Multiple Myeloma: Chemotherapy

What is chemotherapy? 

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cells that grow quickly, like cancer cells. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemo be used to treat multiple myeloma? 

In some cases chemo may be used as a main treatment for myeloma. But that is not very common. It's more likely that chemo may be used:

• Before you have a stem cell transplant (called induction therapy)

• Together with another medicine

• After a stem cell transplant to help keep the myeloma from coming back (called maintenance therapy)

• To help reduce pain and manage other symptoms if your cancer is advanced

How is chemo given for multiple myeloma?

Before treatment starts, you’ll meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines. The provider will talk with you about your treatment options and tell you what you can expect.

The chemo medicines used to treat multiple myeloma can be given in these ways:

• IV (intravenous) infusion. You’ll get the medicine right into your blood through a tube (catheter) that has been put into a vein. It may drip in slowly over a few hours. Or you may get it over a few minutes.

• Shot (injection). The medicine is given as an injection under your skin into tissue.

• Oral. You swallow these medicines as pills or liquids.

Oral chemo medicines can be taken at home.

Chemo medicines given by IV or injection are most often given in an outpatient setting. This means you get them at a hospital, clinic, or healthcare provider's office. Then you go home after treatment. In rare cases, you may need to stay in the hospital during treatment.

Your treatment team will watch you for reactions during your treatments. For chemo given by IV or injection, each treatment may take a while. So you may want to bring something that’s comforting to you, like music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, you’ll get chemo in cycles. Each cycle consists of 1 or more days of treatment, followed by some time to rest. In general, cycles last 2, 3, or 4 weeks. The number of treatment days in each cycle and the number of cycles given depends on the chemo regimen chosen. Your healthcare provider will discuss your treatment schedule with you.

What types of chemo medicine are used to treat multiple myeloma?

Types of chemo medicines used

Chemo is most often used when a stem cell transplant is planned. But it can be used when it's not, too. Common chemo medicines used to treat myeloma are:

• Bendamustine

• Cyclophosphamide

• Cisplatin

• Doxorubicin

• Etoposide

• Melphalan

• Vincristine

In many cases a chemo medicine will be used together with other types of medicines. These can include corticosteroids (steroids). Or medicines to help your immune system fight the cancer (immunomodulating medicines).

What are common side effects of chemo?

Side effects are common with chemo. But it's important to know that they can often be controlled and sometimes even prevented. Most side effects go away after treatment ends. Side effects vary from person to person. This will depend on the type and amount of medicines you are taking.

Some common side effects of chemo include:

• Hair loss

• Nausea and vomiting

• Mouth and throat sores

• Diarrhea

• Loss of appetite

• Changes in how things taste

Chemo can result in low blood counts. This can cause the following symptoms:

• Infections from low white blood cell levels

• Easy bleeding or bruising from low blood platelet levels

• Extreme tiredness (fatigue) from low red blood cell levels

Most side effects are short-term. They go away over time after treatment ends. But some can be long-lasting.

Ask your healthcare provider for details about the side effects of the medicines you're getting. Find out what can be done to help prevent them.

Working with your healthcare team

It's important to know which medicines you're taking. Write their names down, and ask your healthcare team how each medicine works and what side effects each might have.

Talk with your healthcare providers about what signs to look for and when to call them. For instance, chemo can make you more likely to get infections, which can cause fever and chills. You may be told to check your temperature and stay away from people who are sick. You may need to call if you have a fever or chills. Make sure you know what number to call with questions. Is there a different number for evenings, weekends, and holidays?

It may be helpful to keep a diary of your side effects. Write down physical, mental, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.