How to Effectively Treat Multiple Myeloma: A Comprehensive Guide
Once a patient is diagnosed with multiple myeloma, prompt and systematic treatment by a hematologist is essential. This blood cancer requires long-term, specialized management tailored to the individual's age, overall health, and financial circumstances. The primary goal is not only to control disease progression but also to minimize complications and improve quality of life. Treatment typically follows a phased approach: induction therapy, consolidation therapy, and maintenance therapy.
Understanding the Standard Treatment Phases
Induction therapy is the first step after diagnosis, designed to rapidly reduce the number of abnormal plasma cells in the bone marrow. Modern regimens often combine targeted drugs such as proteasome inhibitors (e.g., bortezomib), immunomodulatory agents (e.g., lenalidomide), and corticosteroids like dexamethasone. If a patient achieves at least a partial response (PR) or better, further treatment options are considered based on their eligibility for more intensive procedures.
Role of Stem Cell Transplantation
For eligible patients—typically those under 65 years old with good organ function—autologous hematopoietic stem cell transplantation (HSCT) is often recommended during the consolidation phase. This procedure involves collecting the patient's own stem cells before high-dose chemotherapy, then reinfusing them to restore bone marrow function. Studies show that transplant-eligible patients who undergo this treatment tend to have longer remission periods and improved survival outcomes.
Following transplantation, maintenance therapy plays a crucial role in sustaining remission. Drugs like lenalidomide are commonly used for this purpose, helping to suppress residual cancer cells over an extended period. This phase may last several years and is adjusted based on the patient's tolerance and ongoing response.
Managing Bone-Related Complications
Bone destruction is one of the hallmark features of multiple myeloma. Lytic lesions, fractures, and spinal compression can severely impact mobility and cause chronic pain. To counteract bone loss, most patients receive regular infusions of zoledronic acid, a bisphosphonate that inhibits osteoclast activity and reduces skeletal-related events.
In general, zoledronic acid is administered every 3–4 weeks for up to two years, provided no new bone lesions develop. For patients with severe vertebral fractures affecting daily activities, orthopedic intervention may be necessary. Procedures such as kyphoplasty or vertebroplasty—where bone cement is injected into fractured vertebrae—can stabilize the spine, relieve pain, and restore some physical function.
Protecting Kidney Function During Treatment
Renal impairment affects nearly half of all multiple myeloma patients at diagnosis. Because the abnormal proteins produced by myeloma cells can damage the kidneys, maintaining proper hydration and urine alkalization is critical. Patients are encouraged to drink plenty of fluids unless contraindicated.
Careful medication selection is equally important—doctors avoid nephrotoxic drugs and adjust dosages of chemotherapy agents when kidney function is compromised. With early and appropriate interventions, many patients experience partial or even complete recovery of renal function, which significantly improves prognosis and overall treatment tolerance.
Ultimately, managing multiple myeloma is a multidisciplinary effort involving hematologists, oncologists, nephrologists, orthopedic surgeons, and supportive care specialists. Personalized treatment plans, continuous monitoring, and proactive complication prevention are key to extending survival and enhancing the patient's quality of life in the long term.