Myeloma treatment and side effects
First line treatment for myeloma
First line treatments usually give the longest period of remission, where there are few or no myeloma cells left in the body.
The exact treatment you have will depend on your general health and whether a stem cell transplant is part of your treatment plan.
The treatment is often given in stages.
Stage 1: remission induction
The first stage (remission induction) aims to kill as many myeloma cells as possible and get you into remission. It usually involves a combination of different drugs given over the course of several weeks or months. These are the most commonly used drug combinations:
- daratumumab, bortezomib (trade name Velcade®), thalidomide and dexamethasone
- bortezomib, thalidomide and dexamethasone
- bortezomib, melphalan and prednisolone
- bortezomib, cyclophosphamide and dexamethasone
- lenalidomide and dexamethasone
In Scotland, a combination of daratumumab, lenalidomide and dexamethasone has also been approved as a first line treatment for myeloma, for people who can't have consolidation with a stem cell transplant. It has not been approved yet in the rest of the UK.
Most of these drugs are taken by mouth as a tablet or capsule. Bortezomib is injected under the skin. Daratumumab is injected under the skin or given by a drip into a vein (intravenous infusion). Injections can be done at a hospital clinic, or you can be shown how to do it yourself at home if you prefer.
Read more about how these drugs work.
Stage 2: consolidation
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.
"One week you’re at work, planning your next holiday or whatever and the next minute you're sitting in a chemo ward surrounded by sick people. And that's an immediate and significant change."
Ian, Living with myeloma since 2019
Read about taking care of your mental health.
Stage 3: maintenance
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.
People generally stay on lenalidomide maintenance for about two years. Some people will stop because they have side effects or because it stops working. Lenalidomide is a tablet you can take at home.
Worried about anything or have questions?
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