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Chemotherapy and Drug Therapy

The main treatment for active myeloma is systemic drug therapy (meaning the drugs travel through the bloodstream to kill malignant cells). The initial therapy, or “induction therapy,” for myeloma usually includes a combination of targeted agents and/or standard chemotherapy. This therapy is often followed by stem cell transplantation in eligible patients.

Induction therapy, given before the transplant, has several goals:

  • Achieve rapid disease control
  • Induce high response rates with as few side effects as possible, so that patients can proceed to the next phase of treatment
  • Allow adequate stem cell collection (harvesting) for transplant

For transplant candidates, drug treatment begins with an induction phase consisting of a combination of agents that do not cause marrow damage, for example: bortezomib (Velcade®), lenalidomide (Revlimid®) and dexamethasone (a combination known as VRD); bortezomib, cyclophosphamide (Cytoxan®) and dexamethasone (a combination known as VCD or CyBorD); or other combinations. Note that long-term treatment with lenalidomide may decrease stem cell production. So, for transplant candidates, stem cell collection is often performed after three to six cycles, once a good treatment response has been achieved.

Drugs Used for Myeloma Treatment

Drugs regularly used to treat myeloma either alone or in combination with other drugs include

  • Proteasome Inhibitors
    • Bortezomib (Velcade®)
    • Carfilzomib (Kyprolis®)
    • Ixazomib (Ninlaro®)
  • Immunomodulatory Drugs (IMiDs)
    • Lenalidomide (Revlimid®)
    • Pomalidomide (Pomalyst®)
    • Thalidomide (Thalomid®)
  • Histone Deacetylase (HDAC) Inhibitors
    • Panobinostat (Farydak®)
  • Monoclonal Antibodies
    • Elotuzumab (Empliciti®)
    • Daratumumab (Darzalex®)
    • Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
    • Isatuximab-irfc (Sarclisa®)
    • Denosumab (Xgeva®)
  • Antibody-Drug Conjugates
    • Belantamab mafodotin-blmf (Blenrep®)
  • Alkylating Agents (DNA-Damaging Drugs)
    • Melphalan hydrochloride (Evomela®)
    • Melphalan flufenamide (Pepaxto®)
    • Carmustine (BicNU®)
    • Cyclophosphamide (Cytoxan®)
    • Melphalan (Alkeran®)
  • Selective Inhibitor of Nuclear Export (SINE)
    • Selinexor (Xpovio™)
  • Chimeric Antigen Receptor (CAR) T-Cell Therapy
    • Idecabtagene vicleucel (Abecma®)
  • Corticosteroids
    • Dexamethasone
    • Prednisone
  • Antitumor Antibiotics
    • Liposomal doxorubicin (Doxil®)
    • Doxorubicin (Adriamycin®)
  • Antimetabolites
    • Cytarabine (cytosine arabinoside, Ara-C, Cytosar-U®)

    Drugs used to fight myeloma-related bone disease

    • Bisphosphonates
      • Pamidronate (Aredia®)
      • Zoledronic acid (Zometa®)

    For information about these drugs, visit Drug Listings.


    Oral Therapy and Adherence 

    Treatment methods for myeloma patients have changed a lot over the last several years. Today, some of the drugs used to treat myeloma are taken by mouth, which is called “oral treatment” or “oral therapy." “Adherence” means staying on a set plan or regimen, taking the medication as prescribed—on the right day and at the right time. Poor adherence to a prescribed oral drug regimen can result in the following: drug resistance; poor response to therapy; disease progression; increased doctor visits, laboratory tests and hospitalizations; and even death.

    Download or order the following free LLS resources:

     


    For information about other drugs and drug combinations used for myeloma treatment, access the free booklet, Myeloma.


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