Treating Multiple Myeloma

When treating patients with multiple myeloma, the best outcomes result from a multidisciplinary approach to your care. At Fox Chase Cancer Center, our team of medical oncologists, radiation oncologists, radiologists, and hematopathologists seamlessly work together to assess your cancer and help you understand your treatment options. We value our role in helping you and your loved ones make informed decisions about your treatment.

When you contact Fox Chase, you will be connected with a nurse navigator. The nurse navigator will match you with the right specialists and help you see as many members of your treatment team as possible in one day. Together, your care team weighs in on your case, creates a tailored treatment plan, and meets regularly to discuss your treatment strategies.

Once our specialized hematopathologists (pathologists who specialize in diagnosing blood cancers such as multiple myeloma) have made a definitive diagnosis of multiple myeloma, the first step is to gauge how advanced the disease is. Some patients present with very early disease or may have a precursor condition that requires observation instead of immediate treatment.

We will recommend a treatment plan personalized for your unique diagnosis and condition. Treatment depends on the stage and aggressiveness of your multiple myeloma, as well as your age, health history, and personal goals. We strive to treat your condition in the least invasive way possible with combination therapies that give you the best chance of a successful outcome.

Primary Treatment of Multiple Myeloma at Fox Chase

Induction

This stage is considered initial therapy and typically includes targeted therapies. In recent years, novel therapies (immunomodulatory agents, proteasome inhibitors, and monoclonal antibodies) have increasingly replaced cytotoxic chemotherapy as the main treatment for multiple myeloma. These therapies spare normal issues from damage and are more effective at eliminating cancer cells.

Many patients respond well to this treatment. Our specialists follow patients’ blood counts and track the status of their disease based on the amount of abnormal protein found in their blood or urine.

Consolidation

Although the induction treatment is effective at killing sensitive myeloma cells, it’s very common for some resistant cells to linger in the bone marrow. After patients have responded well to initial therapy, consolidation treatment is used to trigger an even better response. This is done through a single course of very high-dose chemotherapy and a stem cell transplant, which rescues the patient’s blood counts and replaces diseased or damaged bone marrow.

Multiple studies have shown that patients stay in remission longer and have more durable responses with this approach. Stem cell transplants are also a key treatment option for relapsed and refractory multiple myeloma (which has either come back after previous treatment or did not respond to previous treatment at all). The Fox Chase-Temple University Hospital Bone Marrow Transplant Program is a national leader in performing transplants for patients with multiple myeloma and other blood cancers. Fox Chase performs a large number of these transplants each year and has specialized experience with all types of transplants.

When people hear the term “transplant,” they may think of an operation, but a stem cell transplant is not a surgical process. Stem cells are given back to the patient in the same manner as a blood transfusion.

After the stem cell transplant, patients usually undergo a few additional chemotherapy cycles and convert to maintenance therapy afterward. With this intense consolidation treatment, the specialists at Fox Chase are finding that many patients have no lingering signs of multiple myeloma.

Maintenance

After treatment, patients may switch to maintenance therapy, which usually consists of one drug that patients will stay on indefinitely as long as it continues to keep their disease under control.

Clinical Trials for Multiple Myeloma

Engagement in multiple clinical trials allows Fox Chase to be at the forefront of new treatment options for multiple myeloma.

Also, for patients with relapsed or refractory disease (which has either come back after previous treatment or did not respond to previous treatment at all), clinical trials are often recommended. We are proud to be able to offer our patients the most recent advances and promising treatments for multiple myeloma through these trials.

In the absence of an appropriate clinical trial, chemotherapy, immunotherapy, or another stem cell transplant may be used if a patient’s disease comes back or does not respond to their original treatment regimen.

Multidisciplinary Expertise

All patients with multiple myeloma receive supportive care to control their pain and prevent clot formation, skeletal complications, and viral infections. Because Fox Chase uses a multidisciplinary approach to treatment, many different physician specialists are part of the team:

• Hematopathologists, who specialize in diagnosing blood cancers and can differentiate between different subtypes of myeloma and other blood diseases
• Infectious disease experts, who treat patients undergoing transplants who develop low blood counts or infections
• Orthopedic surgeons, who help heal and repair bone fractures and damage sometimes experienced as a side effect of multiple myeloma
• Radiation oncologists, who have special expertise in providing pain relief, through radiation therapy, to multiple myeloma patients
• Pulmonologists and cardiologists, who can address potential lung or heart complications after transplants

“We have a very mature transplant program that is ranked very highly in the country. It’s a multidisciplinary program with physicians who dedicate themselves specifically to transplants and taking care of patients undergoing transplants in cellular therapy. Fox Chase takes a very well-integrated team approach when treating multiple myeloma patients.”

— Michael Styler, MD, Hematology/Oncology