If there is only one tumor in tissue or bone, a patient may be treated with radiation or surgery.
If there is more than one tumor, patients are treated with a combination of drugs — typically, two types of targeted drugs plus a steroid. In some cases, a chemotherapy is included in the mix. Sometimes patients stay on one of the targeted drugs longer to help prevent a relapse.
Patients with bone disease also get a bisphosphonate, which slows bone loss and lowers the risk of fracture. They also may receive radiation.
Those with myeloma also receive supportive treatments, such as transfusions to deal with low blood counts and antibiotics to fight infection.
After a number of rounds of combination drugs, some patients undergo stem cell transplant preceded by high-dose chemotherapy, and this is sometimes followed by more medical treatment. Smoldering myeloma, a precursor to myeloma that doesn’t always progress, is treated with close observation, although there is evidence that treating these patients with medications when they are asymptomatic extends their lives and may decrease organ damage. More research is needed on this.
All patients getting treatment undergo monitoring of their disease status with checks of organ function and blood tests to measure the proteins made by myeloma cells. Scans also may be done, and together these tests can indicate whether the treatment is working or if a change in the therapy regimen is needed.