what are the treatment options?

Using current treatments, myeloma can’t be cured. The aim of treatment is to make patients feel better, and give them as normal a quality of life as possible.

Treatment can slow the cancer down, and even stop it for a while. When the myeloma stops, it is said to be in the plateau phase. This phase may last for months or years.

Your doctors will make a treatment plan especially for you. They will consider...

• how advanced your cancer is, where it is and whether it has spread
  
  
• any problems the myeloma is causing
  
  
• your age and state of health (intensive treatments may not be suitable if you are elderly or very ill).

Your doctors will tell you about the risks, benefits and side effects of your treatment options. You will need to agree to the treatment before it can start. This is called giving your consent. Don’t be afraid to ask questions if there is anything you don’t understand.

People with myeloma are usually under the care of the Haematology Team at The Royal Liverpool Hospital.

You may be offered:

Radiotherapy
If you have areas of bone that are weak or causing pain, your doctor may suggest radiotherapy.

Radiotherapy uses radiation to kill cancer cells. For myeloma, It is given from outside the body – this is called external beam radiotherapy. A beam of radiation is aimed at the part of the body that needs treatment.

If your myeloma is all in one place, radiotherapy may be the only treatment required.

Your doctor will tell you how much radiotherapy you need, and how long the treatment will take. This varies greatly from patient to patient.

Standard chemotherapy
Chemotherapy uses special drugs to kill cancer cells.

There are several drug treatments for the doctor to choose from. Drugs may include Cyclophosphamide, Melphalan and Dexamethosone can be used.

Drugs can be given in different ways – for example by injection, by mouth or as a drip. Your doctor will explain what needs to happen in your case. Treatment lasts for six months on average, but this can vary.

Intensive chemotherapy
A more intensive approach is to give chemotherapy drugs over long periods of time and over several days.

This may be done through a thin plastic tube called a Hickman line, which is put into a vein in the chest. Another method is to use a PICC line, which is fed through a vein in the arm and guided into a large vein in the chest. You have a local anaesthetic before the doctor or nurse puts the tube in place. The line is then connected to a small, portable infusion pump that delivers a controlled dose of drugs into the blood through the Hickman or PICC line. This means that you can have your chemotherapy at home.

Intensive chemotherapy treatment is based on your disease and general health. It is given as several courses (or cycles) of treatment, usually over six months.

High dose chemotherapy with stem cell rescue
Some fitter patients who have responded well to initial chemotherapy may go on to have this treatment.

Chemotherapy can damage bone marrow and lead to problems such as anaemia, infections and bleeding. After standard or intensive chemotherapy, bone marrow recovers on its own… but high dose chemotherapy does more damage, and bone marrow needs help to recover. This is frequently monitored and promptly treated.

Chemotherapy for myeloma is usually given at The Royal Livepool Hospital.

Surgery
Some patients have an operation to help strengthen weakened bones and prevent fractures.

Newer treatments
Doctors are looking at some new options, including the drug Thalidomide. Research is under way to find out how well these treatments work.

At the moment these newer approaches are not recommended as a first treatment, but they may be offered later on in the illness.

Clinical trials
Your doctor will tell you if there are any clinical trials you may be able to enter. A clinical trial is a study to investigate new approaches to treating and caring for those with cancer (and other illnesses).