• Chemotherapy for Multiple Myeloma

    Chemotherapy is the use of drugs to kill cancer cells. Unlike radiation and surgery, which are localized treatments, chemotherapy is a systemic treatment, meaning the drugs travel throughout the whole body. This means chemotherapy can reach cancer cells that may have spread, or metastasized, to other areas. Because myeloma is a systemic disease from the start, chemotherapy is the main treatment.
    Currently, there is no cure for myeloma, so treatment is designed to prolong life by reducing the effects of myeloma on body functions and reducing discomfort. Chemotherapy is usually given after symptoms or complications develop because there has been no evidence that early treatment alters the course of the disease. Chemotherapy drugs are usually used in combination and given in cycles. The drugs can be given intravenously (IV) or by mouth. The IV drugs may be administered at the doctor’s office or in the hospital. Oral drugs may be taken at home. The type of chemotherapy often depends on the amount of tumor present in the body and how well the kidneys are functioning.
    Chemotherapy is given until the abnormal antibody-like protein produced by myeloma cells decreases and reaches a plateau. Complete remission is rare.

    Chemotherapy Drugs

    Examples of chemotherapy drugs used for multiple myeloma include:
    • Bortezomib (Velcade)
    • Cyclophosphamide (Cytoxan)
    • Dexamethasone (Decadron)
    • Doxorubicin (Adriamycin)
    • Lenalidomide (Revlimid)
    • Melphalan (Alkeran)
    • Prednisone
    • Thalidomide (Thalomid)
    • Vincristine (Oncovin)
    • Combination therapy
      • Melphalan and prednisone
      • Vincristine, doxorubicin, and dexamethasone

    Effectiveness

    Fifty to sixty percent of patients reduce the amount of abnormal protein in their blood by half. But, fewer than one in twenty has a complete remission. Typically, multiple myeloma recurs within 1-2 years of ending chemotherapy. At this point, the doctor will usually recommend trying a different chemotherapy regimen. Typically, patients with stage II or stage III disease should undergo evaluation for future stem cell transplant. If a patient is not a candidate for transplant, a combination of melphalan, prednisone and thalidomide, or melphalane and prednisone is given.
    Therapies like bortezomib and lenalidomide might be reserved for disease relapse.

    Side Effects

    Chemotherapy can affect your central nervous system. Because of this, you may feel tired, confused, and depressed . Usually, these feelings go away when the treatment ends. Other common side effects of chemotherapy include:
    Possible Complications
    Melphalan may increase your risk of developing leukemia or myelodysplasia (a disease that affects bone marrow). If you have been given melphalan, you will be closely monitored by your doctor for signs of these conditions.

    References

    Bortezomib. EBSCO Health Library, Lexi -PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed February 10, 2010.

    Cyclophosphamide. EBSCO Health Library, Lexi -PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed February 10, 2010.

    National Cancer Institute website. Available at: http://www.cancer.gov/ .

    Nissen D. Mosby's Drug Consult. St. Louis, MO: Mosby, Inc; 2002.

    Problems related to chemotherapy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 2008. Accessed February 10, 2010.

    Rakel R. Bope E, ed. Conn's Current Therapy 2002. 54th ed. St. Louis, MO: WB Saunders Company; 2002:439-443.

    Washington University School of Medicine Department of Medicine. The Washington manual subspeciality series, hematology and oncology subspeciality consult series . St. Louis, MO: Lippincott Williams & Wilkins; 2008.

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