Chemotherapy
The main treatment of myeloma is chemotherapy. There are two approaches to chemotherapy; the approach used will depend on the age and fitness of the person-:
- High dose chemotherapy and stem cell transplantation – this is a disabling treatment with a recovery time of up to 2 years –people under 65 or who are ‘fit’ are likely to have this treatment. With no cure at 4 years, 50% of people treated will be alive. At 8 years 20% of people treated will be alive.
- Standard chemotherapy which aims to control the disease for a time
High dose chemotherapy and stem cell transplantation
This is an intensive treatment approach. It typically involves the person’s own stem cells being used – this is called an autologous transplant. People of working age are likely to be treated using this approach. This is the treatment with the best long term survival rate. However, some people of working age may not be fit enough to have this treatment. This treatment does not cure but is intended to induce a longer remission than standard out-patient type chemotherapy.
Standard chemotherapy and steroids
People who are going to have high dose chemotherapy will have a course of lower dose standard chemotherapy and steroids first to get the disease under control. This is followed by a further course of high dose chemotherapy treatment and transplant. The possible standard chemotherapy regimens are-:
- Z-Dex or IDEX Idarubicin (trade name Zavedos) with dexamethasone. These two drugs are given orally as tablets for four days every three weeks. There will be between 4 and 6 cycles given.
Disabling effects include:
- General side effects of chemotherapy
- Steroid side effects
- CDT – cyclophosphamide, dexamethasone, thalidomide. This is given orally over 4 cycles followed by high dose chemotherapy and PBSCT
Disabling effects include:
- General side effects of chemotherapy
- Steroid side effects
- Side effects of thalidomide: sleepiness, constipation, increased risk of deep vein thrombosis. Peripheral nerve damage (numbness, tingling, altered sensation) if used over a prolonged period at high doses. In order to limit these problems, the dose is usually adjusted with each cycle to minimise these risks.
- VAD – Vancomycin, doxorubicin (trade name Adriamycin) and Dexamethasone, given intravenously via a PICC line or central venous catheter. 2-4 treatments in 3 week cycles are likely to be given (maximum 6 cycles) and this takes 6-12 weeks.
Disabling effects include:
- Central or PICC line complications
- General side effects of chemotherapy
- Steroid side effects
- VAMP - Vancomycin, doxorubicin (trade name Adriamycin) and methyl prednisolone, given intravenously via a PICC line or central venous catheter. Cycles are given every 3-4 weeks; 3- 5 cycles will be needed but treatment may last longer than this.
Disabling effects include:
- Central or PICC line complications
- General side effects of chemotherapy
- Steroid side effects
- C-VAMP- Vancomycin, doxorubicin (trade name Adriamycin) and methyl prednisolone are given in 3 weekly cycles and cyclophosphamide (another chemotherapy drug) is given once a week on top. Cycles are given every 3-4 weeks; 3-5 cycles will be needed but treatment may last longer than this.
Disabling effects include:
- Central or PICC line complications
- General side effects of chemotherapy
- Steroid side effects
- Bortezomib and dexamethasone – bortezomib is given by intravenous infusion twice weekly for 2 weeks in 3 week cycles.
Disabling effects include:
- General side effects similar to thalidomide, except it may cause low platelets and bleeding disorders rather than thrombosis
- Patients may experience a change in their bowel habit- diarrhoea or constipation that may need additional medication to keep under control.
- An important side effect is peripheral nerve damage that may cause severe nerve pain, to the extent that strong pain killing medication is needed to counteract the effects. Peripheral nerve damage may affect motor function leading to difficulty using the hands or reduced mobility.
- Steroid side effects
All of these regimens take between 3 and 6 months to complete. At the end of treatment people are likely to be significantly fatigued and may have suffered significantly from chemotherapy side effects.
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Amended February 2009
