Chemotherapy for multiple myeloma

Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. Most people with multiple myeloma have chemotherapy. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

• destroy cancer cells in the body
• lower the number of cancer cells in the body (called induction therapy) before a stem cell transplant
• destroy cells in the bone marrow as part of stem cell transplant conditioning
• make a stem cell transplant work better (called consolidation therapy)
• reduce the risk of a relapse (recurrence) and keep the cancer in remission after a stem cell transplant (called maintenance therapy)
• treat multiple myeloma that relapses or is no longer responding to treatment (refractory treatment)

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body.

The most common chemotherapy drugs used to treat multiple myeloma are:

• melphalan (Alkeran, L-PAM)
• cyclophosphamide (Cytoxan, Procytox)

Chemotherapy drugs are usually combined with other chemotherapy drugs, targeted therapy drugs or supportive therapy drugs. The most common combinations of drugs using chemotherapy to treat multiple myeloma are:

• melphalan and prednisone
• MPT regimen – melphalan, prednisone and thalidomide (Thalomid)
• VMP regimen – bortezomib (Velcade), melphalan and prednisone
• CyBorD regimen – cyclophosphamide (Cytoxan, Procytox), bortezomib and dexamethasone (Decadron, Dexasone)
• cyclophosphamide and prednisone
• cyclophosphamide, bortezomib and prednisone
• liposomal doxorubicin (Caelyx, Doxil), vincristine (Oncovin) and dexamethasone
• vincristine, doxorubicin (Adriamycin) and dexamethasone
• bortezomib, doxorubicin and dexamethasone

If multiple myeloma does not respond to drugs used in earlier treatments or if it recurs (comes back), the following drugs may be used:

• liposomal doxorubicin
• liposomal doxorubicin and dexamethasone
• liposomal doxorubicin and bortezomib
• melphalan and prednisone
• MPT regimen – melphalan, prednisone and thalidomide
• cyclophosphamide, bortezomib and dexamethasone
• cyclophosphamide, lenalidomide (Revlimid) and dexamethasone
• DCEP regimen – dexamethasone, cyclophosphamide, etoposide (Vepesid, VP-16) and cisplatin (Platinol AQ, Platinol)
• DT-PACE regimen – dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide
• VTD-PACE regimen – dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, etoposide and bortezomib
• high-dose cyclophosphamide

Side effects can happen with any type of treatment for multiple myeloma, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given (by mouth or by vein) and your overall health. Some common side effects of chemotherapy drugs used for multiple myeloma are:

• hair loss
• sore mouth and throat
• loss of appetite
• nausea and vomiting
• low blood cell counts (called bone marrow suppression)
• diarrhea and constipation
• infection
• fatigue
• difficulty breathing

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.