Newly Diagnosed?
We Can Help Getting the correct diagnosis and the most appropriate treatment from the start is crucial 
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At the present time, no treatment approach is considered to be a cure for multiple myeloma. However, current treatment strategies are designed to slow the progression of disease, prolong survival, and alleviate symptoms.
Physicians caring for patients with smoldering myeloma -- which generally causes few, if any, symptoms -- usually decide that observation, rather than treatment, is the best course to follow. If the patient's protein levels rise or anemia occurs and there are signs that the disease has become active, his or her physician will likely begin treatment. Commonly used treatment regimens include dexamethasone -- a potent corticosteroid -- alone or in combination with other medicines such as doxorubicin, thalidomide, or lenolidamide.
Thalidomide, a medicine first used in the late 1950s as a sleeping pill and to combat the nausea some women experience in the first trimester of pregnancy, was found to cause birth defects and was later banned. In recent years, researchers began testing the drug on other diseases, and it was found to be an effective treatment for leprosy. In the late 1990s, cancer researchers discovered that thalidomide could be used to treat myeloma throughout the course of the disease as both first-line and maintenance treatment, and also for those whose disease has relapsed.
Newer versions of thalidomide, such as lenalidomide (Revlimid®), are designed to be more potent and also appear to have fewer side effects than thalidomide. Researchers theorize that thalidomide and lenalidomide act directly and indirectly in myeloma by promoting the death of cancer cells and by inhibiting myeloma cell growth and survival in bone marrow.
Bortezomib (Velcade®) is the first in a new class of medicines called proteasome inhibitors, and the first treatment in more than a decade to be approved by the FDA for patients with multiple myeloma. Proteasomes are protein complexes found within all cells that break down proteins, and are essential for normal cellular processes like the cell cycle, signal transduction, and gene expression. Inhibiting proteasome activity in cancer cells seems to increase programmed cell death (a process called apoptosis), blocks proliferation, and inhibits the cell cycle, causing cancer cell death. Currently bortezomib is only approved for patients with relapsed myeloma. Through clinical trials, our investigators are combining bortezomib with other agents as an initial treatment for patients with advanced myeloma (ISS stage II and ISS stage III).
To help manage some myeloma symptoms, most patients with the disease are also prescribed bisphosphonates -- such as pamidronate (Aredia®) or zoledronic acid (Zometa®) -- which can slow bone loss and simultaneously help to alleviate bone pain. Bone disease and pain may also be treated with local radiation, and pathologic fractures can be treated through surgical approaches in which surgeons attach metal rods and plates to weight-bearing bones to provide support.
High-dose chemotherapy combined with stem cell transplantation is a standard therapy for patients with myeloma and has been shown to prolong survival. In this procedure, stem cells -- blood-forming precursorcells -- are obtained from the bloodstream or bone marrow during autologous or allogeneic transplantation and then frozen. (When the patient's own stem cells are collected before chemotherapy and returned after treatment it is called autologous stem cell transplantation. When the stem cells come from a donor it is called an allogeneic transplant.) The patient then receives a high dose of chemotherapy that destroys tumor cells and most or all of the stem cells in the patient's bone marrow. The harvested stem cells are then administered (transplanted) to help regenerate the patient's blood and immune systems.
Patients undergoing stem cell transplantation are hospitalized for about three weeks, and recovery takes several months. In patients with myeloma, two consecutive transplants two-to-four months apart have been shown to prolong disease control.
