Chemotherapy is sometimes used to treat multiple myeloma, although this is less common due to newer treatments. When it is used, it’s often in combination with other drugs.

Chemotherapy, often referred to as chemo, may be used to treat multiple myeloma (MM). However, chemo for MM has become less common due to the emergence of newer treatments.

Below, we go deeper into the goals of chemo treatment for MM, the specific chemo drugs used, and the types of side effects to be aware of.

The goal of chemotherapy for MM is to slow or stop the growth of the cancer. Depending on where you are in your MM journey, this can help prepare you for the next phase of your treatment or can work to keep your cancer in remission.

Chemo may still be used in some phases of MM treatment. The phases of MM treatment are:

  • Induction: Induction is the initial part of your MM treatment. Its goal is to reduce the amount of cancer in your body. This may or may not include chemo, often alongside other drugs used to treat MM.
  • Consolidation: Consolidation is a short course of chemo or other drugs sometimes given after a stem cell transplant, one of the main treatments for MM. It helps eliminate any remaining cancer cells.
  • Maintenance: Maintenance works to help keep your MM in remission. Chemo isn’t typically used in this phase. Instead, maintenance typically involves immunomodulating drugs or targeted therapy drugs.

Learn more about multiple myeloma (MM).

Several chemo drugs may be used to treat MM. These include:

The types of treatment that are planned affect which chemo drugs may be used. Some chemo drugs, such as melphalan, can damage the bone marrow. As such, these types of chemo drugs may not be used for people who are having a stem cell transplant.

Chemo for MM is often combined with other types of treatment, such as:

  • targeted therapy
  • immunomodulatory
  • corticosteroids

An example of such a combination is bortezomib, cyclophosphamide, and dexamethasone.

Chemo drugs can also impact healthy, quick growing cells in the body. Because of this, chemo is associated with a variety of side effects.

Some common short-term side effects of chemo include:

These side effects typically go away after you stop chemo. However, there are also some side effects of chemo that can show up months or years later. These are called late effects and may include:

The outlook for people who receive chemo for MM can depend on many factors. These include:

  • the extent and characteristics of your MM
  • the type of chemo drugs used
  • the other types of MM treatment used with or after chemo
  • how your MM responds to your treatment plan
  • whether you’re being treated for a cancer relapse
  • your age and overall health

According to the National Cancer Institute, the relative 5-year survival rate for MM is 57.9%. This is the 5-year survival rate of people with MM compared with people who do not have MM. The relative survival rate is one way to show whether MM shortens the life span of people who have it.

When we discuss cancer outlook, know that outlook statistics don’t take individual factors into account. They also may not reflect recent advances in treatment.

There are potential alternative drug combinations used to treat MM that do not include chemo. These typically include combinations of the following drug types:

One example of a common drug combination for MM that doesn’t include chemo is bortezomib, lenalidomide, and dexamethasone.

If a stem cell transplant is recommended as a part of your treatment, you will likely receive high dose chemo as a part of that procedure. However, in some situations, radiation may be used instead.

Lastly, if other MM treatments haven’t been effective, another potential treatment option is CAR T-cell therapy. This is a type of immunotherapy that modifies immune cells collected from your blood so they attack cancer cells.

Can pregnant people get chemotherapy for multiple myeloma?

First, MM during pregnancy is very rare. A 2022 case report and review notes that, between 1965 and 2020, only 44 instances of MM around or during pregnancy were described in the medical literature.

Some chemo may be given during pregnancy. A 2021 study found that chemo is associated with an increased risk of major birth defects only in the first 12 weeks of pregnancy.

Can I breastfeed during chemotherapy for multiple myeloma?

No. Some chemo drugs may be present in breast milk. This means they may be passed to your baby when you breastfeed.

Talk with your care team about when it’s safe to resume nursing after your chemo treatment has concluded.

Can I get vaccines while I’m having chemotherapy for multiple myeloma?

Yes, you can get some vaccines while you’re undergoing chemo. Because chemo weakens your immune system, these vaccines can help protect you from potentially serious illnesses.

The Centers for Disease Control and Prevention (CDC) notes that it’s important for people with cancer to get the flu shot and possibly the pneumonia shot.

The National Comprehensive Cancer Network also recommends that all people with cancer get vaccinated against COVID-19.

Can multiple myeloma come back after chemotherapy?

Yes, it’s possible for MM to come back after chemo and other treatments. This is called a relapse. A 2022 article notes that almost all people with MM will eventually have a relapse.

Having a relapse early after your initial treatment is associated with poorer outcomes. A 2016 study involving 511 people with MM found that 82 (16%) experienced an early relapse. The median time to relapse in this group was 8 months.

Chemo is sometimes a part of MM treatment. However, its use for MM outside of a stem cell transplant is becoming less common due to newer treatments. When it is used, chemo is typically given in combination with other types of drugs.

Chemo drugs can lead to both short- and long-term side effects. If chemo is recommended as a part of your MM treatment, be sure to discuss its various risks and benefits with your care team beforehand.