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How We Treat Multiple Myeloma

  • Multiple Myeloma: Emerging Treatment Options
    Kenneth C. Anderson, MD, Director of the Jerome Lipper Multiple Myeloma Cancer and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer Institute, and the Kraft Family Professor of Medicine at Harvard Medical School, explores the emerging treatment options for patients with multiple myeloma.

  • Our unique approach

    The Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics is part of Dana-Farber/Brigham and Women's Hematologic Oncology Treatment Center, one of the world's largest and most respected treatment centers for patients with disorders of the blood or bone marrow. Hematological disorders can take many different forms, and your care team will include experts with specialized knowledge in treating various manifestations of multiple myeloma.

    Because treatment for multiple myeloma is evolving quickly, it is important to be seen at — or to consult with — a treatment center like ours that has cared for many patients with this kind of cancer. Many of the most advanced multiple myeloma therapies were developed by research scientists in our own laboratories.

    Multidisciplinary team

    To make your care as seamless as possible, our hematologists/oncologists, researchers, physician assistants, nurses, nutritionists, and clinical social workers work closely together to decide what kind of treatment will work best to combat your particular disease at each stage.

    Experts from every specialty come together each week to evaluate each case and to verify that each patient is getting the optimal care. These specialists review your care plan to reach a consensus recommendation, which we share with you. Your team works to ensure that your care plan offers the best possible outcomes, and that all your needs are met.

    Personalized treatment

    As a highly specialized Center within DF/BWCC's Hematologic Oncology Treatment Center, we focus on the distinct needs of people with multiple myeloma. This enables us to provide a highly personalized approach to your care. In order to create the most effective treatment plan, your care team will adjust the dosing and timing of your therapy based on how you respond to a particular treatment. This approach delivers treatments that are often very effective, and people living with multiple myeloma can have a normal quality of life for a long period of time.

    We view every patient as an individual, with unique needs and expectations. We take time to involve you and your family in each step of the treatment process. As you go through treatment, you will have access to a wide range of resources — from nutrition services to integrative therapies — that we provide to support you and your family.

    Offering Expertise Through Second Opinions

    • We believe there is value in patients with suspected or diagnosed multiple myeloma receiving a second opinion.
    • We routinely evaluate specimens sent to us from outside centers. These specimens are examined by our entire multiple myeloma team, including our expert hematopathologists. Multiple myeloma can be difficult to evaluate and properly treat. Reasons to consider a second opinion include:
      • To confirm your diagnosis.
      • To be treated at Dana-Farber/Brigham and Women's Cancer Center (if you have already received a diagnosis).
      • To determine the optimal therapy — and whether any is needed at this time.
      • To learn more about your cancer from specialists who are world leaders in studying this disease, and who have treated hundreds of other patients like you.
      • To learn if you're eligible for a clinical trial.

    Phone: 877-442-3324
    Online: Complete the Appointment Request Form.

    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion program.

    For Referring Physicians

    Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.

    If you are a physician and have a patient with diagnosed or suspected multiple myeloma, we look forward to working with you. Learn how to refer a patient.

    Treatment for multiple myeloma

    Each patient's care combines the most advanced treatments currently available, with innovative new therapies based on discoveries made through research at our /multiple-myeloma-program/ Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics laboratories.

    Treatments can include:

    Watchful waiting

    Patients who are not experiencing symptoms or who have precursor conditions — smoldering multiple myeloma (SMM) or monoclonal gammopathy of undetermined significance (MGUS) — may not need treatment and can be monitored for disease progression. It's important to note that almost 70 percent of MGUS patients do not get multiple myeloma. And while the percentage of patients with SMM who may get multiple myeloma is higher than with MGUS, not everyone with SMM develops multiple myeloma, either.

    Disease-modifying therapies

    Our researchers are studying the genomic, genetic, and epigenetic factors that characterize precancerous conditions, such as smoldering multiple myeloma and monoclonal gammopathy of undetermined significance, at our Center for Prevention of Progression of Blood Cancers (CPOP).

    We created the CPOP to understand, at the molecular level, why some patients go on to develop disease, while others do not – and to develop non-toxic targeted therapies to prevent progression, or even eliminate the disease before it leads to symptoms.

    Contact CPOP

    If you are a patient, or the physician of a patient, who is willing to have samples of blood and cancer cells collected for the CPOP research effort during a medical appointment, or if you would like additional information, please email precursor@partners.org or call 617-582-8664.

    Related links

    What Are Precursor Blood Conditions and How Are They Treated?
    PCROWD Study: Understanding Blood Precursor Conditions
    Blood Cancer Research Partnership

    For patients diagnosed with multiple myeloma, the treatment approach generally includes:

    1. Initial induction phase
    2. Treatment intensification with autologous stem cell transplantation for selected individuals who are able to receive a transplant
    3. Maintenance therapy
    4. Treatment for relapsed disease

    Induction phase of treatment

    Most people with multiple myeloma receive a combination of three drugs that includes an immunomodulatory drug (IMID), such as lenalidomide; a proteasome inhibitor such as bortezomib; and a corticosteroid such as dexamethasone. In a recent Phase III clinical trial, the combination of lenalidomide, bortezomib, and dexamethasone (also called RVD) was superior to a two-drug combination of lenalidomide and dexamethasone (also called Rd) in terms of duration of response to treatment, as well as overall survival. These findings confirmed the effectiveness of this approach to treatment.

    A three-drug combination that includes an alkylating drug such as cyclophosphamide, proteasome inhibitor such as bortezomib, and corticosteroid can also be used as an induction regimen.

    People who are frail due to advanced age or other medical conditions may receive only two drugs in order to decrease the likelihood and severity of chemotherapy-related side effects. Two-drug combinations include lenalidomide-dexamethasone (Rd) and bortezomib-dexamethasone (Vd).

    Induction chemotherapy is typically administered over a period of four to eight months, and is followed by either treatment intensification with autologous stem cell transplantation or maintenance therapy. Many factors are considered in determining whether or not to pursue transplant, including your age, frailty, other medical conditions that may impact suitability for transplant, response to and tolerance of induction chemotherapy, and your own preferences and goals of care.

    Maintenance therapy

    After the initial treatment, maintenance therapy is often used to help keep the disease in remission for a longer time.

    Several clinical trials have shown a clear benefit for maintenance therapy in terms of the duration of response to treatment and long-term outcomes for patients. Most of these trials have incorporated lenalidomide as the chemotherapeutic agent of choice. On the strength of these results, the FDA recently approved lenalidomide for maintenance therapy following stem cell transplantation.

    After a stem cell transplant

    • People who undergo stem cell transplantation typically start maintenance therapy three to four months after the transplant. In our practice, lenalidomide is usually given once a day for three weeks followed by a week off, or daily continuously.
    • We continue maintenance therapy until the time the disease progresses, as long as you are tolerating it well.

    Without a stem cell transplant

    • For people who do not undergo stem cell transplantation, maintenance therapy typically starts immediately after the induction phase of therapy.
    • We most often use lenalidomide as maintenance therapy, although there are other options, including ongoing administration of a proteasome inhibitor, such as bortezomib or carfilzomib.

    Relapsed disease

    At some point, nearly all people with multiple myeloma experience the progression of their disease. When your disease relapses, you are considered for additional chemotherapy.

    Fortunately, there is a large and expanding number of effective treatment options available. In 2015 alone, six chemotherapy regimens for relapsed multiple myeloma were approved by the FDA. Our Center has played a lead role in the development of many of these regimens.

    • You will have the opportunity to speak with your physician about which regimen is most appropriate for you.
    • Treatment decisions will take into account prior treatment you have received, the effectiveness of these treatments, side effects that you have experienced, and your preferences for treatment.
    • Once treatment starts for relapsed disease, you will be monitored closely to evaluate how the treatment is working. Adjustments are made to enhance its effectiveness and in relation to how well you tolerate the therapy. Treatment generally continues until your disease progresses, provided you tolerate treatment well.
    • Under certain circumstances, therapy could be stopped and you may be observed without treatment.

    Supportive therapy

    Many patients with multiple myeloma experience high rates of musculoskeletal events. To help strengthen patients' bones, we often include supportive therapy as part of the treatment plan. Supportive care may include various therapies to strengthen bones, reduce bone pain, and slow bone loss.

    Clinical trials

    Our Center offers access to a wide range of clinical research trials that aim to extend the duration of patients' responses to treatment, and to improve patient outcomes.

    • Trials include the spectrum of the disease, from smoldering to newly diagnosed to relapsed myeloma.
    • We offer a number of trials evaluating novel drug combinations for newly diagnosed diseases. It will be important that you discuss these with your care team.

    Our research in the laboratory and in clinical trials is focused on several important areas. These include investigations of the genetic abnormalities of myeloma cells; studies of the complex signaling that enables myeloma cells to grow and resist both conventional chemotherapy and novel therapy; efforts to unleash the power of the body's immune system and use it against cancer myeloma; and explorations of the way in which myeloma cells interact with their environment in the bone marrow and outside the marrow compartment.

    Breakthrough Research Informs Breakthrough Treatments

    The last few years have been very encouraging for blood cancer research. Many new targeted therapies and immunotherapies are improving treatment outcomes for patients with multiple myeloma. Researchers at the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) are driving much of the progress being made.

    These breakthrough findings show how whole genome sequencing can lead to the discovery of cancer mutations that can be specifically targeted by new therapies.

    Your care

    All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.

    If you need to be hospitalized during your care, or if you undergo stem cell transplantation, you will be admitted to Brigham and Women's Hospital (BWH) or the Dana-Farber Inpatient Hospital located within BWH. Your medical oncologist and nurse will closely monitor your care and will coordinate your care with additional specialists who will address any other symptoms you may be experiencing. Learn more about your stay.

    If radiation therapy is part of your care plan, our Radiation Oncology department has two separate units, one at Brigham and Women's Hospital and the other at Dana-Farber.

    Survivorship care

    We follow our patients closely between treatment plans while you are in remission. Nurses and nurse practitioners will carefully monitor the results of your lab tests and will stay in close contact with you in person and by phone, to explain options and treatments, and to help you manage side effects.

    Our Adult Survivorship Program helps you find expertise, education, and support to manage issues related to surviving cancer.