Treatment for myeloma

Treatment for myeloma

Once the doctors know the stage of the myeloma they will be able to plan the most appropriate treatment.

* When treatment is given
* Why treatment is given
* What treatments are used
* Multidisciplinary team
* Second opinion
* Giving your consent
* Benefits and disadvantages of treatment

When treatment is given

Myeloma is rarely curable, but it is treatable. Treatment can be very effective at controlling symptoms and stopping the development of the disease. Myeloma can develop very slowly and so some people with myeloma who have no symptoms will not initially need any treatment. Usually they will see the doctor and have blood and urine samples every few months. This is known as active monitoring. Treatment will be started if the myeloma begins to get worse or if symptoms occur.

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Why treatment is given

Treatment may be given:

* To control the myeloma so it goes into remission (remission is when treatment gets rid of the abnormal myeloma cells and they cannot be detected in the blood or bone marrow and normal bone marrow has developed again).
* As maintenance treatment once the myeloma is controlled, to prolong the remission.
* If the disease comes back (relapses).
* To control symptoms and any problems that the myeloma may be causing.


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What treatments are used

Chemotherapy, usually combined with steroids, is the main treatment for myeloma. Some studies are using chemotherapy together with other drugs including bisphosphonates and thalidomide.

Some people may benefit from high-dose chemotherapy. For this treatment, some of the blood stem-cells are removed before the high-dose chemotherapy and are given back through a drip after the treatment. This is known as high dose treatment with stem cell support (stem-cell transplant) and can help some people to stay in remission, but it is an intensive treatment that is not suitable for everyone.

After chemotherapy, interferon or steroids may be used to help keep the myeloma in remission – this is known as maintenance treatment.

Thalidomide has recently been found to be effective in controlling myeloma that has come back after chemotherapy. Thalidomide is also being tested as an initial treatment and as maintenance treatment.

Other drugs that may be used to treat people whose myeloma has come back after initial treatment, are bortezomib (Velcade®) and lenalidomide (Revlimid®).

Drugs known as bisphosphonates are commonly used to reduce bone damage caused by the myeloma and to help bones to heal. They are also very helpful in lowering raised calcium levels in the blood. They can be given alongside chemotherapy or after chemotherapy has finished. They may also be given to help prevent bone damage from occurring.

Radiotherapy may be used to strengthen the bone and reduce pain in the affected areas.

Surgery may also occasionally be used to strengthen weakened bones, to prevent fractures or, rarely, to remove areas of myeloma that are pressing on parts of the body such as the spinal cord.

Other treatments may be needed, such as:

* painkillers to treat bone pain
* blood transfusions, if you are anaemic
* kidney dialysis, if your kidneys are not working properly.

The treatments used will vary from person to person. If you have any questions about your own treatment, don't be afraid to ask your doctor or nurse. It often helps to take a close friend or relative with you to appointments.

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Multidisciplinary team

In most hospitals, a team of cancer specialists will discuss with you the treatment that they feel is best for your situation. This multidisciplinary team (MDT) will often include a doctor who specialises in treating blood disorders (haematologist), chemotherapy and radiotherapy specialists (oncologists) and may include a number of other healthcare professionals such as a:

* nurse specialist
* pathologist (a doctor who specialises in how disease affects the body)
* radiologist (a doctor who specialises in x-rays and scans)
* dietitian
* physiotherapist
* occupational therapist
* psychologist or counsellor.

Together the doctors will be able to advise you on the best course of action taking into account a number of factors. These include your age, general health, and how the myeloma is affecting you.

Occasionally your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might experience, so that you can decide what is the right treatment for you.

Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with the nurses in our cancer support service.

If you have any questions about your own treatment, don't be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.

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Second opinion

Even though a number of cancer specialists work as a team to decide on the most suitable treatment, you may want to have another medical opinion. Most doctors will be willing to refer you to another specialist for a second opinion if you feel that it will be helpful. The second opinion may take some time to organise and may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will be helpful.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and to have a list of questions so you can make sure your concerns are covered during the discussion.

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Giving your consent

Before you have any treatment your doctor will explain its aims to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

* the type and extent of the treatment you are advised to have
* the advantages and disadvantages of the treatment
* any other treatments that may be available
* any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some myeloma treatments are complex, so it is not unusual for people to need their treatment to be explained more than once.

Patients often feel that hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can't make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

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Benefits and disadvantages of treatment

Many people are frightened of having cancer treatments, and of the side effects that may occur. Some people ask what would happen if they did not have any treatment.

Although many of the treatments can cause side effects, these can often be well controlled with medicines.

Treatment can be given for different reasons and the possible benefits will vary depending upon the individual situation. Myeloma is rarely curable and treatment is usually only able to control it, leading to an reduction of symptoms and a better quality of life.

The treatments for myeloma can vary, and some involve far more side effects and risks than others. For some people, the treatment will help to control the myeloma and the side effects of the treatment will be mild. However, for others treatment will have no effect upon the cancer and they will get the side effects with little benefit.

Making decisions about whether to have treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have treatment, you can still be given medicines to control any symptoms that you have. This is known as supportive care (or palliative care).

It is important to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.