Myeloma Treatment Guidelines

Myeloma is the term for a progressive form of cancer that affects certain white blood cells called plasma cells. It affects roughly 20,000 Americans each year and occurs most frequently in African-Americans over the age of 50. Members of other ethnic groups over age 50 are also at risk. While myeloma is currently incurable, extensive progress has been made toward effective treatment.

Understanding Myeloma

• Myeloma begins when abnormal plasma cells form tumors in areas of the bone marrow. These tumors have two effects. First, they disrupt the normal production of important components of the blood, including red blood cells, other white blood cells and platelets. They also directly harm the bones they inhabit, leading to weakness and structural damage. When myeloma forms in multiple sites in the body, it is referred to as multiple myeloma. Roughly 90 percent of myeloma sufferers have multiple myeloma.

First Steps After Diagnosis

• If you are diagnosed with myeloma, the first thing your doctor will do is determine the severity of your condition. He will likely do this through a bone marrow biopsy and through a blood test that measures certain key changes in your plasma cells. He will also determine how far your myeloma has spread, using X-rays, computed tomography (CT) scans and positron emission tomography (PET) scans.

Many Treatment Options

• Based on his assessment, your doctor may pursue any one of a number of different treatment options. Since the progression of myeloma varies greatly from person to person, no two treatment courses are exactly the same.

  If your symptoms are minor or limited, your doctor may initially choose to do nothing other than monitor your myeloma through regular testing. This technique is called watchful waiting. More typically, the presence of myeloma is cause for active intervention.

  Chemotherapy drugs are frequently used, as they fight myeloma throughout the body. Your doctor may also inject chemotherapy drugs directly into the area of an active tumor. Chemotherapy is sometimes used in high doses, accompanied by a stem cell transplant. Stem cells are immature blood cells, and transplanting them may increase your body's ability to make normal adult blood cells.

  Your doctor may also use other forms of drug therapy, including drugs that help prevent tumor formation (thalidomide, lenalidomide), drugs that target myeloma cell proteins (bortezomib) or corticosteroids, which also have anti-tumor properties.

  Monoclonal antibody therapy is another treatment option. It involves intravenous use of antibodies made in the laboratory for the specific purpose of killing myeloma cells directly or disrupting their functions.

  Your doctor may also recommend radiation therapy, which uses focused high-energy X-rays to disrupt or kill myeloma cells. X-ray treatment may involve either the use of external machines or temporary implantation of radioactive materials at the site of myeloma tumors.

  Plasmapheresis may also be used. In this option, your blood is filtered through an external machine, where cancerous cells are removed before the blood is returned to your body. However, this cleansing will not prevent the creation of new cancer cells.

  Surgery may also be needed to deal with particular myeloma tumors. Consult your doctor for a thorough explanation of all treatment options and their potential side effects.