Multiple Myeloma Treatment Options
Information for newly diagnosed patients with multiple myeloma:
Treatment options and common resultsA staging system is utilized for classifying patients into those with more or less advanced disease. This is useful because some patients may not require urgent treatment. It is also useful because more aggressive treatment may be indicated for patients who have advanced disease. The staging generally reflects the amount (or "burden") of myeloma cancer cells a patient may have.
Stage I disease is defined as having all of the following:
- Hemoglobin greater than 10 grams per 100 milliliters of blood (g/dl)
- Serum calcium less than 12 milligrams per 100 milliliters of blood (mg/dl)
- Normal bone structure or solitary plasmacytoma on radiographies
- Low M component (IgG less than 5 g/dl, IgA less than 3 g/dl, and urine light-chain excretion less than 4 grams per 24 hours)
Options for the treatment of Stage I disease are:
- No treatment
- Chemotherapy - controversial, since studies have not shown benefits for the treatment of early (Stage I) disease.
Stage II disease is defined as fitting neither Stage
I nor Stage III.
Stage III disease is defined as having one or more of the following:
- Hemoglobin less than 8.5 g/dl
- Serum calcium greater than 12 mg/dl
- Advanced lytic bone lesions
- Hyper M component (IgG greater than 7 g/dl, IgA greater than 5 g/dl, and urinary light-chain excretion greater than 12 g/24hr)
There are a number of options for the treatment of Stage II and
Stage III disease. These include treatments that are considered standard
practice (or "standard of care") as well as those that are new, experimental
treatments. Both standard and experimental treatment options are described
below:
- Stem cell transplants
- Autologous transplants. These are transplants using the patient's own stem cells which are given back after chemotherapy and/or radiotherapy. Autologous transplants offer higher initial survival rates, but because they do not produce graft-versus-myeloma effect, they may not result in long term remissions.
- Allogeneic transplants. These are transplants of stem cells from a matched donor following chemotherapy and/or radiotherapy. These have higher complication rates, but also higher remission rates and more durable remissions.
- Related allogeneic transplant
- Unrelated allogeneic transplant
- Non-ablative allogeneic transplant (mini-transplants). These are sometimes used for patients who have failed prior autologous transplants, or who are not eligible for other types of transplants. Patients must show a response to salvage therapy. They may also be used when no matched donor can be found.
- Tandem transplant approach, using an autologous transplant followed by a non-ablative (mini) transplant. This is a promising new technique that separates the toxicities of the high dose autologous transplant, which provides substantial anti-tumor effects, from the immunologic graft-versus-myeloma effects of the allogeneic transplant. These have lower risks and a complete response rate of approximately 50%.
- For more information on transplant therapies for multiple myeloma,
contact the Clinical Coordinator's Office at 1-800-804-8824 toll-free or
206-288-1024 local, fax 206-288-1025.
Information about Seattle Cancer Care Alliance treatment facilities
