Treatment Options by Stage    
    

Solitary plasmacytomas: These are treated with radiation therapy. No drugs are given unless or until it becomes clear that multiple myeloma has developed.

Stage I or smoldering myeloma: For patients who have no symptoms, careful follow-up testing without immediate treatment is usually recommended.

All other stages: For patients with symptoms or the beginning signs of bone damage and not expected to have a transplant, combination chemotherapy is recommended.

The usual drug treatment is MP, but other combinations, such as VBMCP may be used.

Bisphosphonates may also be given at this time. When areas of damaged bone causing symptoms do not respond to chemotherapy or bisphosphonates, external beam radiation therapy may be used.

If a transplant is planned, then either VAD or Thal-Dex will be given. A transplant will follow this. Stem cells will be collected after drug treatment with cyclophosphamide and white blood cell-stimulating drugs. High doses of melphalan will then be given intravenously. In most instances, the transplant will be autologous. It may be repeated in 6-12 months.

Another possible treatment is allogeneic SCT. This can be curative but is more toxic than the autologous transplant and can be fatal. SCT with high-dose chemotherapy is only suitable for people younger than 45 to 50 years old, which for myeloma patients means only a handful of people. Another approach, particularly for older people, is the nonmyeloablative allogeneic SCT.

Treatment with interferon after chemotherapy may help keep the myeloma from coming back, but it can cause serious side effects.

Source: American Cancer Society