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Treatment Options for Multiple Myeloma and Other Plasma Cell Disorders

If you are diagnosed with multiple myeloma or another plasma cell disorder, your treatment options will depend on a number of factors. This includes your age, overall health, and preferences, as well as the characteristics of the disease itself.

Treating solitary plasmacytomas

Solitary plasmacytomas are single plasma cell tumors. They usually develop in a bone, but they can also start in other body tissues (such as the lungs or other organs). When this happens, they are called solitary extramedullary (or extraosseous) plasmacytomas.

These tumors are most often treated with radiation therapy.

Sometimes the tumor is removed with surgery first, as part of the testing to determine what it is. But even then, radiation therapy is often given to the area afterward, especially if the tumor is in a bone. Surgery might also be needed to stabilize a bone that has been weakened by a tumor.

Medicines aren't usually part of the treatment for a plasmacytoma, unless it progresses at some point to multiple myeloma.

Treating smoldering multiple myeloma

Smoldering myeloma, also known as asymptomatic myeloma, has some features of active multiple myeloma, but it doesn't cause symptoms. (Learn more about this in What Is Multiple Myeloma?)

People with smoldering myeloma are generally grouped based on their risk of the disease progressing to active myeloma. This is based on the results of the bone marrow biopsy and certain lab tests.

Low-risk smoldering myeloma

People in the low-risk group often do well for years without treatment, so they're typically watched closely without starting treatment right away.

They usually have regular doctor visits and tests to check if the disease has progressed to active myeloma. These are often done every 3 to 6 months for a while, but the time between visits and tests might be extended over time.

If the disease does progress to active myeloma at some point, treatment (as described below) can be started at that time.

High-risk smoldering myeloma

For people with high-risk smoldering myeloma, options might include close monitoring (similar to what's done with low-risk disease) or treatment with medicines, such as lenalidomide, with or without dexamethasone.

This treatment can help lower the risk of the disease progressing to active myeloma and can help prevent organ damage in some people. If the myeloma does progress at some point, treatment options would be the same as those for active myeloma (as described below).

Treating active (symptomatic) multiple myeloma

Medicines are the main type of treatment for active multiple myeloma. Usually, different types of medicines are used together. This offers a better chance to keep the myeloma under control. The choice of medicines depends on many factors, including:

  • The risk group of the myeloma (high risk or standard risk), which is based mainly on certain gene or chromosome changes in the myeloma cells
  • If a person is eligible for (and is considering) a stem cell transplant
  • A person's age, overall health, and preferences

Initial treatment for active multiple myeloma

The first treatment for nearly all people with myeloma is several months of medicines. This is sometimes called induction therapy, because the goal is to induce a response (where there are few or no signs of myeloma still in the body).

Most often, 3 or 4 different types of drugs are given. Many combinations of drugs can be used. Some of the more common combinations used to treat myeloma include:

  • Daratumumab, bortezomib, lenalidomide, and dexamethasone
  • Bortezomib, lenalidomide, and dexamethasone
  • Carfilzomib, lenalidomide, and dexamethasone
  • Daratumumab, lenalidomide, and dexamethasone
  • Bortezomib, cyclophosphamide, and dexamethasone
  • Daratumumab, carfilzomib, lenalidomide, and dexamethasone
  • Isatuximab, bortezomib, lenalidomide, and dexamethasone

Many other combinations of drugs might be options as well.

While 4 drugs might keep the myeloma under control for longer than 3 drugs, it's also likely to cause more side effects. Regimens with 4 drugs are more likely to be used for people who are otherwise fairly healthy, especially those with high-risk myeloma.

People with multiple myeloma typically get a medicine to help keep the bones strong as well, such as a bisphosphonate (pamidronate or zoledronic acid) or denosumab. People might also get other types of supportive treatments to help prevent or treat symptoms from the myeloma.

Further treatment for standard-risk myeloma

After several months of induction treatment, stem cells are usually collected from a person’s blood, if they might get a stem cell transplant at some point.

At this point, the treatment options for a person with standard-risk myeloma might include:

  • Having an autologous stem cell transplant, (for people who are eligible, known as an early stem cell transplant)
  • Continuing with the same medicines, for up to about a year or until the myeloma progresses, and then getting a stem cell transplant (known as a delayed or late stem cell transplant)
  • Continuing with the same medicines, for up to about a year in total or until the myeloma progresses, for people who can't get or don't want a stem cell transplant

Long-term maintenance therapy, most often with a single drug like lenalidomide, might be recommended after any of these approaches.

Further treatment for high-risk myeloma

People with high-risk myeloma are more likely to get a 4-drug regimen for their initial (induction) treatment. After several months of this, stem cells are usually collected from their blood, if they might get a stem cell transplant at some point.

Because of the higher risk of the myeloma progressing, doctors often advise doing an early stem cell transplant at this point, if a person can have it. This is usually an autologous transplant (either a single transplant or a tandem/double transplant, in which two transplants are done, typically 3 to 6 months apart).

To learn more about this, see Stem Cell Transplant for Multiple Myeloma.

For people who can't get a stem cell transplant, treatment with the same medicines is usually continued as long as it's effective, for up to about a year in total.

Long-term maintenance therapy, most often with medicines such as lenalidomide, bortezomib, and/or daratumumab, is typically recommended after either of these approaches.

If the myeloma doesn't respond or stops responding to treatment

Multiple myeloma is very hard to cure, but medicines are often very good at keeping it under control or even shrinking it for long periods of time. Still, sometimes myeloma might not respond well to treatment, or it might start growing again during or after treatment.

If this happens, other options can be tried. There are many types of medicines to treat myeloma. Which treatment is best depends on many of the same factors used to decide on the first treatment, as well as others factors, including:

  • Which medicines have been used to treat the myeloma before
  • How well the myeloma responded to the medicines
  • If the myeloma is likely to respond to the same medicines again
  • When in the course of treatment the myeloma progresses or comes back
  • If a stem cell transplant is now an option

Usually, if the myeloma progresses during the initial (induction) treatment, other combinations of medicines can be tried. A stem cell transplant might be another option.

Newer medicines and treatments, such as T-cell engagers (TCEs) and CAR T-cell therapy, might also be options at some point. These are usually reserved for later lines of treatment (after others have been tried), but doctors are now studying their use earlier in the course of treatment as well.

Myeloma tends to get harder to treat as more lines of treatment have been tried. At any time, taking part in a clinical trial studying a newer treatment might be a good option for some people.

Regardless of which treatments are being used, people with myeloma can often be helped by getting supportive treatments as well. Talk to your cancer care team about supportive treatments that could help prevent or relieve some of your symptoms.

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Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).

Kumar S. Multiple myeloma: Use of hematopoietic cell transplantation. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/multiple-myeloma-use-of-hematopoietic-cell-transplantation on January 15, 2025.

Laubach JP. Multiple myeloma: Initial treatment. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/multiple-myeloma-initial-treatment on January 15, 2025.

Laubach JP. Multiple myeloma: Overview of Management. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/multiple-myeloma-overview-of-management on January 15, 2025.

Laubach JP. Multiple myeloma: Treatment of first relapse. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/multiple-myeloma-treatment-of-first-relapse on January 15, 2025.

Laubach JP. Multiple myeloma: Treatment of second or later relapse. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/multiple-myeloma-treatment-of-second-or-later-relapse on January 15, 2025.

Mateos V-M. Smoldering multiple myeloma. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/smoldering-multiple-myeloma on January 15, 2025.

Mateos V-M. Solitary extramedullary plasmacytoma. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/solitary-extramedullary-plasmacytoma on January 15, 2025.

Mateos V-M. Solitary plasmacytoma of bone. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/solitary-plasmacytoma-of-bone on January 15, 2025.

National Cancer Institute. Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version. 2024. Accessed at https://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq on January 15, 2025.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Multiple myeloma. V.1.2025. Accessed at www.nccn.org on January 15, 2025.

Rajkumar SV, Dispenzieri A. Chapter 101: Multiple myeloma and related disorders. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE. Abeloff’s Clinical Oncology. 6th edition. Philadelphia, PA. Elsevier: 2020.

Last Revised: February 28, 2025

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