Myeloma Nurse Learning Programme Module 5 – Treatment for myeloma Treatment for myeloma

Treatment for myeloma

The options for initial or first-line treatment depend on whether patients are eligible for high-dose chemotherapy and autologous stem cell transplantation (HDT-SCT).

Generally, patients under 70 years of age, who are in relatively good health with adequate kidney, lung and heart function, are suitable candidates. It should be noted though that increasingly, rather that focus largely on age, frailty and fitness scoring systems are being used to guide treatment decisions.

First-line treatment for newly diagnosed patients can therefore be divided into the following categories:

Non-intensive treatment generally for older and/or less fit patients
This type of treatment does not involve HDT-SCT and is generally, but not restricted to, patients over the age of 70 and/or are less medically fit. Drugs are given at standard or reduced doses as intensive treatment with higher doses are considered too toxic for older and/or less medically fit patients.
Intensive treatment generally for younger and/or fitter patients
Intensive treatment for younger and/or fitter patients involves treatment with a combination of drugs at standard dose (referred to as induction treatment) which is almost always followed by HDT-SCT. . This approach is considered to offer a chance of a good depth and duration of response and potentially improved survival. However, there are considerable side effects associated with high doses of chemotherapy.

Treatment decisions should be made within the context of a multidisciplinary team. Individual patient factors and patient preference must be considered. For example, not all patients who are candidates for intensive treatment wish to proceed. Wherever possible, patients should also be encouraged to take part in clinical trials as it provides them with an opportunity to access new drugs being developed for myeloma or new ways of using existing drugs.

Nurses play an important role in providing appropriate and relevant information on treatment options and clinical trials available. They are well placed to answer any questions and to help patients make an informed decision.

Treatment for myeloma

Further reading