Treatment Options for Multiple Myeloma and Other Plasma Cell Disorders

Solitary plasmacytomas

These tumors are often treated with radiation therapy. If the plasma cell tumor is not in a bone, it may be removed with surgery. Other treatments might also be considered if a person is at high risk of progressing to multiple myeloma.

Smoldering multiple myeloma

People with smoldering myeloma often do well for years without treatment. For many people, starting treatment early does not seem to help them live longer. These people are typically watched closely without starting treatment right away.

Based on how abnormal the plasma cells look under the microscope and the levels of immunoglobulins, some people with smoldering multiple myeloma have a high risk of progressing to active myeloma. Some of these people might be helped by treatment with lenalidomide and dexamethasone before they develop symptoms.

Active (symptomatic) myeloma

People with active myeloma or light chain amyloidosis are often given a combination of 2 or 3 drugs. The drugs chosen depend on the person’s health (including their kidney function) and whether a stem cell transplant is planned.

Often, a combination containing bortezomib, lenalidomide, and dexamethasone is used. Combinations containing bortezomib are especially helpful in people with kidney problems and those whose myeloma cells contain certain high-risk chromosome abnormalities.

Many other combinations may be considered as well. If one drug combination stops working (or the myeloma comes back), other drugs can be tried. For more on these drugs and some of the common combinations used, see Drug Therapy for Multiple Myeloma.

Treatment for bone disease (with a bisphosphonate or denosumab) is often started at the same time as well. If the areas of damaged bone continue to cause symptoms, radiation therapy may be used.

People with multiple myeloma also receive supportive treatments, such as transfusions to treat low blood cell counts, and antibiotics and sometimes intravenous immunoglobulin (IVIG) for infections.

A stem cell transplant may be part of treatment. Options for stem cell transplant are discussed in Stem Cell Transplant for Multiple Myeloma.

Some people are given additional cycles of treatment after a transplant. This is called consolidation treatment and increases the chance of a complete response (where all signs and symptoms of the disease go away).

Some people (even some who didn’t have a stem cell transplant) may be given long-term treatment with lenalidomide or bortezomib. This is known as maintenance treatment. It can help delay the return of the myeloma, but it can also cause serious side effects in some people.

CAR T-cell therapy may be another treatment option for some people, especially if several other medicines have already been tried. This treatment helps the body’s own immune system attack the cancer cells. While it can be very effective for many people, it can also cause very serious side effects.