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Treatment of multiple myeloma

Multiple myeloma is treated mainly 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.  

The goal of the treatment is:

  • control the disease
  • improve quality of life
  • prolong survival 

Treatment > 65 years

Since 1950, standard treatment of a biological age > 65 years has been oral melphalan combined with prednisolone administered in 4-6 week intervals. This treatment provides a significant extension in survival time. More than half of the patients respond with a fall in M-component and symptomatic relief.  

Other more toxic chemotherapy combinations have not been shown to be more beneficial than the melphalan-prednisolone combination, either in survival time or life quality.

MP with addition of thalidomid (MP-T):

MP-T is compared to MP in several randomized studies. The combination has a faster and better effect, and two of the studies also show an advantage in survival in Four of MP-T. Thalidomide, however, is not without side effects, especially in the elderly. These side effects must be weighed against the possibility of prolonged survival in each particular case.

MP with addition of bortezomib (B)/lenalidomide (L):

MP with addition of bortezomib (B), alternatively lenalidomide (L) also seems to improve the response and time to progression compared to MP, but so far the documentation is somewhat more sparse. There are no studies comparing the three newer regimens.

It is likely that the treatment algorithms will change in forthcoming years when data are generated from clinical studies. 

Treatment < 65 years

Standard treatment for patients < 65 years in biological age is HMAS (high-dose treatment with autologous stem cell support).

The availability of new medications such as thalidomide, bortezomib, and lenalidomide extend survival after progression. 

Treatment of solitary tumor

A small amount of patients have a solitary tumor of monoclonal plasma cells (localized disease/plasmacytoma) either in bone or extramedullary. Some of these patients can be cured with radiation and/or surgery. However, these patients must be monitored carefully for possible development of multiple myeloma.

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