Multiple myeloma, a cancer of the body’s plasma cells, is seldom curable. But many treatments are available – including chemotherapy, steroids, stem-cell transplants and novel “targeted therapy.” Learn the details of myeloma treatments, what you should expect, and potential treatment side effects...
Multiple myeloma is a type of cancer that starts in plasma cells – a type of white blood cell that makes immune-system antibodies. It’s the most common type of plasma cell cancer.
No one knows the exact cause, but it’s more common in people over age 65, African-Americans and those who have a close relative with the disease. The disease begins when a plasma cell becomes abnormal, then divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells.
In time, myeloma cells collect in the bone marrow, and they may damage the solid part of the bone. When myeloma cells collect in several of your bones, the disease is called multiple myeloma. The disease may also harm other tissues and organs, such as the kidneys.
Myeloma cells make antibodies called M proteins, along with other proteins that can collect in the blood, urine and organs. Common symptoms of multiple myeloma include:
Bone pain, usually in the back and ribs
Broken bones, usually in the spine
Feeling weak and very tired
Feeling very thirsty
Frequent infections and fevers
Weight loss
Nausea or constipation
Frequent urination
Most often, these symptoms aren’t due to cancer. But anyone with these symptoms should tell a doctor so that problems can be diagnosed and treated as early as possible.
Treatments
People with multiple myeloma have many treatment options, including watchful waiting, induction therapy and stem cell transplant. Sometimes a combination of methods is used.
Radiation therapy is used sometimes to treat painful bone disease, either alone or along with other therapies.
The choice of multiple myeloma treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (called smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (“watchful waiting”) so that treatment can start when you begin to have symptoms.
If you have symptoms, you’ll likely get induction therapy. Sometimes a stem cell transplant is part of the multiple myeloma treatment plan.
Treatment can often control the disease and its symptoms, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial of new treatment methods.
Your doctor can describe your myeloma treatment choices, the expected results and the possible treatment side effects. You and your doctor can work together to develop a treatment plan that meets your needs.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat multiple myeloma include hematologists and medical oncologists. Your health care team may also include an oncology nurse and a registered dietitian.
Before starting multiple myeloma treatment, you might want a second opinion about your diagnosis and treatment plan. Many health insurance companies will pay for a second opinion if you or your doctor requests it.
Ask your health care team to explain possible treatment side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects not be the same for each person, and they may change from one treatment session to the next.
You may want to ask your doctor these questions before you begin multiple myeloma treatment:
What stage of myeloma do I have?
Is the disease affecting my kidneys?
How do I get a copy of the report from the pathologist?
What are my treatment choices? Which do you recommend for me? Why?
Will I have more than one kind of treatment? How will my treatment change over time?
What are the expected benefits of each kind of treatment?
What are the risks and possible treatment side effects? What can we do to control the side effects?
What can I do to prepare for myeloma treatment?
Will I need to stay in the hospital? If so, for how long?
What is the treatment likely to cost? Will my insurance cover the cost?
How will treatment affect my normal activities?
Would a clinical trial be right for me? Can you help me find one?
How often should I have checkups?
Watchful Waiting
People with smoldering myeloma or stage I myeloma may be able to put off having cancer treatment, thus avoiding side effects until they have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months).
Although watchful waiting avoids or delays myeloma treatment side effects, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.
You may decide against watchful waiting if you don't want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor.
You may want to ask your doctor these questions before choosing watchful waiting:
If I choose watchful waiting, can I change my mind later on?
Will the cancer be harder to treat later?
How often will I have checkups?
Between checkups, what problems should I tell you about?
Induction Therapy
Many different types of drugs are used in multiple myeloma treatment. People often receive a combination of drugs, and many combinations are used to treat myeloma.
Each type of drug kills cancer cells in a different way:
Chemotherapy. This kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly.
Targeted therapy. This uses drugs to block the action of an abnormal protein that stimulates the growth of myeloma cells.
Steroids. Some steroids have antitumor effects, and it’s thought that they can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma.
You may receive the drugs by mouth or through a vein. The treatment usually takes place in an outpatient part of the hospital, at your doctor’s office or at home. Some people may need to stay in the hospital.
Treatment side effects depend mainly on which drugs are given and how much:
Blood cells. When a drug used for myeloma treatment lowers the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. If your levels are low, your health care team may stop therapy for a while or reduce the dose of drug. There are also medicines that can help your body make new blood cells.
Cells in hair roots. Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract. Chemotherapy and targeted therapy can cause poor appetite, nausea and vomiting, diarrhea, constipation, or mouth and lip sores. Ask your health care team about medicines and other ways to help you cope with these problems.
The drugs used for myeloma may also cause dizziness, drowsiness, numbness or tingling in hands or feet, and low blood pressure. Most of these problems go away when treatment ends.
You may want to ask your doctor these questions before having induction therapy:
Which drugs will I get? What will the treatment do?
When will treatment start? When will it end? How often will I have treatments?
Where will I go for treatment? Will I have to stay in the hospital?
Will I have side effects during treatment? What side effects should I tell you about? Can I prevent or treat any of these side effects?
Will there be lasting treatment side effects? How long will they last? What can I do about them?
How often will I need checkups?
Stem Cell Transplant
Many people with multiple myeloma may get a stem cell transplant, which allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow.
After you receive high-dose treatment, you receive healthy stem cells through a vein. (It’s like getting a blood transfusion.) New blood cells develop from the transplanted stem cells to replace the ones that were destroyed by treatment.
Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.
Stem cells may come from you or from someone who donates their stem cells to you – a family member, or possibly someone who isn’t related. They usually come from the blood (peripheral blood stem cell transplant), or they can also come from the bone marrow (bone marrow transplant).
After a stem cell transplant, you may stay in the hospital for several weeks or months. You’ll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted stem cells will begin to produce healthy blood cells.
Ask your doctor these questions before having a stem cell transplant:
What kind of stem cell transplant will I have? If I need a donor, how will we find one?
How long will I be in the hospital? Will I need special care? How will I be protected from germs? Will my visitors have to wear a mask? Will I?
What care will I need when I leave the hospital?
How will we know if the treatment is working?
What are the risks and the treatment side effects? What can we do about them?
What changes in normal activities will be necessary?
What is my chance of a full recovery? How long will that take?
How often will I need checkups?
Supportive Care
Multiple myeloma treatment and the disease itself can lead to other health problems. At any stage of the disease, you can have supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.
Supportive care includes treatment to prevent or fight infections, to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring.
Supportive care treatment may include the following:
Infections. Because people with multiple myeloma get infections very easily, you may receive antibiotics and other drugs.
Some people receive vaccines against the flu and pneumonia. You may want to talk with your health care team about when to get certain vaccines.
The health care team may advise you to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious and should be treated promptly. You may need to stay in the hospital for treatment.
Anemia. Myeloma and its treatment can lead to anemia, a condition of low red blood cells that may make you feel very tired. Drugs or a blood transfusion can help.
Pain. Multiple myeloma often causes bone pain. Your health care provider can suggest ways to relieve or reduce pain, including:
A brace that relieves pain in the neck or back
Drugs that fight pain anywhere in the body
Radiation therapy from a large machine aimed at the bone
Surgery to fix a compressed (squeezed) spinal cord
Some people get pain relief from massage or acupuncture when used along with other approaches. Also, you may learn relaxation techniques such as listening to slow music or breathing slowly and comfortably.
Thinning bone. Myeloma cells keep new bone cells from forming, and bones become thin wherever there are myeloma cells. Your doctor may give you drugs to prevent bone thinning and help reduce the risk of fractures.
Physical activity, such as walking, also helps keep bones strong.
Too much calcium in the blood. Multiple myeloma may cause calcium to leave the bones and enter the bloodstream. If you have a very high level of calcium in your blood, you may lose your appetite, and you may also feel nauseated, restless or confused.
A high calcium level can also make you very tired, weak, dehydrated and thirsty. Drinking a lot of fluids and taking drugs that lower the calcium in the blood can be helpful.
Kidney problems. Some people with multiple myeloma have kidney problems. If the problems are severe, a person may need dialysis, a process that removes wastes from the blood.
A person with serious kidney problems may need a kidney transplant.
Amyloidosis. Some people with myeloma develop this condition, which is caused by abnormal proteins collecting in tissues of the body. This can cause many problems, some of them severe. For example, proteins can build up in the heart, causing chest pain and swollen feet.
There are drugs to treat amyloidosis.
Nutrition and physical activity. It’s important for you to take care of yourself by eating well, drinking plenty of fluids and staying as active as you can.
However, you may not feel like eating during multiple myeloma treatment or soon after. You may be uncomfortable or tired, and you may find that foods do not taste as good as they used to. Also treatment side effects (such as poor appetite, nausea, vomiting or mouth sores) can make it hard to eat well.
Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.
Research shows that people with cancer feel better when they’re active. Walking, yoga, swimming and other activities can keep you strong and increase your energy. But whatever physical activity you choose, be sure to talk to your doctor before you start.
Follow-up Care
You’ll need regular checkups after multiple myeloma treatment. These help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.
Your doctor will check for return of cancer. Even when the cancer seems to have been completely destroyed, the disease sometimes returns because undetected myeloma cells remained somewhere in the body after treatment. Also, checkups help detect health problems that can result from cancer treatment.
Checkups may include a careful physical exam, blood tests, X-rays, or bone marrow biopsy.
You may want to ask your doctor these questions after you’ve finished multiple myeloma treatment:
How often will I need checkups?
Which follow-up tests do you suggest for me?
Between checkups, what health problems or symptoms should I tell you about?
For more information, visit our Multiple Myeloma Health Center.
How Much Do You Know About Multiple Myeloma?
About 20,520 cases of multiple myeloma are diagnosed each year in the U.S., according to the American Cancer Society. Has your life been affected by a diagnosis?
No comments:
Post a Comment