Induction Therapy for Multiple Myeloma
- Induction therapy for multiple myeloma is the first-line treatment aimed at getting symptoms under control quickly.
- A patient's overall health and whether a stem cell transplant is planned are among the key factors determining the medication regimen for induction therapy.
- Induction therapy usually involves two or three medications given in cycles of three weeks on, one week off.
Induction therapy usually includes two or three different medications designed to control symptoms quickly and reverse complications. But it's also important that the drugs be well-tolerated with little toxicity.
Read MoreThe three drugs are generally given together in cycles, “during which we hope to get the myeloma patients' disease under control," Dr. Pianko says. "Cycles are repeated usually every three weeks or once a month, over and over until we can get the myeloma under better control."
In addition to daratumumab, the use of other monoclonal antibody medications in induction therapy, including isatuximab and elotuzumab, has been growing in the past 10 years. Studies suggest that monoclonal antibody therapy may extend the time before relapse occurs. Other drugs that may be part of an induction therapy regimen may include thalidomide (Thalomid), an immunomodulatory drug, and cyclophosphamide (Cytoxan), an alkylating agent.
While the use of three drugs sometimes called "triplet" induction therapy is considered standard care, "doublet" therapy (two drugs) is often the regimen for frail and elderly individuals.
Medication Considerations
The choice of induction therapy medications is influenced somewhat by the next phase of their treatment. If a patient is going to have a stem cell transplant, standard induction therapy is usually followed by high-dose chemotherapy prior to the stem cell procedure. (A stem cell transplant gives you an infusion of your own healthy stem cells; chemotherapy kills the bad myeloma cells, as well as healthy stem cells. The stem cells given back during a transplant simply replace the good ones that the chemo killed.)
RELATED: What Are the Side Effects Associated With Multiple Myeloma Treatment?
For patients who are not scheduled to have a stem cell transplant, there is the prospect of long-term medication therapy that continues until symptoms are under control and the disease is in remission. But the potential physical and mental toll of ongoing treatment not to mention the financial burden must be part of the decision-making process.
For example, some induction medications carry some potential complications that have to be considered when designing a patient's induction therapy plan. Dexamethasone, for example, can cause blood sugar (glucose) levels to rise in many individuals. So for patients with diabetes, a physician may substitute a different medication if possible. Dr. Pianko notes that even people without diabetes at the start of treatment may experience blood sugar level spikes that require insulin to manage.
Takeaway
While induction therapy is the frontline approach to treating multiple myeloma, it may be the first of many rounds of treatment needed to keep the disease at bay. Ideally, your initial treatment will help control symptoms and slow or reverse disease progression long enough for you to enjoy a renewed quality of life.
You and your doctor should carefully and thoroughly discuss the likely course of your disease and well-being through all possible treatment scenarios. And once treatment begins, it will be incumbent on you to raise concerns about side effects or new symptom to your physician so that any needed changes in therapy can be made promptly.
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