Drug therapy to kill myeloma cells is the mainstay of treatment for myeloma. Drug therapy can cause side effects, especially when chemotherapy is involved. Potent chemotherapy drugs must be toxic enough to kill cancerous cells. At the same time, they take aim at normal cells and cause side effects. Yet, not everyone experiences side effects and people react differently.

If you're experiencing myeloma symptoms, your doctor will first decide whether you could be a candidate for stem cell transplantation. For transplant candidates, drug treatment begins with a combination of induction agents that do not cause marrow damage.

A stem cell transplantation may not be appropriate for all patients, such as certain older patients or patients with other medical problems for which the potential risks of transplantation may outweigh the benefits. For patients who are not transplant candidates, treatment may begin with a combination drug therapy. Often, two or three drugs are used simultaneously. As many as six drugs are combined in some intensive treatment programs. You may be given the drugs as pills to swallow, by injection or through a catheter (a thin, flexible tube or intravenous line) surgically placed in a vein, normally in your upper chest.

Drug therapy has led to long-term remission in some patients and a temporary remission or significant slowing of the disease in other patients. As newer, more effective drugs become available, longer remission periods are becoming more common.

Drugs Used for Myeloma Treatment

Drugs regularly used to treat myeloma either alone or in combination with other drugs include

• Alkylating Agents (DNA-Damaging Drugs)
  • Carmustine (BicNU®)
  • Cyclophosphamide (Cytoxan®)
  • Melphalan (Alkeran®)
  • Melphalan hydrochloride (Evomela®)
• Antitumor Antibiotics
  • Doxorubicin (Adriamycin®)
  • Liposomal doxorubicin (Doxil®)
• Antimetabolites
  • Cytarabine (cytosine arabinoside, Ara-C, Cytosar-U®)
• Corticosteroids
  • Dexamethasone
  • Prednisone
• Histone Deacetylase Inhibitors
  • Panobinostat (Farydak®)
• Immunomodulatory Drugs
  • Lenalidomide (Revlimid®)
  • Thalidomide (Thalomid®)
  • Pomalidomide (Pomalyst®)
• Monoclonal Antibodies
  • Daratumumab (Darzalex®)
  • Daratumumab and hyaluronidase-fihj (Darzalex Faspro^TM)
  • Elotuzumab (Empliciti™)
  • Isatuximab-irfc (Sarclisa®)
• Proteasome Inhibitors
  • Bortezomib (Velcade®)
  • Carfilzomib (Kyprolis®)
  • Ixazomib (Ninlaro®)
• Selective Inhibitor of Nuclear Export (SINE)
  • Selinexor (Xpovio™)

Drugs used to fight myeloma-related bone disease

• Bisphosphonates
  • Pamidronate (Aredia®)
  • Zoledronic acid (Zometa®)

Drug used for prevention of skeletal-related events in patients with multiple myeloma

• Denosumab (Xgeva®)

For information about these drugs, visit Drug Listings.

Oral Therapy and Adherence 

Treatment methods for myeloma patients have changed a lot over the last several years. Today, some of the drugs used to treat myeloma are taken by mouth, which is called “oral treatment” or “oral therapy.” Click here to read about the benefits and challenges of oral therapies, and to access resources provided by The Leukemia & Lymphoma Society.

“Adherence” means staying on a set plan or regimen, taking the medication as prescribed—on the right day and at the right time. Poor adherence to a prescribed oral drug regimen can result in the following: drug resistance; poor response to therapy; disease progression; increased doctor visits, laboratory tests and hospitalizations; and even death. Read more here: Myeloma Oral Treatment Adherence

For information about other drugs and drug combinations used for myeloma treatment, access the free booklet, Myeloma.

Related Links

• Chemotherapy and Other Drug Therapies 
• Measuring Treatment Response
• Managing Side Effects
• Integrative Medicine and Complementary and Alternative Therapies
• Food and Nutrition
• Download or order The Leukemia & Lymphoma Society's free booklet, Myeloma.
• Download or order The Leukemia & Lymphoma Society's free booklet, Understanding Side Effects of Drug Therapy