Multiple myeloma is mainly treated with drugs.
Treatment of smouldering multiple myeloma has not been documented to extend survival. The treatment indication is primarily when the patient has clinical symptoms such as osteolytic lesions or signs of organ involvement such as anemia, renal failure, or hypercalcemia, or the presence of biomarkers as pathological light chain ratio (> 100), very large number of plasma cells (>60%) or more than one lesion at MRI scan.
The goal of the treatment is:
- improve quality of life
- prolong survival
High-dose chemotherapy with autologous stem cell support (ASCT) can prolong survival in younger patients. In rare cases, an allogeneic stem cell transplantation may be alternative.
Allogeneic stem cell transplantation has curative potential. However, the risk of fatal or troublesome side effects is so substantial that the treatment is rarely used. Allogeneic stem cell transplantation is so far not established in the routine treatment.
Patients who cannot be offered high-dose treatment are given myeloma directed drugs to improve quality of life and prolong survival.