Beginning Your Multiple Myeloma Treatment Journey
- The first step in treating multiple myeloma is called induction therapy. Before induction therapy, doctors collect clinical information about an individual’s cancer through imaging and bone marrow biopsies.
- Though there is variation, most patients’ induction therapy regimen will include three drugs: proteasome inhibitor, an immunomodulator, and a steroid.
- The goals of induction therapy include managing the disease, reversing complications caused by it, limiting the risk of early mortality, and avoiding interfering with stem cell collection.
Before any treatment is given, however, doctors gather information about the specifics of a patient's disease through imaging and a bone marrow biopsy.
Factors to Consider
Read MoreStandard Drugs for Multiple Myeloma Induction Therapy
Once the relevant clinical information is collected and the doctors decide if a patient is eligible for a stem cell transplant, they will sit down with the patient and their family to plan out the best regimen for first induction therapy. For most patients, this will involve three types of drugs: a proteasome inhibitor, an immunomodulator, and a steroid.
- A proteasome inhibitor. Proteasomes are like your cells' clean-up crew. They sweep away extra proteins that would otherwise kill the cells. Drugs like bortezomib (brand name: Velcade) and carfilzomib (brand name: Kyprolis) block proteasomes to speed the destruction of multiple myeloma cells.
- An immunomodulator. These drugs work on your immune system to treat multiple myeloma. Examples are lenalidomide (brand name: Revlimid), thalidomide (brand name: Thalidomid), and cyclophosphamide (Cytoxan).
- A steroid. Corticosteroids, also known as steroids, treat cancer and bring down inflammation in your body. Dexamethasone is a steroid that doctors often use to treat multiple myeloma.
Common three-drug regimens include:
- Bortezomib (Velcade), lenalidomide (brand name: Revlimid), and low-dose dexamethasone
- Bortezomib, cyclophosphamide (Cytoxan), and dexamethasone
Describing one of the most commonly used regimens, Dr. Ye said, "We call them RVDthat is a three drug combination with Revlimid, Velcade, and dexamethasone."
RELATED: The Induction Phase of Multiple Myeloma Therapy — What’s the Standard?
Some patients will receive a quadruplet regimen to include RVD (revlimid, velcade, dexamethasone) + Darzalex (daratumumab), but triplet regimens are most commonly given.
The Purpose of Induction Therapy for Multiple Myeloma
The main goals that doctors consider when planning this stage of treatment include :
- managing the disease
- reversing complications caused by it
- limiting the risk of early mortality
- avoiding interfering with stem cell collection
Why Are There So Many Options?
Dr. Ye acknowledged that the different treatment options for induction therapy can be overwhelming. But that's not necessarily a bad thing.
"When you go to internet," she said, "You may feel there are regimens with two drug combinations, three drug combinations, and four drug combinations. This is not a surprise. That means our science is being advanced through different clinical trials."
Though induction therapy treatments are not completely standardized across health care providers, this is a sign that researchers have found some success in honing different ways to treat the disease.
"So that’s why it’s very important for patients to see a multiple myeloma specialist in big cancer centers that have a dedicated multiple myeloma team to take care of the patients," Dr. Ye told SurvivorNet. "At least a one consultation would be very helpful for you to learn more about multiple myeloma and also learn about the treatment options."
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