Treatments for multiple myeloma

If you have multiple myeloma, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for multiple myeloma, your healthcare team will consider:

• your age and health status
• whether or not you have symptoms and which symptoms you have
• if you have complications of the disease, such as kidneys not working well
• whether or not you are eligible to have a stem cell transplant – this depends on age, performance status and if you have other health issues
• risk stratification based on chromosomal changes– you will be told if you are good (low) risk, intermediate risk or high risk
• the type of multiple myeloma
• the stage of multiple myeloma
• if you have had other treatments and how well you responded to them
• if you would be a good candidate for a clinical trial

Multiple myeloma can’t be cured. The goal of treatment is to reduce symptoms, slow the progression, or advancement, of the disease and put the disease into remission. Remission for multiple myeloma is when most or all signs and symptoms of the disease disappear.

You will have tests at some point after your treatment that will help tell the doctors how well the treatment worked. This is called response to treatment. The International Myeloma Working Group categorizes the response to treatment into the following categories.

A stringent complete response (sCR) is defined by the following:

• There is a complete response.
• There are no myeloma cells in the bone marrow.

A complete response (CR) is defined by any one of the following:

• Immunofixation (a specialized type of electrophoresis that identifies the type of M-protein or immunoglobulin light chain) does not find M-protein in the blood or urine.
• An extramedullary plasmacytoma disappears.
• Plasma cells make up 5% or less of the cells in the bone marrow.

A very good partial response (VGPR) is defined by either of the following:

• Immunofixation finds M-protein in the blood or urine, but M-protein isn’t found by standard electrophoresis.
• M-protein in the blood has dropped by 90% or more, and M-protein in urine is less than 100 mg (in urine collected over 24 hours).

A partial response (PR) is defined as:

• M-protein in the blood has dropped by 50% or more, and M-protein in the urine has dropped by more than 90% or is less than 200 mg (in urine collected over 24 hours).
• If the blood and urine M-protein can’t be measured, PR is defined by a drop of 50% between the uninvolved and involved free light chain (Bence-Jones protein) levels.
• If neither M-protein nor free light chains can be measured, PR is defined by a drop of 50% or more of plasma cells in the bone marrow (if the baseline bone marrow plasma cell percentage was 30% or more).
• If there was an extramedullary plasmacytoma found at the time of diagnosis, it has shrunk by more than 50%.

Progressive disease (PD) is defined by one or more of the following:

• M-protein in the blood or urine or both has risen by 25% or more, or the bone marrow plasma cell percentage has risen by 25% or more (the plasma cells making up 10% or more of all cells in the bone marrow) or both.
• You have new abnormal areas in the bone or plasmacytomas.
• You develop hypercalcemia (high levels of calcium in the blood) related to multiple myeloma.

Stable disease (SD) means that the person does not meet the criteria for any of the categories above.

To make the decisions that are right for you, ask your healthcare team questions about treatment.