem cells removed from their blood or bone marrow. When possible, enough stem cells should be collected for two transplants in case there is a second transplant at a later date.
Patients who are not eligible for a transplant typically continue with the same drugs used during induction. The goal is to deepen the gains made with the initial cycles of therapy before starting maintenance therapy.
Drugs used for myeloma treatment
Drugs regularly used to treat myeloma either alone or in combination with other drugs include the following:
- Proteasome inhibitors
- Bortezomib (Velcade®)
- Carfilzomib (Kyprolis®)
- Ixazomib (Ninlaro®)
- Immunomodulatory drugs (IMiDs)
- Lenalidomide (Revlimid®)
- Pomalidomide (Pomalyst®)
- Monoclonal antibodies
- Elotuzumab (Empliciti®)
- Daratumumab (Darzalex®)
- Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
- Isatuximab-irfc (Sarclisa®)
- Denosumab (Xgeva®)
- Alkylating agents (DNA-Damaging Drugs)
- Melphalan hydrochloride (Evomela®)
- Cyclophosphamide (Cytoxan®)
- Melphalan (Alkeran®)
- Selective inhibitor of nuclear export (SINE)
- Selinexor (Xpovio®)
- Chimeric Antigen Receptor (CAR) T-Cell Therapy
- Idecabtagene vicleucel (Abecma®)
- Ciltacabtagene autoleucel (Carvykti™)
- Corticosteroids
- Dexamethasone
- Prednisone
- Dexamethasone
- Bispecific B-cell maturation antigen (BCMA)
- Teclistamab-cqyv (Tecvayli™)
Drugs used to fight myeloma-related bone disease include the following:
- Bisphosphonates
- Pamidronate (Aredia®)
- Zoledronic acid (Zometa®)
- Bone-modifying agent
- Denosumab (Xgeva®)
For information about the drugs listed on this page, visit our cancer drug listing.
Oral therapy and adherence
Treatment methods for myeloma patients have changed a lot over the last several years. Today, some of the drugs used to treat myeloma are taken by mouth, which is called “oral treatment” or “oral therapy." “Adherence” means staying on a set plan or regimen, taking the medication as prescribed—on the right day and at the right time—and reporting side effects to your doctor. Poor adherence to a prescribed oral drug regimen can result in the following: drug resistance; poor response to therapy; disease progression; increased doctor visits, laboratory tests, and hospitalizations; and even death.
Download or order the free Blood Cancer United fact sheet, Oral Treatment Adherence Facts
High-dose chemotherapy and stem cell transplantation are important parts of treatment plans for eligible, recently diagnosed myeloma patients. There are two types of stem cell transplantation:
- Autologous transplant: one that replaces the patient’s stem cells with their own stem cells
- Allogeneic transplant: One that uses replacement stem cells from a donor
Allogeneic transplant is not commonly used to treat myeloma, but it may be a treatment option for patients participating in a clinical trial.
Autologous stem cell transplantation for myeloma
Autologous stem cell transplantation is associated with good response rates and remains the standard of care after completion of induction therapy for eligible patients, as determined by the transplant team. However, autologous transplant is not appropriate for all patients and is not a cure for myeloma.
The patient’s own stem cells are collected for this type of stem cell transplant. These collected cells are eventually transfused back into the patient's bloodstream. If needed, a doctor may use special medications to help "mobilize" stem cells from the marrow into the bloodstream so that more can be collected.
The patient is then treated with high doses of chemotherapy.
After chemotherapy, the stem cells are returned to the patient's bloodstream by IV (similar to a blood transfusion). The goal is for the stem cells to restore normal blood cell production.
Patients may need maintenance therapy after autologous stem cell transplantation.
Tandem autologous stem cell transplantation: This term refers to a planned second course of high-dose chemotherapy and stem cell transplant within six months of the first course. According to recent studies, this should only be considered as a treatment option for patients who do not achieve a good response with the first transplant and who have
Learn more about autologous stem cell transplantation.
This is the continued use of therapy to maintain the response obtained with induction therapy or stem cell transplantation. During maintenance therapy, medications are given at lower doses or with less frequency to keep the successful results of prior treatment going.
Lenalidomide (Revlimid®) is the preferred agent for post-transplant maintenance, based on the results of several clinical trials. It does not produce the neurotoxicity of other immunomodulatory drugs, such as thalidomide. However, lenalidomide appears to increase the risk for developing a secondary cancer during maintenance therapy, especially after transplantation or after therapy with a regimen that contains melphalan.
Maintenance therapy with bortezomib (Velcade®) or ixazomib (Ninlaro®) is recommended for patients with certain cytogenetic abnormalities.
For information about the drugs listed on this page, visit our cancer drug listing.
Maintenance therapy is intended to be continued over the long term. If or when there are signs and/or symptoms indicating disease progression, you and your doctor will discuss additional treatment. Patients should share their questions or concerns about disease progression and future treatments with their treatment team. Studies remain ongoing to determine the optimal maintenance regimen and duration of maintenance therapy.
Learn more about stem cell transplantation.
This treatment, which uses high-energy rays (X-rays) to kill cancer cells, is used selectively in myeloma treatment to kill myeloma cells. For example, radiation therapy is the main treatment for solitary plasmacytoma and for carefully selected patients whose bone pain does not respond to chemotherapy. However, radiation therapy may be impractical if there are widely distributed areas of painful bone involvement in the body.
Learn more about radiation therapy.
Taking part in a clinical trial may be the best treatment choice for some myeloma patients. Clinical trials are underway to develop treatments that increase the remission rate of myeloma or cure the disease. Today's standard treatments for cancer are based on earlier clinical trials. (LLS continues to invest funds in myeloma research.
Clinical trials can involve new drugs, new combinations of drugs, or approved drugs being studied to treat patients in new ways, such as new drug doses or new schedules to administer the drugs. Clinical trials are conducted worldwide under rigorous guidelines to help doctors find out whether new cancer treatments are safe and effective or better than the standard treatment.
Learn more about clinical trials.
Get free clinical trial support! Visit our Clinical Trial Support Center (CTSC).
Connect with registered nurses with expertise in blood cancers who can personally assist you or your caregiver through each step of the clinical trial process.
Palliative (Supportive) care and disease complications
Supportive care for myeloma helps manage the complications of the disease and the adverse side effects of the drugs used for treatment. Open each section below to learn more.
Bone marrow is constantly producing new red blood cells, white blood cells and platelets. Myeloma and myeloma treatments often cause drops in blood cell counts. If not managed effectively, low blood cell counts can be life threatening and interfere with treatment and quality of life. Treatment for low blood cell counts may include blood transfusions and medications that help the bone marrow make more blood cells.
- Anemia: a condition where there is a low number of red cells in the blood, which can cause fatigue and shortness of breath
- Neutropenia: a condition where there is a low number of neutrophils (a type of white blood cell), so the immune system cannot effectively guard against infection. Neutropenia can lead to serious infections that require antibiotic therapy and possibly hospitalization. Certain drugs, such as filgrastim (Neupogen®), pegfilgrastim (Neulasta®), or sargramostim (Leukine®), may be prescribed to treat neutropenia.
- Thrombocytopenia: a condition where there is a low number of platelets, which can cause bleeding and easy bruising with no apparent cause
Learn more about infections, iron overload, low blood counts and how to manage them.
Order or download the free Blood Cancer United fact sheet, Side-Effect Management: Managing Low Blood Cell Counts.
Fatigue is one of the most common complaints reported by myeloma patients. It can be caused by many factors, including disease-related anemia, treatment side effects, physical immobility, sleep disturbances, nutritional deficits, depression, stress, and anxiety. Each patient should be evaluated in order to identify the possible causes for fatigue. Management strategies can then be implemented to alleviate the issues causing or related to fatigue.
Learn more about cancer-related fatigue and how to manage it.
Bone pain may occur because the growth of myeloma cells in the bone causes bone thinning and lesions. Patients may also experience pain that radiates from the back when the back bones (vertebrae) collapse and press on the nerves. Bone fractures may also result in pain. Options to manage bone pain include the following:
- Pain medications, including narcotics. (Note: nonsteroidal drugs such as ibuprofen should be avoided in patients with myeloma, given the increased risk of kidney failure.)
- Bisphosphonates, such as pamidronate (Aredia®) and zoledronic acid (Zometa®), to alleviate bone pain and the risk of bone fractures. (Note: these drugs increase the risk of developing osteonecrosis of the jaw [ONJ]. This treatment should be managed by an experienced oncologist and an oral surgeon and/or dental specialist.)
- Denosumab (Xgeva®), a monoclonal antibody, to prevent bone fractures. This medication is recommended when bisphosphonates cannot be used due to potential damage to the kidneys.
- Surgical techniques to help with back pain
Order or download the free Blood Cancer United fact sheet, Pain Management Facts.
Learn more about disease- and treatment-related pain and how to manage it.
Myeloma and its treatment can suppress parts of the immune system. The following measures should be considered to prevent infections:
- IV immunoglobulin therapy (for frequent and life-threatening infections)
- Vaccinations for flu, pneumonia, shingles and COVID-19
- Treatment to prevent Pneumocystis pneumonia (PCP) herpes and fungal infections, for some patients who have received a high-dose drug regimen
Order or download the free Blood Cancer United fact sheet, Side-Effect Management: Reducing Your Risk of Infection.
Learn more about infections, iron overload, low blood counts and how to manage them.
Myeloma patients may have serious problems with their kidney function. Timely, adequate treatment of myeloma can improve kidney function and potentially even return it to normal in most cases. When this is not the case, some patients may end up needing dialysis support.
Drinking adequate amounts of water and other healthy fluids can flush the kidneys and help them filter impurities from the blood. It is also very important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), iodinated IV contrast, and aminoglycoside antibiotics.
Learn more about heart, kidney, liver and lung function.
This is the term for damage to nerves of the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body and from the body back to the brain. There are several possible causes for this condition. It can be a result of the disease, or it can be a side effect of certain cancer treatments. Other problems that can either cause or contribute to neuropathy include diabetes, nerve compression from vertebral fractures, and vitamin deficiencies. Symptoms may include numbness, tingling, burning, coldness, or weakness in the arms or legs. Patients who develop neuropathy while receiving chemotherapy should tell their healthcare providers immediately. Often, reducing the dosage of the drugs being used, or stopping them altogether, can alleviate the symptoms or even allow them to resolve completely.
Order or download the free Blood Cancer United fact sheet, Side-Effect Management: Managing Peripheral Neuropathy (Nerve Damage).
Learn more about managing peripheral neuropathy.
The term “deep vein thrombosis” (DVT) refers to the condition caused by a blood clot that forms in the deep veins of the body, usually in the legs. A DVT can cause blood flow obstruction, pain, and swelling. Patients who receive myeloma treatments that are associated with DVT risk are usually prescribed medication to reduce the likelihood of developing this condition.
Pulmonary embolism is a sudden blockage in a lung artery. In most cases, it happens when a blood clot breaks loose, travels through the bloodstream, and lodges in the arteries of the lungs. Depending on the size and number of clots that reach the pulmonary arteries, a patient may experience chest pain, shortness of breath, and other potentially severe or even life-threatening effects.
In addition to specific cancer treatments, other factors that can increase the risk of DVT include the presence of a central line (central venous catheter), decreased mobility, recent surgery, pregnancy, smoking, a prior history of DVT, or a family history of blood-clotting problems.
Order or download the free Blood Cancer United fact sheet, Side-Effect Management: Managing Blood CLots and Deep Vein Thrombosis (DVT).
Myeloma patients have an increased risk of developing other types of cancer, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), especially after treatment with certain cytotoxic drugs. This rare complication occurs in a small number of patients.
Side effects of myeloma treatment
The main goal of treatment for myeloma is to get rid of myeloma cells. The term “side effect” is used to describe how treatment affects healthy cells. Patients react to treatments in different ways. Sometimes there are very mild side effects; other side effects may be serious and last a long time.
Myeloma patients should talk with their doctors about side effects before they begin any type of treatment. There are drugs and other therapies can prevent or manage many side effects.
Side effects of myeloma treatment may include the following:
- Upset stomach and vomiting
- Mouth sores
- Constipation
- Extreme tiredness
- Infections
- Low red cell count (called “anemia”)
- Low white cell count (called “neutropenia”)
- Low platelet count (called “thrombocytopenia”)
- Achy feeling
- Numb feeling in arms, hands, legs, or feet
Learn more about myeloma treatment side effects and how to manage them.
Our Survivorship Workbook collects all the important information you need throughout diagnosis, treatment, follow-up care, and long-term management of blood cancer.
Measuring treatment response for myeloma
Your doctor must monitor your response to treatment for myeloma. By measuring your progress, your doctor can see whether any changes to your therapy are needed.
Your doctor will use the following tests to measure your treatment response:
- Bone imaging studies, such as X-ray studies, CT- scans, MRI, and PET-CT scans
- Blood and urine tests to check blood cell counts, kidney function, and myeloma cell growth
- Bone marrow aspiration and biopsy to observe the pattern and amount of myeloma cells in the marrow
Your doctor will also likely test for measurable residual disease (MRD). Even when a complete remission is achieved, myeloma cells that cannot be seen with a microscope may remain in the bone marrow. The presence of these cells is referred to as measurable residual disease (MRD). The tests most often used to detect MRD are called flow cytometry and next-generation sequencing.
Your doctor may use one of the following terms to describe your response based on your test results:
- Remission: No sign of disease; the terms “complete remission” (complete response) or “partial remission” (partial response) are sometimes used.
- Complete response: No sign of the monoclonal protein (M protein) in the blood and urine.
- Very good partial response: A 90 percent or greater decrease in the amount of M protein in the blood.
- Partial response: More than a 50 percent decrease in the amount of M protein in the blood; more than a 90 percent decrease in the amount of M protein in the urine over a 24-hour collection time period.
- Stable disease: Not meeting the criteria to be called a “complete response” or a “very good partial response,” or even a “partial response”; but also not meeting criteria to be called “progressive disease.”
- Progressive disease: At least a 25 percent increase in the amount of M protein in the blood and urine, new areas of bone damage or a new mass of myeloma cells. Progressive disease usually indicates the need to change therapies.
Relapsed and refractory myeloma
Some patients with myeloma have refractory disease. Refractory myeloma is cancer that does not respond to treatment. After a time, almost all myeloma patients will experience relapse, which means the cancer returns after a successful course of treatment.
Treatment for relapsed and refractory myeloma
Treatment for relapsed and refractory myeloma depends on a few factors:
- Previous therapy
- How quickly or slowly the myeloma is growing
- Patient health and other health conditions
- Genetic abnormalities in the myeloma cells that have developed over time
Treatment for relapsed or refractory myeloma may include:
- A clinical trial
- Medications that have been used before
- New medications
- Bispecific antibodies
- Autologous stem cell transplantation
- Chimeric antigen receptor (CAR) T-cell therapy
Below are some drug treatments commonly used in the treatment of relapsed or refract myeloma:
- KPd: carfilzomib, pomalidomide, dexamethasone
- Dara-Kd: daratumumab, carfilzomib, dexamethasone
- Dara-Pd: daratumumab, pomalidomide, dexamethasone
- Elranatamab (a bispecific antibody)
- Elo-Pd: Elotuzumab, pomalidomide, dexamethasone
- Isa-Pd: Isatuximab, pomalidomide, dexamethasone
- Isa-Kd: Isatuximab, carfilzomib, dexamethasone
- Seli-Vd: Selinexor, bortezomib, dexamethasone
- Talquetamab (a bispecific antibody)
- Teclistamab (a bispecific antibody)
- Venetoclax (Used in certain cases that your doctor may discuss)
Stem cell transplantation: The use of high-dose chemotherapy followed by autologous stem cell transplantation may also be an option for some relapsed or refractory myeloma patients who have either not been treated with a transplant before or who had a good durable response to a prior transplant.
Chimeric antigen receptor (CAR) T-cell therapy: CAR T-cell therapy is a type of cellular immunotherapy that consists of engineering a patient’s own immune cells to first recognize and then attack cancerous cells. The T cells are genetically engineered to produce receptors on their surface called “chimeric antigen receptors” (CARs). These receptors recognize and bind to a specific target found on the cancerous cells. CAR T-cell immunotherapy for myeloma targets the B-cell maturation antigen (BCMA). BCMA is considered an ideal target because it is expressed on the surface of plasma cells but not on hematopoietic stem cells in the bone marrow.
Learn more about CAR T-cell therapy.
Clinical trials: Many new agents being studied in clinical trials are also showing promising results in the treatment of relapsed or refractory myeloma.
Follow-up care
Find more information about follow-up care, including what to expect, long-term and late effects of treatment, survivorship clinics, and other resources, such as The National Comprehensive Cancer Network (NCCN) treatment guidelines.
Use the Survivorship Workbook to collect all the important information you need throughout diagnosis, treatment, follow-up care, and long-term management of a blood cancer.
Get free, one-on-one support
Call, email, or chat with a member of our highly trained support team.
Blood Cancer United resources
Find free, specialized guidance and information for every type of blood cancer, request financial support, find emotional support, and connect with other members of the blood cancer community.
