Doctors often consider a combination of medications to treat multiple myeloma, including chemotherapy, various immunotherapies, and other supportive drugs to help with complications like bone disease.

Multiple myeloma is a type of cancer that affects plasma cells in the bone marrow. Treating multiple myeloma often requires different types of medications to control it effectively.

Multiple myeloma medications work together to destroy myeloma cells, boost the immune system, and support bone health.

This article will discuss different classes of multiple myeloma medications, including how they work, their effectiveness, and potential side effects or risks.

Chemotherapy targets and destroys rapidly dividing cancer cells. These medications are highly effective in reducing the number of myeloma cells in the body.

Your doctor can administer these medications orally, intravenously, or through injections. Doctors also often administer chemotherapy drugs in combination with other treatments, such as radiation or surgery, to enhance their effectiveness.

Common examples of chemotherapy drugs for multiple myeloma include:

Commonly reported side effects include:

  • nausea
  • vomiting
  • hair loss
  • increased risk of infections

Long-term use of chemotherapy medications can also lead to secondary cancers and damage to other organs like the heart and kidneys.

Immunomodulators (IMiDs) enhance your body’s immune response, preventing the growth of myeloma cells and blocking the formation of blood vessels that tumors need to grow.

IMiDs have significantly improved the outlook for people with multiple myeloma, offering better treatment responses and longer survival times.

Common examples include:

  • thalidomide (Thalomid)
  • lenalidomide (Revlimid)
  • pomalidomide (Pomalyst)

Despite their efficacy, immunomodulators have several side effects and risks, including:

If taken during pregnancy, these medications can also cause severe structural irregularities in newborns. To protect against this, strict birth control measures are necessary.

Proteasome inhibitors block the action of proteasomes, which are involved in breaking down unneeded or misfolded proteins within cells. This leads to the accumulation of proteins that can cause cancer cell death.

Proteasome inhibitors for treating multiple myeloma include:

Proteasome inhibitors have proven effective in treating multiple myeloma, whether used alone or in combination with other treatments.

Side effects of proteasome inhibitors include:

Your doctor will monitor you carefully for side effects when taking proteasome inhibitors. Sometimes, they may need to adjust the dose to ensure your treatment is as safe and effective as possible.

Monoclonal antibodies are a class of immunotherapy drugs that target specific antigens on cancer cells. For multiple myeloma, these antibodies bind to antigens on the surface of myeloma cells, marking them for destruction by the immune system.

Monoclonal antibodies have shown promising efficacy in improving survival rates and managing multiple myeloma, particularly in people who have relapsed or are resistant to other treatments.

The currently approved monoclonal antibodies for multiple myeloma include:

Monoclonal antibodies may cause infusion-related reactions, which can cause various symptoms, such as fever, chills, and difficulty breathing. However, your doctor may prescribe other medications that can help you manage these reactions.

Other side effects include:

  • nausea
  • fatigue
  • diarrhea
  • low blood cell counts

BiTEs are a newer class of medications that engage T cells to target and destroy myeloma cells. These medications have shown promising results in clinical trials, especially for people with relapsed or refractory multiple myeloma.

Common examples of BiTEs include:

Possible side effects may include toxic effects on your nervous system and cytokine release syndrome (CRS). CRS is a severe immune reaction that can occur after treatment.

Symptoms of CRS include:

  • fever
  • fatigue
  • headache
  • low blood pressure

Nuclear export inhibitors such as selinexor (Xpovio) are a class of medications that block the export of cancer-related proteins from the nucleus, leading to cancer cell death.

Research shows that nuclear export inhibitors can be effective in treating multiple myeloma, especially in people who have become resistant to other therapies.

Side effects include:

  • nausea
  • fatigue
  • low platelet count
  • weight loss

Combination treatments for multiple myeloma

Combination treatments for multiple myeloma involve using two or three therapeutic agents together to enhance efficacy and overcome drug resistance.

This approach can include a combination of different drug classes, such as immunomodulators, proteasome inhibitors, monoclonal antibodies, and corticosteroids.

By targeting multiple pathways simultaneously, combination treatments aim to achieve better outcomes than single-agent therapies, leading to improved response rates, longer remission periods, and better overall survival.

CAR T-cell therapy involves taking your T cells, genetically modifying them to target myeloma cells, and then infusing them back into your body.

Clinical trials have shown promising results, with many people experiencing significant remission, which means the signs and symptoms of cancer are reduced or disappear.

CAR T-cell therapies for multiple myeloma include:

  • idecabtagene vicleucel (Abecma)
  • ciltacabtagene autoleucel (Carvykti)

Possible side effects and risks include:

  • CRS
  • nervous system problems such as confusion and seizures
  • low blood cell counts

Due to the potential for severe side effects, your healthcare team may need to monitor you closely.

Corticosteroids reduce inflammation and suppress the immune system, which can help control the abnormal growth of plasma cells in multiple myeloma.

Your doctor may prescribe corticosteroids alone or combine them with other chemotherapy drugs to enhance their effectiveness and manage symptoms caused by chemotherapy.

They include:

Possible side effects include:

  • high blood sugar
  • changes in mood
  • weight gain

Long-term use can also weaken bones and suppress the immune system, increasing the risk of infections.

Bisphosphonates help treat bone disease in multiple myeloma by inhibiting osteoclasts, cells that break down bone tissue. Bisphosphonates help reduce bone resorption and strengthen bones.

These medications have proven efficacy in reducing skeletal-related events, such as fractures, spinal cord compression, and the need for radiation or surgery to bone.

Common examples include pamidronate (Aredia) and zoledronic acid (Zometa). Doctors may also use denosumab (Xgeva) to treat myeloma bone disease. Denosumab isn’t a bisphosphonate, but a RANK ligand inhibitor.

Possible side effects include:

  • diarrhea
  • abdominal pain
  • flu-like symptoms such as fevers and headaches
  • low calcium levels (hypocalcemia)

Rare side effects include osteonecrosis of the jaw, which is a serious condition involving the death of bone tissue in the jaw.

Treating multiple myeloma involves using various medications, such as immunomodulators, proteasome inhibitors, and monoclonal antibodies.

Combination treatments and CAR T-cell therapy provide advanced options, while corticosteroids and bisphosphonates offer essential supportive care.

Talk with your healthcare team about which medications may best suit you and what side effects you may expect.