The WashU Medicine physicians at Siteman are the most experienced myeloma specialists in the region. They treat this disease every day, and they build your plan around your specific diagnosis.
Myeloma as a Chronic Disease
There is not a cure for multiple myeloma yet. But our WashU Medicine specialists are skilled at managing it as a chronic disease. We can slow or stop its progression, control your symptoms, and in many cases achieve long-term remission. Our goal is to increase your survivability and help you live well, not just longer.
Most people with myeloma are treated with combinations of medications. These drug regimens are highly effective at controlling the disease.
The right treatment depends on your specific diagnosis, your genetics, your overall health, and your prior therapies. That is why specialist experience matters. At Siteman, a dedicated myeloma team matches you with the right therapies at the right time.
Research is changing what is possible for our patients. Our WashU Medicine physicians at Siteman lead clinical trials that produced two of myeloma’s most important recent advances: CAR T-cell therapy and bispecific antibodies. When you are treated here, that research is available to you.
What treatment could I have for my multiple myeloma?
Your treatment plan may include one or more of the following:
- Drug therapy (This is sometimes called “medical therapy.”)
- Immunotherapy
- Monoclonal antibodies
- CAR T-cell therapy
- Bispecific antibody therapy
- Stem cell transplant
- Radiation therapy
- Surgery (This is rare.)
What is drug therapy for multiple myeloma?
Drug therapy is the most common first treatment for myeloma. These combinations of medicines target myeloma cells and keep the disease in check. Drug therapies include:
- Proteasome inhibitors
- Immunomodulatory drugs
- Chemotherapy
- Immunotherapy
- Monoclonal antibodies
- CAR T-cell therapy
- Bispecific antibodies
- Corticosteroids
What are proteasome inhibitors?
Proteasome inhibitors are the first line of drug therapy for multiple myeloma patients. They can be given as an injection, IV infusions, or in pills.
These drugs block proteasomes. Proteasomes are like recycling centers in cells. Myeloma cells need proteasomes to survive. When the drug blocks them, the myeloma cells die.
What are immunomodulatory drugs?
Immunomodulatory drugs are taken as pills. There are many kinds of these medications, but each can alter the immune cells and how they behave. Because these medications change how B cells, T cells, or other immune cells work, they disrupt how multiple myeloma cells are growing. Patients might receive immunomodulatory drugs in combination with other therapies to increase their effectiveness.
Chemotherapy for multiple myeloma
Chemotherapies are drugs that kill cancer cells. Doctors usually give them through an IV, although some chemotherapies are now available as pills or injections.
Chemotherapy is almost always given alongside other treatments. Because so many effective new options now exist, it is rarely used on its own.
Immunotherapy for multiple myeloma
Immunotherapies help a patient’s immune system recognize and destroy cancer cells that are in their body. Cancer cells do a good job of hiding from the body’s natural immune system. Immunotherapies show the body where harmful cells are and give them a way to kill them. The current FDA-approved immunotherapy drugs kill myeloma cells by attaching themselves to them cells. This is how antibodies and T cells are able to attack multiple myeloma.
There are a few different types of immunotherapies:
- CAR T-cell therapy
- Monocolonal antibodies
- Bispecific antibodies
CAR T-cell therapy: CAR T-cell therapy uses a patient’s T ells and changes them to have a small molecule added to it. This molecule is called a “chimeric antigen receptor,” or “CAR.” Before they are changed, multiple myeloma cells are able to hide from T cells. But the created CAR T-cells can see that multiple myeloma cells are dangerous. The CAR part of the T cell sticks to the myeloma cells and attacks them.
Monocolonal antibodies: Patients with multiple myeloma are most often treated with monoclonal antibodies, which are lab-created antibodies that attach to cancer cells and prompt the immune system to attack them.
Bispecific antibodies: A bispecific antibody is another kind of monocolonal antibody. A bispecific antibody attaches to two (bi) parts of the myeloma cell, and a monocolonal antibody attaches to just one (mono).
Stem cell transplant for multiple myeloma
Some patients with myeloma receive a stem cell transplant, also called a bone marrow transplant. The transplant returns healthy stem cells in your bone marrow so your body can make new, healthy blood cells. The goal is to achieve long-term remission, one where the myeloma cells are no longer active.
Multiple myeloma is treated with autologous transplants, where your own stem cells are used. Other transplants are rarely, if ever, used for myeloma.
What is an autologous transplant?
In an autologous transplant, your own stem cells are collected and stored before treatment begins. Think of it as donating to yourself. No outside donor is needed.
After your stem cells are stored, you receive intensive chemotherapy to destroy the myeloma cells. Then your stored stem cells are returned through an IV. Because they were never exposed to chemotherapy, they are still healthy. These cells act quickly to rebuild your immune system.
When do patients with multiple myeloma receive radiation therapy?
Radiation is not used for survivability with myeloma, but it is an important tool for managing symptoms. It can reduce bone pain and help prevent fractures where myeloma has weakened the bone.
If your radiation oncologist recommends radiation for you, they will be precise with how they use it. To make sure you only get the radiation you need, they use CT simulations to target radiation beams. This directs the radiation beams to keep healthy tissue safe.
Is surgery ever used to treat multiple myeloma?
Surgery is almost never used to treat multiple myeloma. Rarely, a lymph node may need to be removed, but this is highly uncommon.
Myeloma cells can occasionally form tumors, but surgery for them is uncommon. Plasmacytoma is a related but distinct condition that can sometimes be treated with surgery. But it is not the same as multiple myeloma.
Your Second Opinion at Siteman
Siteman wants to be your first choice for cancer care, but that might not always be possible. If you have received a cancer diagnosis, started care somewhere else, or are a physician seeking specialized care for your patient, ask us about a second opinion. You can start the process. To make it easy, our care coordinators guide scheduling for yourself or your patient.
