Treatment of Multiple Myeloma

For information about the treatments listed below, see the Treatment Option Overview section.

Patients without signs or symptoms may not need treatment. These patients can have watchful waiting until signs or symptoms appear.

When signs or symptoms appear, there are two categories for patients receiving treatment:

• Younger, fit patients who are eligible for a stem cell transplant.
• Older, unfit patients who are not eligible for a stem cell transplant.

Patients younger than 65 years are usually considered younger and fit. Patients older than 75 years are usually not eligible for a stem cell transplant. For patients between the ages of 65 and 75 years, fitness is determined by their overall health and other factors.

The treatment of multiple myeloma is usually done in phases:

Induction therapy: This is the first phase of treatment. Its goal is to reduce the amount of disease, and may include one or more of the following:

• For younger, fit patients (eligible for a transplant):
  • Chemotherapy.
  • Targeted therapy with a proteasome inhibitor (bortezomib) and a monoclonal antibody (daratumumab).
  • Immunotherapy (lenalidomide).
  • Corticosteroid therapy (dexamethasone).
• For older, unfit patients (not eligible for a transplant):
  • Chemotherapy.
  • Targeted therapy with a proteasome inhibitor (bortezomib or carfilzomib) or a monoclonal antibody (daratumumab).
  • Immunotherapy (lenalidomide).
  • Corticosteroid therapy (dexamethasone).

Consolidation therapy: This is the second phase of treatment. Treatment in the consolidation phase is to kill any remaining cancer cells. High-dose chemotherapy is followed by either:

• one autologous stem cell transplant, in which the patient's stem cells from the blood or bone marrow are used; or
• two autologous stem cell transplants followed by an autologous or allogeneic stem cell transplant, in which the patient receives stem cells from the blood or bone marrow of a donor; or
• one allogeneic stem cell transplant.

Maintenance therapy: After the initial treatment, maintenance therapy is often given to help keep the disease in remission for a longer time. Several types of treatment are being studied for this use, including the following:

• Chemotherapy.
• Immunotherapy (lenalidomide).
• Corticosteroid therapy (prednisone or dexamethasone).
• Targeted therapy with a proteasome inhibitor (bortezomib or ixazomib) or a monoclonal antibody (daratumumab).

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.