Treatment Approaches for Newly Diagnosed Multiple Myeloma Patients

Brought to you in partnership with the Multiple Myeloma Research Foundation (MMRF)

If you have been recently diagnosed with multiple myeloma, you may understandably have several questions. At the forefront of those questions may be what are your treatment options and how effective are they? The good news: your care team can help decide which course of therapy is best for you, based on your myeloma subtype and treatment goals.

For newly diagnosed myeloma patients, initial treatment usually consists of induction, or front-line therapy, which is meant to decrease disease burden to a very low or even undetectable level. Exactly which induction therapy your care team will recommend depends on whether you are a candidate for autologous stem cell transplant.

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Induction therapy choices (3-4 cycles of therapy):

For transplant eligible patients:

• 3 drug regimens, including Revlimid-Velcade-dexamethasone, Ninlaro-Revlimid-dexamethasone, Kyprolis-Revlimid-dexamethasone
• Though not preferred, some patients receive Velcade-Cytoxan-dexamethasone
• A clinical trial

For transplant-eligible patients, induction therapy is usually followed by stem cell collection and storage, high dose melphalan chemotherapy and autologous stem cell transplantation. This regimen is then followed by consolidation and/or maintenance therapy. Some patients may choose not to undergo transplantation immediately and will go directly from induction and stem cell collection to consolidation/maintenance, reserving their stem cells for an autologous transplant procedure at a later date.

For transplant-ineligible patients:

• Any of the regimens approved for transplant-eligible patients
• Darzalex-Revlimid-dexamethasone
• Revlimid-Velcade-dexamethasone lite (a lower dose of this common triplet regimen, used for frail patients)
• A 2 drug regimen such as Revlimid-dexamethasone may be considered for frail patients
• A clinical trial

Transplant-ineligible patients go directly from induction therapy of varied length to consolidation or maintenance therapy, depending on their response to induction therapy.

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Maintenance therapy

After induction and autologous stem cell transplant (if eligible), patients will either undergo observation without treatment (less common) or maintenance (continuous) therapy with an approved myeloma agent. Maintenance therapy has been shown to improve progression-free survival (it can increase the length of time the patient spends in remission before they relapse), but is also associated with treatment side effects. Revlimid is an approved maintenance therapy option, but there are also clinical trials underway to study Ninlaro, Velcade, Kyprolis, Darzalex and Empliciti as maintenance therapy options.

Treatment goals

Because there is no standard way to treat myeloma, your doctor may also work with you to create a personalized treatment plan. Treatment goals may affect the duration of the treatment you receive and include the following:

• Destroying all evidence of disease
• Preventing damage to other organs of the body by controlling the disease
• Preserving normal performance and quality of life for as long as possible
• Providing lasting relief from pain and other disease symptoms, as well as managing side effects of treatment

It’s important that you get on the right track as soon as possible to improve your outcome. As someone newly diagnosed with myeloma, MMRF encourages you to get on ‘The Right Track’, which are these 3 critical steps: 

1. Seeing the right team: First, find the right team. It is best to consult with specialists who diagnose and treat a high volume of multiple myeloma patients. You can find these specialists at National Cancer Institute (NCI)-designated cancer centers. Seeking a second opinion at any point is also highly recommended to get the best care possible.
2. Having the right tests: Next, get the right tests. Every multiple myeloma patient is different—the right tests can help speed you to a specific diagnosis and a more accurate treatment approach. You will need diagnostic tests, imaging tests and, most importantly, genomic testing—which will help determine your best treatment options. 
3. Getting the right treatment: Then, determine the right treatment for your multiple myeloma. Discuss your treatment goals with your healthcare team and know all of your treatment options at every stage of your disease. Is there a standard of treatment for your subtype? Depending on your diagnosis, a clinical trial may be the best option. Our Patient Navigation Center can help you identify treatment options and clinical trials that may be right for you.

As someone that has been newly diagnosed with multiple myeloma, it is important to know that there is no shortage of treatment options. Treatment options are constantly advancing for myeloma patients. With the right care team and treatment plan, your myeloma can effectively be treated.