First-line treatment for multiple myeloma generally includes a combination of:
- Proteasome inhibitors such as bortezomib (Velcade). These block digestion of proteins produced by MM cells.
- Immunomodulatory drugs (IMiDs) such as lenalidomide (Revlimid) and thalidomide (Thalomid). These help the immune system fight multiple myeloma cells. These are also used for maintenance therapy, which can help prolong remission after successful first-line treatment.
- Chemotherapy with agents like cyclophosphamide (Cytoxan). These stop or slow the growth of multiple myeloma cells.
- Steroids such as dexamethasone. These kill multiple myeloma cells and reduce inflammation.
Second-Line or Later Therapy:
These treatments are used if multiple myeloma returns or doesn’t respond to first-line therapy. They may include any of the first-line treatments that weren’t used initially, or:
Monoclonal antibodies (MoAbs) such as daratumumab (Darzalex), elotuzumab (Empliciti), isatuximab-irfc (Sarclisa), and belantamab mafodotin-blmf (Belamaf). These are synthetic proteins that act like naturally occurring antibodies in the immune system.
Side effects can often be prevented or managed.
Here are some tips on what you can do for:
- Immune system effects such as increased risk of infection, low blood counts, and fever.
- Cardiac effects, such as changes in blood pressure, fluid retention, new or worsening heart failure, fatigue due to anemia, and risk of bleeding or bruising due to low platelet count.
- Neurological effects such as numbness, tingling, stabbing, or burning pain in your hands or feet, or tremors.
- Respiratory effects, such as shortness of breath and respiratory infections.
- Endocrine effects, such as increased blood sugar.
- Skin problems, such as slow wound healing or rash.
- GI effects: Oral mucositis, nausea, vomiting, bloating, appetite changes, heartburn, diarrhea, changes in liver function, constipation.
You may also experience other effects during treatment, such as:
- Sleep problems.
- Musculoskeletal effects like pain, muscle weakness, or osteoporosis.
- Eye problems such as optic nerve damage, eye infections, cataracts, or blurred vision.
- Mental health issues, including mood swings, irritability, and personality changes.
Unique reactions can also occur, including interference with certain types of medical tests or infusion reactions and allergic-type reactions. Talk to your healthcare team about any concerns you have or symptoms you experience.