Multiple myeloma is mainly treated with drugs.
Treatment of asymptomatic multiple myeloma has not been documented to extend survival. The treatment indication is primarily when the patient has clinical symptoms such as bone metastasis or sign of organ involvement such as anemia, increased tendency for infection, bone marrow failure, kidney failure, and 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 (HDT with SCS) can prolong survival in younger patients. In some cases, an allogeneic stem cell transplantation may be appropriate.
Allogeneic stem cell transplantation has curative potential and can provide a very long remission in those with a suitable donor. However, the risk of fatal or troublesome side effects is so substantial that the treatment is rarely used. Allogeneic stem cell transplant with reduced pre-treatment is under evaluation in multiple studies and is so far not established in the primary treatment.
Patients who cannot be offered high-dose treatment are given chemotherapy to improve quality of life and prolong survival