Multiple Myeloma Treatment Chemotherapy

Chemotherapy uses systemic medications to kill cancer cells. Systemic means that the medication affects the entire body, not just the diseased area. Because it is a “total body” treatment, chemotherapy is often used to treat cancer that has metastasized (spread to other organs).

As widespread bone tumors are one of the main characteristics of multiple myeloma, chemotherapy plays an important role in treatment and disease management.

Melphalan and Prednisone

A combination of the alkylating drug melphalan and the steroid prednisone is often the initial treatment for multiple myeloma. Alkylating drugs hinder the growth and division of cells by interfering with DNA replication. Steroids such as prednisone are often used in combination with alkylating agents because they’ve been shown to enhance the treatment results.

Most people respond well to the combination of melphalan and prednisone, commonly referred to as MP. Unfortunately, once MP treatment ends, most patients relapse and begin to show renewed signs of the cancer. Melphalan treatment must be monitored: drug side effects can include bone marrow toxicity and, in some cases, bone marrow failure.

Other options are available for patients who don’t respond to melphalan with prednisone. The alkylating medications cyclophosphamide and chlorambucil may be used instead of melphalan, as they have similar effects when combined with steroids.

Relapse Treatment

Patients who don’t respond to MP or its alternatives and those who relapse after MP treatment often react well to a combination chemotherapy regimen known as VAD. VAD stands for vincristine, adriamycin and high-dose dexamethasone. VAD-resistant cases may benefit from a combination of VAD and cyclophosphamide.

Thalidomide and Interferon Alpha

If MP, VAD or similar therapies prove ineffective, patients may be prescribed thalidomide. Thalidomide gained notoriety during the 1950s and 1960s when it was discovered that the drug has severe side effects, including birth defects. More recent clinical trails have examined the cancer-fighting properties of thalidomide.

Thalidomide has anti-angiogenic properties: that is, it hinders the formation of new blood vessels. By preventing new blood vessel formation in myeloma tumors, thalidomide inhibits nutrients from reaching the cancer cells. In effect, the tumor starves to death.

Approximately fifty percent of multiple myeloma cases that don’t respond to MP and VAD respond to thalidomide. Clinical trials are investigating the effectiveness of using thalidomide as a primary treatment in combination with chemotherapy and interferon alpha. Interferon alpha is an experimental biological therapy that stimulates the immune system. Clinical trials indicate that, like thalidomide, interferon alpha has anti-angiogenic properties.

High Dose Therapy (HDT)

High dose therapy (HDT) is the use of chemotherapy drugs at exceptionally high levels for limited periods of time. Combining HDT with bone marrow transplantation has produced better results than chemotherapy alone.

Drug Side Effects

Chemotherapy affects both healthy and cancerous cells. As a result, a number of drug side effects occur during treatment. Perhaps the most serious is the effect chemotherapy has on bone marrow. Treatment greatly reduces the bone marrow’s ability to produce new blood cells, causing high rates of infection and bleeding abnormalities. Growth factor drugs may be used to stimulate the production of blood cells during treatment.

Additional drug side effects may include:

  • diarrhea
  • digestive problems
  • fatigue
  • hair loss (usually temporary)
  • nausea
  • sexual function difficulties
  • urination problems
  • vomiting.

Resources

Beers, M. H.,