If you or a loved one has been diagnosed with multiple myeloma, you may be worried about what happens next with this type of blood cancer. Although myeloma is not yet curable for most people, many different multiple myeloma treatment options are available to help fight the cancer. Your health care team will work with you to find treatments that can keep your myeloma in remission — meaning symptoms and signs of cancer are either not apparent or significantly reduced — for as long as possible.

Here are some facts about myeloma treatments to know as you talk to your doctor about your treatment goals and preferences and ask questions about treatment options.

1. There Are More Treatments for Myeloma Than Ever

Myeloma treatments include a range of therapies that have been approved by the U.S. Food and Drug Administration (FDA). In people with myeloma, abnormal plasma cells (a type of white blood cell) grow uncontrollably and form cancerous tumors. Healthy blood cells can be crowded out. Treatment is aimed at slowing, stopping, and killing cancer cells.

Here are some of the therapies typically used in the treatment of myeloma:

• Targeted therapy — Drugs known as proteasome inhibitors are designed to attack particular chemicals in cancer cells to promote cancer cell death.
• Immunomodulatory drugs — These medications, such as lenalidomide (Revlimid), have several anticancer properties, including directly killing tumor cells, cutting off nutrient supplies to tumor cells, and enhancing the immune system to fight tumor cells.
• Corticosteroids — These drugs fight inflammation and also help enhance the effects of other anticancer drugs.
• Bone marrow transplant — This procedure replaces cancer cells with healthy cells.
• Bisphosphonates — These medications prevent bone destruction caused by multiple myeloma.
• Immunotherapy drugs — These help the immune system fight cancer cells and include biologic drugs (monoclonal antibodies), bispecific antibodies, and chimeric antigen receptor (CAR) T-cell drugs.
• High doses of chemotherapy drugs — These kill or slow fast-growing myeloma cells.
• Radiation therapy — This treatment uses beams of energy, such as X-rays, to kill cancer cells.

New drugs are in development and being tested with clinical trials, which study the safety and effectiveness of potential therapies. New types of treatment may become available during the course of your myeloma. Clinical trials can also offer people who qualify an opportunity to gain access to new drugs. All treatments have a risk of side effects or adverse reactions. It’s important to discuss potential side effects with your doctor before starting a new treatment.

Your doctor can help you understand the potential risks and benefits of all treatment options, including clinical trials.

2. It’s Common To Combine Treatments for Myeloma

Often, doctors will recommend for people with myeloma to take a combination of two or more drugs at one time because each medication fights cancer or manages symptoms in different ways. Doctors often tailor drug combinations to a person’s particular health condition, taking into consideration factors such as:

• The stage of the person’s myeloma
• Kidney function
• Whether a bone marrow transplant is planned
• Whether the person’s cancer cells have high-risk chromosomal abnormalities

3. Your Myeloma May Relapse or Become Refractory

Even if treatment is initially successful, people with myeloma almost always experience relapses (periods when cancer returns). At times, myeloma becomes refractory (stops responding to treatment). In a 2016 study, researchers found that 16 percent of people with multiple myeloma relapsed within one year. Around 50 percent of the participants relapsed within 26.9 months of completing first-line therapy.

A relapse occurs when signs and symptoms reappear after a period of improvement following treatment for multiple myeloma. Your myeloma may relapse more than once throughout the disease.

If your myeloma relapses or becomes refractory, your oncologist will review your treatment history, determine the degree of relapse or refractory myeloma, and consider your overall health before recommending a treatment course. Sometimes drugs that have worked before may be effective again, but your doctor may advise a new treatment option.

4. Some People Are Candidates for Bone Marrow Transplant

In an autologous bone marrow transplant, your healthy bone marrow cells are harvested, and then your diseased bone marrow is destroyed with high-dose chemotherapy. Finally, your healthy cells are infused back into your body to replace the cancer cells.

In some cases, a bone marrow transplant can provide an extended remission of myeloma. One large study published in the journal Blood Advances showed that the five-year survival rate of people with myeloma who had bone marrow transplants had increased from 35 percent to 63 percent, largely due to improved drug combinations used along with the transplant.

Your overall health is one of the most important considerations in determining if a bone marrow transplant may be right for you. While transplants are most commonly recommended for those under age 65, each case is considered individually and reviewed for risk factors. For instance, a healthy and fit older person may be considered a candidate. Doctors and researchers don’t always agree on when or for whom bone marrow transplants should be considered. More studies are needed to establish whether earlier or later in the treatment regimen is best, and for whom.

Recent studies have also shown that tandem transplants — undergoing a second planned transplant a few months after the first — may be viable for younger people who’ve had poor responses to initial treatments. You can discuss this with your doctor if you are a candidate for this kind of treatment.

5. You’ll Likely Be on Myeloma Treatment Long Term

As treatment for myeloma has improved in recent decades, survival rates have gone up. This is largely due to long-term treatment approaches, including maintenance treatment and continuous therapy.

Both of these approaches are aimed at increasing progression-free survival and overall survival rates. With continuous therapy, treatment continues until progression, at which point treatment would be reevaluated. With maintenance treatment, long-term treatment is adjusted after intensive treatment. Its timeframe may vary on a case-to-case basis.

One study published in the Blood Cancer Journal showed that the average duration of treatment after bone marrow transplantation was 28 months. For people with myeloma who didn’t receive a bone marrow transplant, long-term therapy varied depending on the treatment used.

6. Monitoring During Treatment Helps You Stay Healthy

People who are living with multiple myeloma can expect ongoing monitoring. Once you start treatment, your oncologist will want to assess your response to the treatment and monitor you for relapses.

Blood tests that measure monoclonal protein (M-protein) levels are standard practice for measuring response to treatment. Other blood tests, bone marrow biopsy, and imaging tests such as positron emission tomography/CT and MRI are also used to measure treatment outcomes and monitor for relapse.

If a bone marrow examination shows monoclonal gammopathy of undetermined significance, and you’ve been diagnosed with smoldering myeloma, you will be monitored for signs of disease progression.

You’ll also be monitored for side effects to help prevent any serious complications of myeloma treatment.

7. Palliative Care Makes Sure You Feel Your Best

Myeloma or myeloma treatment can cause uncomfortable symptoms and side effects. Potential side effects of myeloma treatment include:

• Fatigue
• Anemia
• Peripheral neuropathy (nerve pain in hands and feet)
• Infection
• Bone pain and bone damage
• Kidney damage
• Blood clots

If you experience bothersome side effects during myeloma treatment, supportive care (also known as palliative care) can help reduce the severity of adverse reactions and help you maintain your myeloma treatment plan. Palliative care aims at treating side effects, reducing pain, and improving comfort levels so that your quality of life can be as good as possible.

Depending on your particular condition, supportive care may include:

• Calcium and vitamin D supplements to support bone health
• Bone disease medication
• Vaccines to help prevent infection
• Medication to help prevent blood clots
• Pain relievers
• Exercise to help with fatigue

8. Sticking With Treatment and Talking to Your Doctor Are Vital

Once you have a treatment plan for your myeloma, sticking with it is your best chance to live as long and feel as good as possible. If you experience any problems staying on your myeloma treatment, let your doctor know right away. They can help you overcome many challenges.

Taking an active role in decisions about your treatment can help you understand your myeloma care better and help you become more clear about your own treatment goals and preferences. It can be beneficial to openly talk about your treatment concerns with your oncologist, hematologist, and other members of your cancer care team.

Shared decision-making with your doctor can help ensure that your values and preferences are prioritized and that you and your health care team work in partnership to manage your myeloma. Being involved in decisions about your treatment for multiple myeloma is one way to make sure you get the best care possible.

Meet Others Who Understand

On MyMyelomaTeam, the social network for people with multiple myeloma and their loved ones, more than 22,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Which treatments have you undergone for myeloma? How did you decide on treatment options with your doctor? Share your experience in the comments below, or start a conversation by posting on your Activities page.