Chemotherapy for multiple myeloma

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Most people with multiple myeloma have chemotherapy. If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

Chemotherapy may be used along with other cancer treatments. You may have chemotherapy to:

• destroy cancer cells in the body
• lower the number of cancer cells in the body before a stem cell transplant (called induction therapy)
• lower the number of cancer cells in the body when you can't have a stem cell transplant
• destroy cells in the bone marrow as part of stem cell transplant conditioning
• treat multiple myeloma that has come back after it was treated (called relapsed multiple myeloma) or is no longer responding to treatment (called refractory multiple myeloma)

Chemotherapy drugs are usually combined with targeted therapy drugs or supportive therapy drugs or both.

The most common chemotherapy drugs used to treat multiple myeloma are:

• melphalan
• cyclophosphamide

The most common combinations of chemotherapy drugs used to treat multiple myeloma are:

• CyBorD – cyclophosphamide, bortezomib (Velcade) and dexamethasone
• Dara-CyBorD – daratumumab (Darzalex), cyclophosphamide, bortezomib and dexamethasone
• VTd-PACE – bortezomib, thalidomide (Thalomid), low-dose dexamethasone, cisplatin, doxorubicin, cyclophosphamide and etoposide
• KCd – carfilzomib (Kyprolis), cyclophosphamide and low-dose dexamethasone
• PCP – pomalidomide (Pomalyst), cyclophosphamide and prednisone

Side effects of chemotherapy will depend mainly on the drug, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects of chemotherapy drugs for multiple myeloma include:

• hair loss
• sore mouth and throat
• low blood cell counts
• infection
• nausea and vomiting
• diarrhea
• fatigue
• skin problems( such as rash and itching)
• loss of appetite

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.