Induction therapy for multiple myeloma

Induction therapy is the first phase of treatment for multiple myeloma. The goal of induction therapy for multiple myeloma is to reduce the number of plasma cells (myeloma cells) in the bone marrow and the proteins that the plasma cells produce. Induction therapy is usually given for several months.

Induction therapy is given to people with active (symptomatic) multiple myeloma. Induction therapy is the first phase of treatment before higher-dose chemotherapy is given. Induction therapy usually is a combination of 2 or 3 of the following types of drugs:

• targeted therapy
• chemotherapy
• corticosteroids

Candidates for a stem cell transplant are usually 70 years of age or younger and in generally good health. Candidates will have induction therapy followed by high-dose chemotherapy and a stem cell transplant. Induction therapy is usually given for several cycles.

Induction therapy for multiple myeloma in people who are considered candidates for a stem cell transplant may include these drugs:

• CyBorD regimen – cyclophosphamide (Cytoxan, Procytox), bortezomib (Velcade) and dexamethasone (Decadron, Dexasone)
• VRD regimen – bortezomib, lenalidomide (Revlimid) and dexamethasone
• thalidomide (Thalomid) and dexamethasone
• lenalidomide and low-dose dexamethasone
• bortezomib and dexamethasone
• VTD regimen – bortezomib, thalidomide and dexamethasone
• bortezomib, cyclophosphamide and prednisone
• bortezomib, doxorubicin (Adriamycin) and dexamethasone
• dexamethasone
• liposomal doxorubicin (Caelyx, Doxil), vincristine (Oncovin) and dexamethasone

Candidates for an autologous stem cell transplant should never have induction therapy with the drug melphalan (Alkeran, L-PAM). Melphalan can lower the number of stem cells in your body so it makes it difficult to collect enough cells for a stem cell transplant. It may be given if a person is going to have an allogeneic stem cell transplant, which uses a donor’s stem cells.

Some people with multiple myeloma can’t have a stem cell transplant. But some of the same drugs can be used in induction therapy as the drugs used for people who are candidates for a stem cell transplant. People who can’t have a stem cell transplant may have induction therapy using the following drugs:

• CyBorD regimen – cyclophosphamide, bortezomib and dexamethasone
• lenalidomide (Revlimid) and low-dose dexamethasone
• MPT regimen – melphalan, prednisone and thalidomide
• VMP regimen – bortezomib, melphalan and prednisone
• MPL regimen – melphalan, prednisone and lenalidomide
• melphalan and prednisone
• bortezomib and dexamethasone
• dexamethasone
• liposomal doxorubicin, vincristine and dexamethasone
• thalidomide and dexamethasone
• VAD regimen – vincristine, doxorubicin and dexamethasone
• VRD regimen – bortezomib, lenalidomide and dexamethasone