Cancer chemotherapy is the use of drugs to kill cancer cells. Unlike radiation and surgery, which are localized treatments, chemotherapy is a systemic treatment, meaning the drugs travel throughout the whole body. This means chemotherapy can reach cancer cells that may have spread, or metastasized, to other areas. Because myeloma is a systemic disease from the start, chemotherapy is a mainstay in treating it.

Currently, there is no cure for myeloma, so treatment is designed to prolong life by reducing the effects of myeloma on body functions and reducing discomfort from the disease. Chemotherapy is usually given after symptoms or complications develop because there has been no evidence that early treatment alters the course of the disease. Chemotherapy drugs are usually used in combination and given in cycles. The drugs can be given intravenously (IV) or by mouth. The drugs given by IV may be administered at the doctor’s office or in the hospital. Oral drugs may be taken at home.

Chemotherapy is given until the abnormal antibody-like protein produced by myeloma cells decreases and reaches a plateau. A complete remission—a total loss of the abnormal protein or total destruction, at least for a time, of the cells that make up myeloma—is rare.

The type of chemotherapy recommended often depends on the amount of tumor present in your body and your kidney function.

Chemotherapy Drugs Used for Multiple Myeloma

  • Cyclophosphamide (Cytoxan)
  • Dexamethasone (Decadron), may be used alone
  • Doxorubicin (Adriamycin0
  • Melphalan (Alkeran)
  • Prednisone
  • Vincristine (Oncovin)

Chemotherapy Combinations:

MP

  • Melphalan (Alkeran)
  • Prednisone

Taken by mouth daily for four days every four to six weeks, typically for a year.

VAD

  • Vincristine (Oncovin), given by IV
  • Doxorubicin (Adriamycin), given by IV, continuous infusion
  • Dexamethasone (Decadron), taken by mouth

This combination starts acting faster than MP. It is given on four days starting on days 1, 9, and 17 of each month.

Effectiveness

Fifty to sixty percent of patients receiving either regimen reduce the amount of abnormal protein in their blood by half, but fewer than one in twenty has a complete remission. Typically, multiple myeloma recurs within one to two years of ending chemotherapy. At this point, the doctor will usually recommend trying the other chemotherapy regimen; typically MP is given first, and VAD is given when the disease comes back.

Side Effects and Possible Complications

Melphalan may increase your risk of developing leukemia (cancer of the other blood forming cells, usually the white cells, but sometimes the red cells) or myelodysplasia (a precancerous condition of blood cells, which often leads to leukemia). If you've been given melphalan, you will be closely monitored by your doctor for signs of these conditions.