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Multiple myeloma is a cancer of the plasma cells in your bone marrow. When plasma cells divide out of control, they crowd out healthy blood cells like red blood cells, white blood cells, and platelets, causing the symptoms of multiple myeloma.

Multiple myeloma isn’t a very common type of cancer. The American Cancer Society estimates that an individual’s lifetime risk of developing multiple myeloma is about 1 in 132 (0.76 percent).

There are many different treatment options for multiple myeloma. Which one is recommended to you can depend on factors like your age, overall health, and the stage of the cancer.

Below, we’ll break down each of the potential treatment options for multiple myeloma, when they’re used, and their possible side effects. Keep reading to discover more.

A stem cell transplant uses a high dose of chemotherapy to kill the cells in your bone marrow, including both healthy and cancerous cells. Afterward, you receive a transplant of healthy stem cells to replace the cells in your bone marrow.

Good candidates for a stem cell transplant are typically younger than age 65 and in good health. Individuals between the ages of 65 and 75 may also be considered for a stem cell transplant based off of an evaluation by their doctor.

Most of the time, the stem cells used for a stem cell transplant are collected from you prior to the high-dose chemotherapy. This is called an autologous stem cell transplant.

Sometimes, stem cells are collected from a donor, typically a sibling, instead. This is called an allogeneic stem cell transplant. Allogeneic stem cell transplants are much less common than autologous stem cell transplants.

Prior to receiving a stem cell transplant, you’ll undergo a phase of treatment called induction therapy to reduce the amount of cancer in your body. This can include the use of one or a combination of the following:

  • chemotherapy
  • targeted therapy
  • immunotherapy
  • corticosteroid therapy

You’ll also receive similar treatments to the ones listed above after your stem cell transplant. This is called maintenance therapy and helps to prevent cancer from recurring.

Side effects of stem cell transplants

The potential side effects of stem cell transplants are similar to those of chemotherapy or radiation therapy and can include things like:

If you had an allogeneic stem cell transplant, there’s also a risk of a serious side effect called graft-versus-host disease. This is when the transplanted cells see your own tissues as foreign and react to them.

Targeted therapy is a type of cancer treatment that uses drugs that specifically target proteins that are present on or in cancer cells. In this way, they’re less harmful to healthy cells than chemotherapy or radiation therapy.

Targeted therapy can be given by mouth, injected, or given by IV. The method and frequency of administration can depend on the specific type of drug that’s being used.

There are several different types of targeted therapy that can be used for multiple myeloma:

  • Monoclonal antibodies: Monoclonal antibodies attach to specific proteins on the surface of cancer cells. This can either kill them or prevent them from growing. They can also be used to carry drugs directly to cancer cells. Examples are:
    • daratumumab (Darzalex)
    • elotuzumab (Empliciti)
    • isatuximab (Sarclisa)
    • belantamab mafodotin (Blenrep)
  • Proteasome inhibitors: Cells use an enzyme complex called a proteasome to get rid of proteins they no longer need. When targeted therapy inhibits the proteasome, accumulation of proteins cause the cancer cell to die. Examples include:
    • bortezomib (Velcade)
    • carfilzomib (Kyprolis)
    • ixazomib (Ninlaro)
  • Histone deacetylase (HDAC) inhibitors: HDAC inhibitors block enzymes that are vital for the growth and division of cancer cells. An example of an HDAC inhibitor for multiple myeloma is panobinostat (Farydak).
  • Nuclear export inhibitors: Nuclear export inhibitors inhibit a protein that helps to transport other proteins in and out of the cell’s nucleus. Selinexor (Xpovio) is a nuclear export inhibitor that can be used for multiple myeloma.

Targeted therapy is used for:

  • induction therapy and maintenance therapy in those receiving a stem cell transplant
  • treatment of individuals that aren’t eligible for a stem cell transplant
  • multiple myeloma that’s relapsed or has been resistant to other treatments

Side effects of targeted therapy

The side effects associated with targeted therapy can depend on the type that’s used.

Some of the potential side effects of monoclonal antibodies are:

The side effects of proteasome inhibitors can include:

The possible side effects of HDAC inhibitors can include:

  • fatigue
  • fever
  • nausea or vomiting
  • diarrhea
  • feelings of weakness
  • reduced appetite
  • swelling in the arms or legs
  • low blood counts
  • changes in mineral levels, such as those of sodium, potassium, and calcium

Some of the side effects of nuclear export inhibitors can include:

Immunotherapy is a type of cancer treatment that harnesses the power of your immune system to respond to the cancer cells. There are a couple different types of immunotherapy that can be used for multiple myeloma:

  • Immunomodulators: Immunomodulators affect the immune system through an unclear mechanism. Some examples of immunomodulators for multiple myeloma include:
    • thalidomide (Thalomid)
    • lenalidomide (Revlimid)
    • pomalidomide (Pomalyst)
  • CAR T-cell therapy: In this treatment, T cells are removed from your body and are modified in a laboratory to be able to target cancer cells. They’re then placed back into your body, where they can identify and destroy cancer cells. Idecabtagene vicleucel (Abecma) is the type of CAR T-cell therapy used for multiple myeloma.

Immunomodulators are taken orally. CAR T-cell therapy is given by IV.

Immunotherapy is used for:

  • induction therapy and maintenance therapy in those receiving a stem cell transplant
  • treatment of individuals that aren’t eligible for a stem cell transplant
  • multiple myeloma that’s relapsed or has been resistant to other treatments

Side effects of immunotherapy

As in targeted therapy, the side effects of immunotherapy can depend on the type that’s used.

The potential side effects of immunomodulators can include:

  • fatigue
  • neuropathy
  • increased risk of blood clots
  • low blood counts

Some of the possible side effects of CAR T-cell therapy can be potentially serious and may include:

  • low blood counts
  • a serious allergic reaction
  • problems with the nervous system, such as:
  • cytokine release syndrome, which happens when the T cells produce chemicals that activate the immune system and can include symptoms like:
    • fatigue
    • high fever
    • chills
    • feeling dizzy
    • headache
    • severe digestive symptoms like nausea, vomiting, or diarrhea
    • rapid heartbeat

Corticosteroid drugs have been found to have an antitumor effect for multiple myeloma. This is likely mediated through their anti-inflammatory and immunosuppressive effects.

The corticosteroids used as a part of multiple myeloma treatment are typically dexamethasone (DexPak) or prednisone (Rayos). These medications are taken orally.

Corticosteroids are used in both those that can receive a stem cell transplant and those that cannot. They’re typically used in combination with other multiple myeloma treatments, such as chemotherapy or targeted therapy.

Side effects of corticosteroids

The potential side effects of corticosteroids are:

Chemotherapy utilizes strong drugs to kill cancer cells or stop them from growing. It can be given in many ways, including by mouth, injection, or IV.

Some examples of chemotherapy drugs that may be used for multiple myeloma include:

  • cyclophosphamide (Cytoxan)
  • doxorubicin (Adriamycin)
  • melphalan (Alkeran)
  • bendamustine (Treanda)

Since newer treatments have been developed, chemotherapy is generally used less often for multiple myeloma. When it’s used, it’s typically for:

  • induction therapy and maintenance therapy in those receiving a stem cell transplant
  • treatment of individuals that aren’t eligible for a stem cell transplant
  • multiple myeloma that’s relapsed or has been resistant to other treatments

Additionally, a high-dose of the chemotherapy drug mephalin is used prior to a stem cell transplant. This kills the cells in the bone marrow, preparing an individual to receive the healthy stem cells.

Chemotherapy side effects

The potential chemotherapy side effects can include:

  • fatigue
  • nausea or vomiting
  • diarrhea
  • constipation
  • reduced appetite
  • mouth sores
  • hair loss
  • low blood count

Radiation therapy uses high-energy radiation to kill cancer cells or stop them from growing. It can be used along with high-dose chemotherapy during a stem cell transplant or to treat bone disease that happens due to multiple myeloma.

A type of radiation therapy called external radiation therapy is used for multiple myeloma. In external radiation therapy, a machine is used to help target the radiation to the location of the cancer in your body.

Side effects of radiation therapy

The potential side effects of receiving radiation therapy are:

  • fatigue
  • nausea
  • diarrhea
  • redness or blistering of the skin that’s exposed to the radiation
  • low blood counts

Watchful waiting means that your doctor continues to monitor your condition without giving treatment. Treatment may be initiated if you develop new symptoms or your symptoms change.

Watchful waiting is often used for smoldering multiple myeloma (SMM). SMM is a precancerous state that hasn’t yet progressed to multiple myeloma. The risk of SMM progressing to multiple myeloma is about 10 percent per year.

In this type of watchful waiting, your doctor will periodically perform tests to evaluate how your plasma cells look under a microscope. They’ll also monitor the levels of abnormal immunoglobulins produced by plasma cells.

Multiple myeloma can also cause a variety of health complications. You’ll also receive treatment for these as well. This is called supportive therapy.

Now let’s take a look at the different complications of multiple myeloma and how they’re treated.

Bone disease

Multiple myeloma can lead to bone disease. This is because the cancer can cause overactivation of cells that break down bone tissue (osteoclasts).

Bone disease may manifest in several different ways, including:

  • bone pain
  • easy fracturing
  • spinal cord compression
  • hypercalcemia, a high level of calcium in the blood

Bone pain in multiple myeloma can be severe. Opioid medications are typically used to relieve this type of pain.

Biphosphates are given to help improve bone health in people with multiple myeloma. These work to inhibit the activity of osteoclasts. An example of a biphosphate is zoledronic acid (Reclast).

Individuals with spinal cord compression may need to undergo radiation therapy or surgery.

Low blood counts

In multiple myeloma, cancerous cells in the blood marrow crowd out healthy blood cells, leading to a low blood count. Low blood counts can lead to several health problems, including:

  • anemia
  • increased infection risk
  • easy bruising or bleeding

Anemia can be treated using an erythropoiesis-stimulating agent, which is a type of medication that stimulates red blood cell growth. Examples include epoetin alta (Procrit) and darbepoetin alta (Aranesp). Blood transfusions may also be used.

Infection risk can be addressed in several ways, such as:

  • prophylactic antibiotics or antivirals
  • intravenous (IV) immunoglobulin, which provides your body with antibodies that can fight infections
  • receiving the influenza and pneumococcal vaccines

If platelet levels become very low, a platelet transfusion may help.


Hyperviscosity is when abnormal immunoglobulins produced by plasma cells begin to build up in the blood. This makes the blood become thicker, leading to problems with circulation.

Plasmapheresis can be used to alleviate hyperviscosity. Plasmapheresis involves the following steps:

  1. A catheter is placed into a vein in your neck, groin, or under your collarbone.
  2. Blood flows through the catheter and into a special machine.
  3. The machine separates out the blood plasma, which contains the immunoglobulins.
  4. After the plasma has been separated, the machine returns the blood to your body along with some healthy donor plasma.

Kidney disease

Kidney disease can also happen in people with multiple myeloma. This can occur due to a variety of factors, including:

  • build-up of abnormal immunoglobulins in the blood
  • hypercalcemia
  • infections
  • medication side effects
  • dehydration
  • preexisting health conditions like diabetes

The exact treatment for kidney disease during multiple myeloma depends on the cause. Being sure to stay hydrated during treatment can help.


In some cases, neuropathy may develop. This may be due to multiple myeloma disease activity or due to the side effects of some multiple myeloma treatments.

If you have neuropathy due to multiple myeloma, certain prescription medications may help. Some examples include gabapentin (Neurontin) and tricyclic antidepressant drugs.

There are many possible treatments for multiple myeloma. Which treatment options are a part of your treatment plan can depend on your age, overall health, and the stage of your cancer. Most of the time, a combination of treatment methods are used.

Multiple myeloma can also cause several types of health complications. Your doctor will also work to treat these as well.

If you’ve recently been diagnosed with multiple myeloma, your doctor will work with you to develop a treatment plan. During this time, they’ll discuss your treatment options, their benefits, and their potential side effects.