Multiple myeloma: questions when starting a new therapy

Multiple myeloma (MM) is a type of blood cancer where the bone marrow produces cancerous plasma cells. Plasma cells are a type of white blood cell that are found in the bone marrow and produce antibodies that help the body fight infections.

When a person has MM, plasma cells have undergone mutations that cause them to reproduce at a much faster rate than normal—and expire at a much slower rate. This leads to a buildup of cancerous MM cells in the bone marrow, which crowds out healthy cells, damages and weakens affected bones, and can cause tumors. MM cells also produce abnormal antibodies, called M protein, which can thicken the blood and damage organs like the kidneys.

There is no cure for MM, and treatment focuses on controlling the disease—reducing symptoms, slowing progression, and if possible, putting the cancer into remission. Remission refers to periods where the cancer is well controlled and symptoms are minimal. However, remission does not mean cured. Ultimately, the goal of treatment is to help a person live as long as possible while having the best quality of life possible.

Treatment for MM

MM affects different people in different ways, and treatment will need to be tailored to the person being treated, their overall health, and their individual needs.

A good understanding of the cancer is essential when making treatment decisions. This includes the stage, how the cancer is behaving at the cellular level, the genetic changes that are present within cancer cells, and how the cancer is affecting the body. Your best source of information will always be a healthcare provider.

While surgery and radiation therapy may be used in some cases (to target specific tumors, for example), the main treatment for MM is drug therapy. This includes drugs that are given as infusions as well as drugs that are taken as oral medications. A wide variety of drug therapies are used in the treatment of MM, and a person will typically take several different drugs with different mechanisms in combination with one another.

In addition to drug therapy, your healthcare team might discuss other treatment options, such as stem cell transplant or CAR T-cell therapy.

Starting or switching to a new treatment

Treatment for MM can change over time. Nearly all cases of MM become resistant to drug therapies and/or relapse (return after a successful treatment). This means that a person will need to change what therapies they are using to treat MM.

Questions to ask when starting a new drug therapy

As a person living with MM or a caregiver to a person living with MM, it’s important to know what therapies are being used, how each therapy is given, and what side effects you’ll need to watch for. Start with these questions:

• What is the name of the therapy? What dosage will I be given?
• How does this treatment work and why is it recommended?
• What are the goals of this therapy?
• How is the medication administered? For example, will I be taking a pill? Will I be going to an infusion center or hospital?
• How long will this part of treatment take?
• How will we know if this treatment is working? What kind of follow-up appointments will I need?
• How will my day-to-day life be affected by this treatment? How will it impact my ability to work, exercise, what I can eat, how I need to take care of myself?
• Are there things I will need to avoid during this part of treatment?
• What treatment options do I have if this therapy doesn’t work?
• What will this therapy cost? Who can I talk to if I have concerns about the cost?
• Should I seek a second opinion before making a decision about this therapy? Some studies have found second opinions to be associated with better treatment outcomes for MM.
• Where can I learn more about my different treatment options?

Questions about possible side effects and interactions

Cancer treatments cause side effects, and it’s important to discuss side effects before starting any treatment. Ask your healthcare providers:

• What side effects are common with this treatment?
• Is there a risk of serious side effects?
• What can be done to reduce or manage side effects?
• Can this therapy interact with other drugs? Tell your healthcare provider about all drugs you are taking, including prescription medications, over-the-counter medications, and supplements.
• What changes—in symptoms, in how you feel—do I need to watch for? Who can I reach out to if I have a question? When should you seek emergency care? Who should I contact if I have an emergency?

Remember, your healthcare providers will be your best source of information about your diagnosis and your treatment options. You are also an important source of information for your healthcare providers. It can help to keep a journal where you record how you feel, your questions, and concerns you want to discuss.