What is the first line treatment of Myeloma?

This section covers the common diffuse type of myeloma, treatment of localised extramedullary or isolated plasmacytoma are described separately. Treatment of myeloma is quite effective at prolonging survival for a period but it rarely cures the disease completely. If myeloma is not causing too many symptoms this might be called asymptomatic myeloma or ‘smouldering’ myeloma in the medical evidence. Treatment can be postponed until symptoms occur. These people will be monitored closely with frequent blood tests and begin treatment if the disease progresses or if they develop symptoms.

People with symptoms or signs of organ damage begin treatment immediately. The aim of treatment is to reduce the amount of myeloma in the body or put the disease into remission. If remission is achieved further treatment may be given to prolong remission for as long as possible, this is called ‘maintenance therapy’. Response to treatment is monitored by periodically checking the amount of myeloma (M) protein in the urine or blood.

• Myeloma that is improving with treatment is called ‘responsive’
• Myeloma that responds to treatment up to a point and then remains stable for a minimum of a few months is described as ‘stable’ or ‘plateau’.
• Myeloma that gets worse on treatment is called ‘progressive’.
• Myeloma that initially responded to treatment but then gets worse is called ‘relapsing’.

Amended February 2009