Multiple Myeloma Has a Growing Body of Treatment Options

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Treatment decisions should depend on the patient, their disease, and their disease progression.

Multiple myeloma is a form of cancer that develops around plasma cells, a type of white blood cells. These cancerous cells build up in the bone marrow over time and create proteins that are not healthy for the bones.¹

According to the American Cancer Society, approximately 35,780 new cases of multiple myeloma will be diagnosed in the United States in 2024, which will cause about 12,500 deaths. More men are impacted than woman by this type of cancer, with a rate of 1 in 103 men and 1 in 131 women. Risk factors may increase or decrease these chances.²

Woman receiving ambulatory chemotherapy in a recliner with an IV

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Signs and symptoms of multiple myeloma may differ from person to person. At the initial stages, there might not even be any noticeable symptoms. As the disease advances, nausea, constipation, loss of appetite, tiredness, infections, weight loss, thirst, bone pain, and other symptoms can emerge.¹

Some of the risk factors for this cancer include getting older, being male, being Black, and having a family history of multiple myeloma. As the risk factors increase, the complications of the disease may increase as well, especially when the disease progresses. These complications can include various infections as the body’s ability to fight infections weakens. Other complications may include bone problems such as pain and broken bones, kidney problems such as kidney failure, and anemia associated with low red blood cells.¹

When it comes to the diagnosis of multiple myeloma, there are various tools that can help diagnose the disease. These may include blood tests, urine tests, bone marrow tests, and imaging such as X-rays, MRI scans, CT scans, or PET scans.

Treatment for multiple myeloma may include various treatment pathways. Chemotherapeutic options include cyclophosphamide, etoposide, doxorubicin, liposomal doxorubicin, melphalan, and bendamustine. The treatment may include corticosteroid therapy, as well, with dexamethasone or prednisone. Immunomodulary drugs may include thalidomide, lenalidomide, and pomalidomide. Proteasome inhibitors may also be used to break down the proteins that control the cell division, including bortezomib, carfilzomib, and ixazomib.³

Monoclonal antibodies that can be used against multiple myeloma include anti-CD38 antibodies such as daratumumab, daratumumab and hyaluronidase, and isatuximab. Other antibodies may include anti-SLMAF7 antibodies such as elotuzumab. Bispecific T-Cell engagers (BiTEs) may also be beneficial to fight multiple myeloma and work by attaching to the CD3 protein on T cells. These include teclistamab, elrenatamab, and talquetamab. Finally, nuclear export inhibitors such as selinexor may be another option for the treatment of multiple myeloma.3

With multiple myeloma, bones in the body can weaken or even break. To help with this aspect of the disease, bisphosphonates might be used. These may include pamidronate, zoledronic acid, or denosumab.³

Treatment decisions should depend on the patient, their disease, and their disease progression. As with many treatment options, many of these drugs may also have their own adverse effects. Some of these include high blood pressure, high blood sugar, insomnia, hair loss, mouth sores, loss of appetite, diarrhea, constipation, low blood cell count, and respiratory tract infections.³

As diagnostic tools for multiple myeloma advance and more treatment options become available, many of these impacted patients may be able to receive more effective treatments sooner in their disease course. Combinations of these treatment options, as ordered by the specialist or the provider, can improve the prognosis for these patients.

References

1. Multiple myeloma. Mayo Clinic. September 2, 2023. Accessed February 6, 2024. https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/symptoms-causes/syc-20353378

2. Key Statistics About Multiple Myeloma. American Cancer Society. Updated January 19, 2024. Accessed February 6, 2024. https://www.cancer.org/cancer/types/multiple-myeloma/about/key-statistics.html

3. Drug Therapy for Multiple Myeloma. American Cancer Society. Updated August 15, 2023. Accessed February 6, 2024. https://www.cancer.org/cancer/types/multiple-myeloma/treating/chemotherapy.html

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