Stages II-III Multiple Myeloma
Stage II or III multiple myeloma is characterized by an intermediate or high amount of cancer in the body. Patients with either of these stages of multiple myeloma often have bone complications as a result of their disease and usually experience symptoms that require treatment.
With current therapy, curing patients with multiple myeloma is uncommon; recent advances in treatment incorporating new drugs, stem cell transplantation, and maintenance therapy however, have prolonged survival by several years. The only potentially curative treatment for multiple myeloma remains high-dose therapy followed by a stem cell transplant using donor cells (allogeneic stem cell transplant). This treatment, however, is associated with significant side effects and is only appropriate for younger patients or those who have failed other therapies.
There are a large number of effective chemotherapy drugs now available for initial, standard-dose induction treatment of patients with multiple myeloma. The main goal of initial therapy of multiple myeloma is to produce a complete or near complete disappearance of myeloma cells in the body. Approximately 30-50% of patients can expect to achieve this goal with current therapies.1
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About this Treatment Information
The following is a general overview of conventional and investigative treatments for stage II-III multiple myeloma. Cancer treatment may consist of chemotherapy, targeted therapy, high-dose therapy and stem cell transplant, or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patient’s chance of cure and prolonging survival.
In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Planning Treatment for Multiple Myeloma
Before beginning treatment for multiple myeloma your physician may discuss with you the option of undergoing high-dose chemotherapy with an autologous stem cell transplant (ASCT), which utilizes a patient’s own stem cells. Most of the clinical trials conducted over the past two decades have shown that patients who undergo ASCT after they have achieved a remission with conventional chemotherapy are more likely to experience a prolonged time to disease progression compared to patients who undergo conventional dose induction chemotherapy.2
It is important consider the possibility of a future ASCT at the time of diagnosis because stem cells have to be collected and frozen early in the disease course even if the treatment plan involves reserving the transplant for treatment after a myeloma recurrence.
The other reason it is important to have this discussion is that opting to plan for an ASCT determines which chemotherapy drugs will make up the initial treatment. A type of chemotherapy drug called an alkylating agent such as Alkeran® (melphalan) damages stem cells making collection difficult or impossible. Thus, patients who elect to have stem cells collected and stored are frequently treated with induction regimens that do not include alkylating agents. Patients who elect not to receive a stem cell transplant, or who are not candidates for stem cell transplantation because of advanced age or poor health, are often treated with an Alkeran® -based regimen.