Myeloma Treatment Approaches
Just as every patient is different, we recognize that every multiple myeloma case is different. What distinguishes City of Hope in the treatment of patients with myeloma is seamless continuity of care. From a new diagnosis to treatment with the newest drugs within our extensive program of myeloma clinical trials to transplantation, patients are treated by the same team of doctors who see them through every phase of treatment and recovery. City of Hope also offers the expertise of geriatric oncologists who specialize in the treatment of older patients.

Our patients are provided treatments based on the latest evidence available and up-to-date clinical guidelines. Factors that determine the therapy regimen include:

  • Stage of myeloma
  • If there are related conditions—such as kidney damage, brittle/fractured bones or infection—present
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the myeloma treatment regimen may include one or more of the following:

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, is often an essential component of myeloma treatment because a systemic approach is necessary to kill cancerous cells in the bone marrow and throughout the bloodstream. Chemotherapy is usually given in cycles, with breaks in between to allow patients to recover from side effects.

Standard chemotherapy drugs used for myeloma may include one or more of the following:
 
  • Bartezomib (Velcade®)
  • Carfilzomib (Kyprolis®)
  • Dexamethasone
  • Fludarabine (Fludara®)
  • Lenalidomide (Revlimid®)
  • Melphalan (Alkeran®)
  • Pomalidomide (Pomalyst®)
 
Additionally, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against myeloma. In particular, City of Hope researchers are studying cancer drugs (and drug combinations) that are more effective against relapsed myeloma.
 

Immunotherapy

By modifying the immune system, the patient’s own disease-fighting cells can be used to track and attack myeloma cells throughout the body. This can dramatically enhance other myeloma therapies and lead to better outcomes.
 
Immunotherapy approaches being used or studied at City of Hope include:
 
Monoclonal Antibodies
 
Unlike standard chemotherapy that typically affects both cancerous and normal cells, monoclonal therapies are highly targeted drugs that can hone in on cancer cells. After attaching to the cell, the antibody can interfere with the myeloma’s growth, be used as a delivery or targeting mechanism for other cancer therapies and/or trigger an immune response against the myeloma.

Adoptive T-Cell Therapy
 
T-cells are a powerful part of the immune system, and new approach being studied at City of Hope involves redirecting T-cells to recognize cancer cells specific to myeloma. T-cells are extracted then genetically modified so they can recognize, target and destroy the cancer cells. Studies are ongoing for this novel approach to treat recurrent, relapsed or refractory myelomas.
 

Stem Cell Transplantation

City of Hope is a leader in the use of stem cell transplantation to treat myeloma and other blood cancers. Since the program began in 1976, more than 12,000 transplants have been performed and it has been recognized for superior survival outcomes for nine consecutive years—the only transplant center in the United States with such an achievement.
 
Transplants are sometimes performed early in the course of treatment to improve long-term results or it may be utilized when other treatments are not working. Studies have shown that high-dose chemotherapy with stem cell transplant increases response and survival rates compared to standard chemotherapy alone for myeloma patients.
 
In this procedure, a patient undergoes intensive chemotherapy, and sometimes radiation therapy, to destroy the cancer-causing cells followed by an infusion of healthy new stem cells. The stem cell transplant may be either autologous (extracted from the patient’s own body) or allogeneic (using stem cells taken from another person.)

One known complication of allogeneic transplants is graft versus host disease (GvHD), in which the newly transplanted cells does not recognize the recipient’s body as their own and forms an immune response against it. City of Hope is on the forefront of tackling this condition and is constantly improving allogeneic transplant protocols to minimize GvHD risk and severity.
 
Nonmyeloablative (Mini) Transplants
 
City of Hope physicians also specialize in “mini” stem cell transplants for patients who cannot tolerate the side effects associated with a standard stem cell transplantation, such as older patients or patients with other medical conditions. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself. This novel approach has patients who otherwise ineligible, including patients in their 70s, to be treated with this lifesaving procedure. Thus, this is particularly beneficial for CLL patients, who are usually in this age range upon diagnosis.
 
 
Some myeloma patients may be treated in an outpatient setting with City of Hope’s day hospital, which allows them to receive their stem cell transplant without staying at the hospital overnight. Studies have shown that the day hospital model meets clinical standards for stem cell transplant without compromising quality of care. Further, this can improve patient satisfaction by giving them the option to spend their evenings at home with loved ones.
 
Learn more about the day hospital for myeloma patients.
 

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. City of Hope is the first in the western United States to treat myeloma using the Helical TomoTherapy System® , which reduces the unwanted exposure of normal tissues and reduces potential complications. The system combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects compared to traditional whole-body irradiation, which unnecessarily exposes healthy tissues.

Surgery

Because myeloma spreads throughout the bone marrow and bloodstream, surgery plays a limited role in treatment.  However, surgery may be performed to treat localized myeloma-related conditions.

How to Become a Patient

If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.