Chemotherapy for myeloma
What is chemotherapy?
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy myeloma cells. The chemotherapy drugs travel in the blood and can treat myeloma cells wherever they are in the body.
You usually have chemotherapy as an outpatient, but sometimes you may need to spend a few days in hospital.
Chemotherapy drugs for myeloma
Chemotherapy drugs used to treat myeloma include:
Treatment often involves a combination of 2 or more chemotherapy drugs. These may be given with other drugs, such as steroids and targeted therapies.
Drug combinations may include:
- CTD – cyclophosphamide, thalidomide and dexamethasone
- MPT – melphalan, prednisolone and thalidomide
- VCD or CVD – cyclophosphamide, bortezomib (Velcade®) and dexamethasone
- VMP – melphalan, prednisolone and bortezomib (Velcade®)
- VTD – bortezomib (Velcade®), thalidomide and dexamethasone
- VTD-PACE – VTD may sometimes be given with cisplatin, doxorubicin, cyclophosphamide and etoposide.
You have treatment for 1 day, or over a few days. This is followed by a break of a few weeks without treatment. The days having the chemotherapy and the treatment break make up a cycle of treatment.
Usually, 4 to 6 cycles make up a complete course of treatment. This means a course of treatment usually takes a few months to complete. But the length of treatment depends on which treatments are used and how well the myeloma responds.
During the course of treatment, you have regular blood tests to check the effect of the drugs. The dose of the drugs may be changed according to the results of your blood tests, or any side effects.
We have more information about treatment for myeloma.
How chemotherapy is given
There are different ways of giving chemotherapy. Some chemotherapy drugs for myeloma are given by injection or drip (infusion) into a vein (intravenously). Some may be given subcutaneously (an injection under the skin). Others are taken as tablets or capsules by mouth (orally).
If you are having your treatment by drip (infusion), your doctor may suggest you have:
- a central line – a nurse puts a plastic tube into a vein in your chest
- a PICC line – a nurse puts a plastic tube into a vein above the bend of your elbow (PICC line)
- an implantable port – a nurse puts a thin, soft, plastic tube into a vein in the chest that has an opening (port) just under the skin of the chest or arm.
Lines and ports can stay in place during the course of your treatment. This can be used to take blood samples and give you treatment. The community nursing team will look after your line or port. Your nurses may also show you how to care for it when you are home.
Side effects
Chemotherapy drugs cause side effects. Different drugs cause different side effects. But there are usually ways these can be controlled. Your doctor or nurse will give you information about the likely side effects of your treatment. They will also tell you what can be done to control and manage side effects.
We have more information about the side effects of chemotherapy.
About our information
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References
Below is a sample of the sources used in our myeloma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management. NICE guideline [NG35]. Published: 10 February 2016 Last updated: 25 October 2018. Available from: https://www.nice.org.uk/guidance/ng35/chapter/recommendations Accessed: 19/07/22
Jonathan Sive et al., on behalf of the British Society of Haematology. British Journal of Haematology. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Published: 21 March 2021 Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17410 Accessed: 19/07/22
M.A. Dimopoulos et al. Annals of oncology. European Society for Medical Oncology (ESMO). Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Volume 32, ISSUE 3, P309-322, March 01, 2021. Available from: https://www.annalsofoncology.org/article/S0923-7534(20)43169-2/fulltext Accessed: 19/07/22
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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