There’s no cure for multiple myeloma, but remission is possible with treatment. If your multiple myeloma treatment doesn’t work, there are many alternatives to improve your quality of life and help you live long term with the disease.
Once a doctor determines the stage of your cancer and comes up with a treatment plan, you may look forward to putting multiple myeloma behind you. There’s no cure for this type of cancer, but remission is achievable.
Of course, not everyone responds to every type of treatment. Learning that your treatment didn’t work (or that you’ve relapsed) can be frightening and discouraging.
You now have to decide the next steps in your recovery. A doctor will offer recommendations based on your individual situation.
Just because one treatment didn’t work for multiple myeloma doesn’t mean others will fail.
Doctors use your health as a basis for their initial treatment recommendations. They also base their guidance on what they believe will work at your stage, as well as where they locate the cancer cells.
Many therapies are available for multiple myeloma. These different treatments are usually called “lines.” If some lines don’t work, the doctor will suggest additional lines. Most people go through several lines of treatment as treatments stop working.
Medical professionals may treat early stages of multiple myeloma with local therapies. For example, surgery or radiation therapy that helps target tumors without affecting the rest of your body.
Doctors may select systemic treatments, such as targeted therapies, if cancer cells are present in multiple areas of your body.
It’s important to know that several treatment options exist for multiple myeloma. A doctor may suggest a combination of therapies tailored to the stage and type of cancer. These may include biological therapy (also called immunotherapy), chemotherapy, or radiation.
Immunotherapy consists of drugs that modulate your immune system to fight cancer cells. Experts consider this the future of multiple myeloma cancer treatment. This therapy consists of the following categories:
- Monoclonal antibodies: These human-made antibodies may help attack proteins on the surface of multiple myeloid cells. Examples include daratumumab (Darzalex) and isatuximab (Sarclisa) for CD38 proteins, or elotuzumab (Empliciti) for SLAMF7 proteins.
- Chimeric antigen receptor (CAR) T-cell therapy: This type of immunotherapy relies on T-cells taken from your own blood. They are then genetically modified in a lab before being placed back into your body. Due to the potential for serious side effects, medical professionals may use this type of immunotherapy as a last resort.
- Immune checkpoint inhibitors: When used in combination with other therapies, these drugs may help treat myeloid cells, according to in-vivo studies.
Chemotherapy is a powerful treatment used to kill cancer cells. While
- bendamustine (Treanda)
- cyclophosphamide (Cytoxan)
- doxorubicin (Adriamycin)
- etoposide (VP-16)
- liposomal doxorubicin (Doxil)
- melphalan
Also, a healthcare professional may prescribe a steroid such as prednisone to offset some chemotherapy side effects while also suppressing inflammation and cancer cell growth.
Radiation uses beams of high energy to shrink malignant cells and stop cancer growth. Commonly used for solitary plasmacytomas, healthcare teams may also consider radiation therapy in cases of bone damage or a nonresponse to chemotherapy.
Clinical trials or experimental drugs are another option when a prior therapy doesn’t work. These controlled research studies help discover new strategies and medications for fighting certain types of diseases. Ask a doctor for information on clinical trials.
Multiple myeloma is a blood cancer. You may be a candidate for a bone marrow transplant (also known as a stem cell transplant) when other therapies prove ineffective.
Bone marrow is a soft tissue inside your bone that creates blood-forming cells. This procedure transplants a donor’s healthy blood-forming cells into your body. Transplantation replaces your diseased cells with healthy cells, which can help you recover.
A bone marrow transplant can sometimes have high risk complications. Make sure you understand the complications of this procedure.
You’ll want to reduce the likelihood of your body rejecting the new bone marrow. To do this, you’ll take medication before the procedure to suppress your immune system.
You’ll also remain in the hospital for weeks after the transplant. And because there’s the risk of infection, you’ll be confined to a germ-free room until your immune system recovers and strengthens.
Your doctor may suggest maintenance therapy after a bone marrow transplant. You’ll take low doses of a targeted drug for an extended period of time to keep the disease in remission.
Keep in mind that if you choose to continue cancer treatments and extend your life, palliative care is still an option. You’ll receive medication to treat the cancer and relieve symptoms at the same time.
Palliative care is different from other types of therapies. Instead of treating the illness and extending your life, palliative care focuses on relieving symptoms like pain and nausea.
It helps you enjoy a better quality of life. It may include drug therapy, nutritional guidance, physical therapy, occupational therapy, and counseling.
At any point in the multiple myeloma experience, you may receive a referral or ask for a referral to receive palliative care. These trained professionals can support any symptoms affecting your quality of life or other supportive care needs.
Before deciding next steps, have an honest conversation with a doctor to discuss your outlook. Sometimes, multiple myeloma doesn’t respond despite aggressive treatments. So even if you proceed with another therapy, the disease may progress and your health may decline.
If a doctor believes that treatment won’t improve your condition, you may decide to forgo putting your body through the stress of chemotherapy, radiation, or a bone marrow transplant. If so, the next step may be palliative care.
Some drugs administered during this period are like those used to treat cancer. The end goal is to help you live in as much comfort as possible.
When multiple myeloma progresses to the point of being at the end stage, your doctor may recommend hospice care. This care is unique because it treats you, not the disease. The purpose is to enhance your quality of life during this time.
Hospice care can occur in a nursing home or in your own home.
You likely won’t receive chemo or radiation to treat the cancer. But you could receive them if a doctor used them primarily to improve your symptoms like bone pain or difficulty breathing. You may continue to receive treatment for pain or nausea.
You can still be active and energetic in the early stages of hospice care. It’s important to stay as active as possible and live life to the fullest.
Contrary to what some people believe, you don’t have to be immobile to qualify for hospice care. Also, turning to this option doesn’t mean that you’ve given up. It’s a choice, and there’s no reason why you shouldn’t be comfortable during your final days.
Multiple myeloma can be unpredictable, but don’t let a relapse or a nonresponse to therapy discourage you. There isn’t a cure for this type of cancer, but it’s possible to live long term with the disease.
Talk with a doctor and discuss your options and, if necessary, get a second opinion. This can help you decide which steps to take next.