Myeloma first line treatment

• First line treatment for myeloma is usually in stages – induction, consolidation and maintenance.
• Induction usually involves a combination of drugs and aims to get you into remission.
• Consolidation may involve a stem cell transplant or a drug treatment.
• Maintenance treatment usually involves ongoing drug treatment to keep you in remission.

You will probably have treatment for myeloma in stages.

The first stage is often called remission induction. It aims to kill as many myeloma cells as possible and get you into remission. It usually involves a combination of different drugs over several weeks or months.

The exact drugs will depend on whether you plan to have a stem cell transplant afterwards. Your doctor will explain what they recommend for you. It will depend on your general health and fitness, as you need to be relatively well to have a stem cell transplant.

You’ll usually have the following drug combination to help get you into remission before a stem cell transplant:

• daratumumab, bortezomib, thalidomide and dexamethasone.

In Scotland, you might be offered the following drug combination instead:

• daratumumab, bortezomib, lenalidomide and dexamethasone.

There may also be a suitable clinical trial that you could take part in.

A stem cell transplant is not right for everyone. It might not be safe or helpful enough for you, or you may simply not want a transplant. In this case, your first treatment will usually be one of the following:

• daratumumab, lenalidomide and dexamethasone
• isatuximab, bortezomib, lenalidomide and dexamethasone
• lenalidomide and dexamethasone.

Again, there may also be a suitable clinical trial that you could take part in.

Read more about how different myeloma drugs work.

This will depend on the treatment you are having. You can take some drugs at home, while others are given at a hospital.

To find out how a particular drug is taken, see our list of myeloma drugs.

The next stage of treatment (consolidation) aims to keep you in remission for as long as possible. This may involve a stem cell transplant depending on your age and overall fitness level. Less fit people may continue to have a drug treatment.

After a stem cell transplant, you may have lenalidomide on its own. This is called maintenance treatment because it aims to keep you in remission for longer. Speak to your hospital team about how long you may take lenalidomide for.

If you have not had a stem cell transplant, you will keep using your original drug treatment unless you have too many side effects. If this happens, your hospital team may suggest changes to your treatment.

At some point, the myeloma may come back (relapse). Your hospital team will then talk to you about treatments for relapsed myeloma.

This information has been accredited with the PIF TICK, the UK's only quality mark for trusted health information.

Last full review May 2026. Next full review due May 2029. We may make factual updates between reviews.

Thank you to Consultant Haematologist Dr Emma Searle and Myeloma Nurse Practitioner Amie Martin for checking the clinical accuracy of our myeloma information. Thanks also to Cecelia, Craig, Joan, Kaleigh, Kerry, Louise, Mart, Sandra, Scott for supporting this project and sharing their experience of living with myeloma.