Myeloma Treatments and Survival

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March 13, 2024 
This page was reviewed under our medical and editorial policy by Michael Rosenzweig, M.D., Chief, Division of Multiple Myeloma, City of Hope Duarte

Multiple myeloma treatment plans are tailored to the disease stage, type of myeloma and the patient’s general health. Many types of treatment are available to help manage the disease, alleviate myeloma symptoms such as bone pain and improve survival.

Multiple Myeloma Treatments

The standard of care for people who are newly diagnosed with multiple myeloma is initial induction therapy, followed by a stem cell transplant and maintenance therapy.

Induction therapy uses a combination of treatments to reduce the number of myeloma cells in the bone marrow along with the proteins that these cells produce. Administered over several cycles, multiple myeloma induction therapies often include an immunomodulator drug to help the immune system work more efficiently, a proteasome inhibitor to stop myeloma cells from surviving and a steroid.

Multiple Myeloma Drug Therapy

Drug therapy is a cornerstone of multiple myeloma treatment. Several classes of medication are used to treat this blood cancer. Each treatment has a different way of working toward the same goal: controlling and destroying multiple myeloma cells. Proteasome inhibitors may be used during all stages of the disease. These drugs stop proteasomes in cells from breaking down the proteins that play a role in cell survival. Cancer cells divide more rapidly than normal cells, and these drugs seem to zero in on cancer cells and limit their survival.

Three proteasome inhibitors are approved for use in multiple myeloma treatment:

  • Velcade® (bortezomib)
  • Kyprolis® (carfilzomib)
  • Ninlaro® (ixazomib)

Bortezomib and ixazomib may be used as a maintenance treatment to prevent relapse.


When given in high doses, steroids such as dexamethasone and prednisone may destroy multiple myeloma cells. They may also decrease inflammation and help relieve pain. Sometimes steroids are given to alleviate side effects from chemotherapy, such as nausea and vomiting.

Chemotherapy for Multiple Myeloma

Chemotherapy is a systemic cancer treatment that destroys all fast-growing cells in the body. Cancer cells grow and divide more frequently than most healthy cells, but normal cells may be harmed in the process. Chemotherapy isn’t used that often in early-stage multiple myeloma. A high dose may be used before a stem cell transplant to destroy any errant cancer cells and make room for healthy new cells. Chemotherapy may be combined with treatments such as targeted therapies or steroids for induction therapy.

Stem Cell Transplant for Multiple Myeloma

Stem cell transplants may help treat blood-related cancers by restoring healthy bone marrow. Stem cells promote the growth of new bone marrow and repair the immune system.

Before the stem cell transplant procedure, healthy stem cells are collected from bone marrow, circulating (peripheral) blood or umbilical cord blood. These blood-forming stem cells are then infused intravenously into the body to replace diseased or damaged bone marrow.

The goal of transplantation is to stimulate new bone marrow growth, suppress the disease and reduce the possibility of relapse. Patients undergo a conditioning regimen before their transplant.

With an allogeneic stem cell transplant, stem cells come from a matching donor. This approach is rarely used for multiple myeloma today.

In contrast, an autologous stem cell transplant uses the patient’s own stem cells, which are harvested and frozen until needed. They are then infused into the patient after intensive chemotherapy.

Immunotherapy for Multiple Myeloma

Immunomodulatory drugs (IMiDs) weaponize the body's immune system to fight cancer, and they are considered a cornerstone of myeloma care.

Many types are used to treat multiple myeloma, including:

  • Revlimid® (lenalidomide)
  • Pomalyst® (pomalidomide)
  • Thalomid® (thalidomide)

These immunotherapy drugs tweak the immune system and inhibit the development of new blood vessels that could fuel myeloma cells. Lenalidomide and pomalidomide may be used as maintenance therapy to keep myeloma at bay after treatment.

CAR T Cell Therapy for Multiple Myeloma

Chimeric antigen receptor (CAR) T cell therapy is a type of immunotherapy that collects a patient’s own T cells and trains them to attack a specific protein found in cancer cells. They are then reintroduced to the body to destroy targeted tumor cells. To prepare, patients undergo chemotherapy before the CAR T cells are reintroduced. CAR T cells for multiple myeloma target a protein on myeloma cells. These treatments may be used in patients who have already received other types of treatment for their multiple myeloma.

CAR T cell therapies for multiple myeloma include:

  • Abecma® (idecabtagene vicleucel)
  • Carvykti® (ciltacabtagene autoleucel)

These are immunotherapies made from the patient’s own T cells.

Targeted Therapy for Multiple Myeloma

Targeted therapies are drugs directed to molecules on or inside cancer cells. These molecules help signal cancer cells to grow or divide. By blocking the signal, targeted therapy may stop the cancer from spreading. Several types of targeted therapy are used in multiple myeloma, including those listed below.

Monoclonal antibodies

These targeted drugs fight disease by activating the immune system. They seek out and bind to myeloma cells so the immune system may recognize and destroy them.

Monoclonal antibodies used to treat multiple myeloma include:

  • Empliciti® (elotuzumab)
  • Darzalex® (daratumumab)
  • Darzalex Faspro® (daratumumab and hyaluronidase-fihj)
  • Sarclisa® (isatuximab-irfc)
  • Xgeva® (denosumab)

Xpovio® (selinexor), a nuclear export inhibitor

This drug prevents tumor suppressors from leaving cells so they may work to stop tumor growth from the inside out.

B cell maturation antigen (BCMA) targeting agents

These drugs use an antibody to bind to BCMA, a protein on the surface of myeloma cells, and deliver chemotherapy directly to the cell.

Bispecific antibodies

These are a newer type of targeted cancer treatment. They tag team two distinct proteins on cancer cells to help the immune system focus and attack the cancer cells. Bispecific antibodies are typically used after other therapies have failed.

Radiation Therapy for Multiple Myeloma

Radiation therapy, which uses X-rays to destroy myeloma cells, is the main treatment for solitary plasmacytoma, and it’s sometimes used to ease bone pain. A solitary plasmacytoma occurs when abnormal plasma cells build up in one area of the bone, forming a tumor.

Multiple Myeloma Surgery

Surgery may be used to remove plasmacytomas, but it’s rarely used to treat multiple myeloma. However, if spinal cord compression causes paralysis or other severe symptoms, emergency surgery may be needed. Other times, surgery may help support brittle bones and prevent or treat fractures that occur because the cancer weakens and invades the bones.

Myeloma Survival Rate

The five-year relative survival rate for people diagnosed with multiple myeloma is 61.1%, according to data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. This means that approximately 61% of people with multiple myeloma will likely still be alive five years after their diagnosis when compared to people who don’t have that cancer type.

Survival rates are estimates based on large groups of people, and every patient's experience is unique. The statistics are estimates and may not account for recent treatment advances in place today. In general, early and aggressive treatment has been shown to increase the odds of survival with myeloma.

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