Multiple Myeloma: Treatment Planning
Treatment for multiple myeloma varies greatly depending on the stage (or extent) of your myeloma and your preferences and goals.
Some people with stage 1 multiple myeloma, who have no symptoms, opt for active surveillance that includes regular tests and monitoring. Others with later stages may get drug therapy, a blood and marrow transplant, radiation therapy and surgery.
WHAT TO KNOW ABOUT MULTIPLE MYELOMA TREATMENT PLANNING
1Getting Started In Your Care
2Getting Your Diagnosis
3Planning Your Treatment
Considering Your Options
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
Assessment
Evaluating Options
Choosing Treatment
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the multiple myeloma
- Type of multiple myeloma you have
- Markers, such as growth factors, that provide genetic information about the subtype of the cancer
Learn more about multiple myeloma
- Your age and overall health
- Whether you have had cancer before
- There are a number of other consideration which may impact your treatment plan.
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of the three main types of treatment: surgery, radiation therapy, and drug therapy (medications that travel through the bloodstream to attack cancer anywhere in the body). The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Learn about treatments for multiple myeloma
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of multiple myeloma, from the least to the most severe.
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you. An oncologist leads your team and remains your main doctor throughout treatment.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for multiple myeloma have different goals, such as:
- Slowing or stopping the growth of cancer
- Destroying cancer cells
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing multiple myeloma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the multiple myeloma
- Type of multiple myeloma you have
- Markers, such as growth factors, that provide genetic information about the subtype of the cancer
Learn more about multiple myeloma
- Your age and overall health
- Whether you have had cancer before
- There are a number of other consideration which may impact your treatment plan.
close Assessment
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of the three main types of treatment: surgery, radiation therapy, and drug therapy (medications that travel through the bloodstream to attack cancer anywhere in the body). The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Learn about treatments for multiple myeloma
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of multiple myeloma, from the least to the most severe.
close Evaluating Options
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you. An oncologist leads your team and remains your main doctor throughout treatment.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for multiple myeloma have different goals, such as:
- Slowing or stopping the growth of cancer
- Destroying cancer cells
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing multiple myeloma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
close Choosing Treatment
Every cancer is different, even in the early stages. The best treatment for one person might not be the best treatment for another. Your doctor will help you make an informed decision about which options may be right for you. Your treatment plan may consist of one or any combination of the following:
Surgery
Your care team may recommend surgery to diagnose, stage, or treat cancer:
- Diagnosis: Your doctor may recommend that you have a biopsy, to obtain tissue samples and determine a more precise diagnosis.
- Staging: Surgery can help determine the stage of multiple myeloma, by showing the size of the tumor and other details.
- Treatment: Surgically removing the tumor may provide the best treatment for you.
Surgery Resources
Should surgery be part of your care plan, we are here to help guide you through the process.
If surgery provides a good treatment option, you will meet with a surgical oncologist to develop a plan. Surgery for multiple myeloma is different for every patient. Your surgical oncologist (cancer surgeon) will work with you to determine the least invasive and most effective surgery for the type of multiple myeloma you have.
Combining surgery with other treatments
To achieve the best possible outcome, your care team may recommend combining surgery with other treatments such as radiation therapy or chemotherapy. The additional treatment can be given 1 of 2 ways:
- Neoadjuvant therapy: This treatment occurs before surgery to make it easier and more effective. Undergoing chemotherapy before surgery, for example, may shrink a tumor and make removal more successful.
- Adjuvant therapy: This treatment occurs after surgery to reduce the risk of the cancer coming back. Chemotherapy or radiation therapy after surgery can destroy remaining cancer cells.
Drug Therapy
Drug therapy, also called systemic or medical therapy, is treatment that works throughout the body to fight multiple myeloma. These drugs slow the growth of cancer cells or destroy them. You can receive drug therapy:
- By mouth (orally) as a pill
- Through the blood vessels (intravenously, or IV) as an injection or infusion
Types of Drug Therapy for Multiple Myeloma
At Stanford, our medical oncologists use several types of drug therapy, including:
Chemotherapy: This group of medications stops the growth of rapidly dividing cells in the body, both cancerous and noncancerous. While powerful, chemotherapy can cause more side effects than other medication types, because it cannot distinguish between cancerous and healthy cells. Chemotherapy is a treatment option for almost anyone with cancer.
Chemotherapy Resources
Chemotherapy is a treatment option for most multiple myelomas. We are here to help you prepare and guide you through the process.
Immunotherapy
These medications provoke your immune system to attack cancer cells. Immunotherapy treatments are the newest class of anti-cancer drugs. Some available for treatment today; others are being developed and will be available for treatment soon.
The primary types of immunotherapy include:
- Monoclonal antibodies These are man-made copies of proteins that naturally occur in the immune system. Antibodies can be designed to attack certain features on cancer cells that weaken the cells and cause them to die.
- Immune checkpoint inhibitors: These drugs essentially remove immune system controls and free the immune system to recognize and attack cancer cells.
- Cancer vaccines: Vaccines prompt an immune response against certain diseases. We usually think of vaccines as medications prescribed to fight infections like measles or the flu. Some vaccines can help prevent or treat cancer.
Immunotherapy Resources
Should immunotherapy be part of your care plan, we are here to help you prepare and guide you through the process.
Targeted Therapy
These medications slow the growth and spread of cancer by cancer by stimulating the immune system or interfering with specific parts of cancerous cells.
For treatment to work, the cancer must have the specific markers a particular medication was designed to target. Some multiple myeloma cells have certain proteins on the cells that promote growth. These proteins cause cancer to grow quickly and spread. Our pathologists look for the presence of these proteins by examining samples of tissue taken during a biopsy.
Targeted Therapy Resources
Should targeted therapy be part of your care plan, we are here to help you prepare and guide you through the process.
Drug therapy scheduling
If your treatment plan involves drug therapy, you will have routine visits to have lab work done, see your doctor, and receive medication. You may need to come in once or twice per week. If you need an infusion, you will visit one of Stanford’s infusion treatment centers, where a nurse specializing in Multiple myeloma care will provide your treatment.
Drug therapy side effects
Side effects from drug therapies vary depending on the type of medication you receive. For example, chemotherapy may affect your hair and nails, because it slows their growth as it slows the growth of cancer cells. Fatigue is also possible. Ask your care team – we can help you manage or prevent many symptoms and side effects that can affect your everyday life.
Radiation Oncology
Radiation therapy is painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Our radiation oncologists have years of experience safely and effectively treating multiple myeloma with radiation. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue.
Radiation therapy may provide effective treatment for the type of multiple myeloma you have. If so, your doctor will speak with you about the best options. The types of radiation therapy we use for multiple myeloma treatment at Stanford include:
External radiation uses a machine called a linear accelerator (LINAC) to deliver radiation to the area where the cancer cells are found. Some of the types of external radiation we use include:
Radiation Therapy Resources
Should radiation therapy be part of your care plan, we are here to help you prepare and guide you through the process.
What to expect during external radiation therapy and how to prepare
- 3D (3-dimensional) conformal radiation therapy (3D-CRT)
With this method, 3D images help the doctor better target the tumor. The images are created using a special machine — a computed tomography (CT) or magnetic resonance imaging (MRI) machine. The radiation beams can be aimed from many different angles to match the exact shape of the cancer. - Intensity-modulated radiation therapy (IMRT)
This method is similar to the first method, but the doctor can adjust how much radiation you get from each beam. In certain situations, this enables the doctor to avoid nearby normal cells to reduce the risk for side effects. - Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR)
This method works like the first two methods, and the total amount of radiation you get is similar. But with SBRT, the radiation is given in fewer but stronger doses. This is often used for multiple myelomas or other cancers.
Clinical Trials
At Stanford, our doctors are always working to improve care for people with cancer. As an academic medical center, we conduct clinical trials to evaluate new medical techniques, devices, medications, and other treatments for safety and effectiveness.
We study new approaches to preventing, screening, detecting, diagnosing, and treating cancer. Some clinical trials look at new methods, while others evaluate new combinations of approved, existing approaches.
Depending on your individual circumstances, a clinical trial may provide a treatment option for you. Like any treatment, clinical trials have possible risks and benefits, including:
Possible benefits of joining a clinical trial:
- Access to a new treatment that isn’t widely available
- Expert care from our world-renowned cancer specialists and their teams
- Low- or no-cost treatment
- Participation in research that can save lives in the future
Possible risks of a clinical trial:
- Treatment that may not work for you
- Side effects that may be unexpected or worse than current standard-of-care treatments
- Additional doctor visits, meaning more time and travel
- Additional tests, which may be uncomfortable or time consuming
- Extra expenses if your health insurance does not cover all patient costs for a trial
To learn more about Stanford’s clinical trials, speak with your care team. We can help you decide if a clinical trial may be right for you.
Your health care team brings together a multispecialty team of experts dedicated to treating your multiple myeloma.
Your doctors
Hematologist
A hematologist provides diagnosis and treatment for adults with blood cancers such as leukemia or myeloma.
View All {0} HematologistsOncologist
An oncologist is a cancer doctor who provides diagnosis and treatment for cancer. Some oncologists specialize in particular cancer treatments like drug therapy, surgery or radiation therapy.
Medical Oncologist
This type of doctor has specialized training in drug therapy for cancer. Medical oncologists often serve as one of your main health care providers for leukemia.
If you are also getting additional treatment, the medical oncologist will help coordinate your treatment among several specialists.
View All {0} Medical OncologistsSurgical Oncologist
This type of doctor has specialized training in surgery for cancer.
View All {0} Surgical OncologistsBlood And Marrow Transplant Specialist
A blood and marrow specialist doctor is trained in therapy to transfer healthy bone marrow cells into a patient after their own unhealthy bone marrow has been eliminated.
View All {0} Blood And Marrow Transplant SpecialistsRadiation Oncologist
This specialist is a radiation cancer doctor who provides your radiation therapy for cancer. A radiation cancer doctor has additional specialty training in using radiation therapy for the treatment of cancers.
View All {0} Radiation Oncologists
Extended care team
This health care provider works with your cancer doctors to help with diagnosis and treatment. An advanced practice provider can be a nurse practitioner, physician’s assistant, or clinical nurse specialist.
Multidisciplinary care coordinators are specialized registered nurses who provide one-on-one support to guide you through the cancer treatment process. These coordinators serve as your point of contact to help manage your care, from your first appointment through follow-up visits. They assess your needs, answer your questions, make referrals, coordinate appointments, and provide patient education.
The administrative assistants help with administrative issues such as scheduling your appointments, managing your paperwork, and requesting your medical records.
This team member helps you during your doctor visits by:
- Bringing you to your exam room after you check in for an appointment
- Providing you with a hospital gown or other clothing for your physical exam
- Taking your vital signs before your doctor sees you
A staff member calls you before your first appointment to:
- Provide information that you need to know to prepare
- Provide a list of what you need to bring
- Help gather your medical records
Support services
PathWell is your connection to personalized support services before, during, and after your treatment. Our teams of doctors, nurses, social workers, spiritual care providers, nutrition experts, financial counselors, and more work with your cancer care team to provide comprehensive specialized care to you and to your family.
PathWell can also connect you to the Stanford Cancer Supportive Care Program, which provides free classes, workshops, fitness classes, services, and support to all cancer patients. The program offers a leukemia and lymphoma support group designed to provide mutual support and education to members who could benefit from meeting with others whose situations are similar to their own. Caregivers, family, and friends are welcome.
- 650-498-6000 Ask for the PathWell team
Stanford Health Library
For confidential help with your health care questions, contact the Stanford Health Library. Professional medical librarians and trained volunteers can help you access journals, books, e-books, databases, and videos to learn more about medical conditions, treatment options, and related issues.
- 875 Blake Wilbur, Palo Alto: 1st floor near the cafe, 650-736-1960
- South Bay Cancer Center: 3rd floor lobby, 408-353-0197
- Email us your questions: healthlibrary@stanfordhealthcare.org