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Treatment Options

It’s important to learn about your treatment options so you and your doctor can make an educated decision.

Being diagnosed with multiple myeloma can be scary. Understanding your treatment options may help you feel more in control and help you communicate with your oncologist.

Multiple myeloma is an incurable condition, but a tremendous amount of progress has been made in research of treatments for the disease. Physicians now have more options to treat multiple myeloma than ever before.

Goals of Treatment

You and your healthcare provider will decide what your goals for treatment are. Generally, the aim of treatment for multiple myeloma is to decrease as many cancerous plasma cells as possible in the body.

A person with multiple myeloma is considered in remission when the M-protein level is greatly reduced, or becomes so low that it cannot be measured, and other symptoms of illness disappear. Though this is not the same as a complete cure, some people have stayed in remission for many years.

Determining a Course of Therapy

Your oncologist will discuss your treatment options with you to determine the best course of therapy for you. The type of treatment you receive is based on a number of considerations. These include your age and general health; your disease stage; your symptoms; your treatment goals; and your test results, including renal function and blood tests.

Keep in mind that seeking a second opinion may provide more information and help you feel more confident about your treatment plan.

Treatment Plan Options

Watchful Waiting

Patients who are in the early stages of multiple myeloma may not need to undergo treatment immediately. Your physician may schedule you for regular visits to monitor for any changes in your condition. Treatment may be necessary once a patient begins to experience symptoms.

Active Treatments

Drug Therapy

There are several different types of drugs that are approved to help fight symptomatic multiple myeloma, and these drugs are given alone or in combination with one another. There are a number of different combinations that a patient may receive, and each type of drug works to fight cancer cells in a different way; however, they may all affect healthy cells as well:

  • Chemotherapy kills fast-growing myeloma cells
  • Targeted therapies are usually directed against molecules involved in the process leading to multiple myeloma. Examples include:
  • Steroids that have antitumor effects

Stem Cell Transplantation

Stem cell transplantation can be used to treat patients with multiple myeloma. Stem cell transplants allow patients to receive higher doses of chemotherapy or radiation. The higher doses of drugs destroy both myeloma cells and, as a side effect, healthy cells in the bone marrow. To replace the healthy cells that were destroyed during treatment, the doctor will give the patient a stem cell transplant.

In a stem cell transplant, blood-forming cells (stem cells) are removed from the patient’s or the donor’s blood or bone marrow. The stem cells are frozen while the patient receives high-dose treatment and then reinfused into the patient’s bloodstream. The new blood cells replace the ones that were destroyed by treatment.

Certain factors affect whether or not a patient is eligible to have a stem cell transplant, including age and other diseases and conditions the patient may have. VELCADE has not been studied in transplant-eligible patients.

Supportive Therapies

Supportive therapies are treatments used to help manage symptoms of the disease.

Radiation Therapy

Radiation therapy uses focused high-energy beams to penetrate the tissues of the body to reach and destroy cancerous cells. Radiation treatment is often given to areas of the bone damaged by myeloma that are causing severe pain.

Surgery

Surgery is not used to treat multiple myeloma but rather to manage complications from the disease. In some cases, patients may elect to have metal rods or plates attached to weight-bearing bones that are or will become fractured due to damage. These rods or plates help support the bones.

Supportive Care

Other drugs may also be given to slow down the process of bone deterioration that can result in bone weakness and fractures. A class of drug called bisphosphonates helps strengthen bones in patients with multiple myeloma.

Clinical Trials

Clinical trials involve studies of new or experimental treatments that are administered to patients with specific diseases. They help doctors test whether investigational therapies work. These studies are one of the steps in the development of new treatments to determine if they are safe and effective.

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Plasma Cells

A type of white blood cell that produces antibodies

M-Protein

An antibody found in unusually large amounts in the blood or urine of people with multiple myeloma and other types of plasma cell tumors. Also called monoclonal protein.

Renal

Relating to kidneys

Chemotherapy

Use of chemical agents (drugs) in the treatment or control of disease such as cancer

Proteasome Inhibitor

A drug or an agent that blocks the action of the proteasome, a large protein complex that helps destroy other proteins in the cell when they are no longer needed

Stem Cell Transplantation

Medical procedure that involves transplantation of hematopoietic stem cells (immature blood-forming cells). Patients are given high-dose cancer treatment that will destroy the cells in the patient’s bone marrow. The stem cells can be used to help “rescue” the bone marrow from this intensive treatment. In an autologous transplant some of the patient’s stem cells are taken and stored before they have the high-dose treatment. After the high-dose treatment, the patient’s stem cells are given back to them through an intravenous line (like a blood transfusion). When the stem cells come from another person, it is called an allogeneic transplantation

Bone Marrow

Soft, sponge-like area in the center of large bones that contains hematopoietic stem cells for production of white blood cells, red blood cells, and platelets

Radiation Therapy

The use of high-energy X-rays and similar rays (such as electrons) to treat disease. This can be given either as external radiotherapy from the outside of the body using X-rays or from within the body as internal radiotherapy. Radiotherapy works by destroying the cancer cells in the treated area. Although normal cells can also be damaged by the radiotherapy, they can usually repair themselves. Radiotherapy treatment can cure some cancers and can also reduce the chance of a cancer coming back after surgery. It may be used to reduce cancer symptoms.

Clinical Trials

Scientifically controlled study of the safety and effectiveness of a medication (such as a drug or vaccine) using consenting human subjects

Anti-Angiogenic Drugs

Drugs that interfere with the formation of new blood vessels; can be used to treat certain types of cancer

Immunomodulatory Drugs

Drugs that interfere with and influence immune system activity; can be used to treat disease including autoimmune disease and some cancers

Steroids

Steroids are naturally occurring in the body and have a variety of functions. They can also be used as medication to treat certain conditions. Three main categories of steroids are sex hormones for sexual maturation, corticosteroids for metabolism, immune function and regulation of salts and fluids in the body, and anabolic steroids for muscle and bone growth


Important Safety Information

What is VELCADE® (bortezomib) used for?

VELCADE is approved for the treatment of patients with multiple myeloma (a cancer of the plasma cells). VELCADE is also approved for the treatment of patients with mantle cell lymphoma (a cancer of the lymph nodes) who have already received other treatments.

How is VELCADE administered?

VELCADE is prescribed by a physician experienced in the use of medications to treat cancer. It is administered by a healthcare professional as an injection into your vein (intravenously, or IV) or under your skin (subcutaneously). VELCADE must not be administered into your spinal fluid (intrathecally).

Who should not receive VELCADE?

Before you receive treatment with VELCADE, tell your doctor about all of your medical conditions. You should not receive VELCADE if you are allergic to bortezomib, boron, or mannitol.

What are the possible side effects of VELCADE?

VELCADE can cause serious side effects, including:

  • Peripheral neuropathy. VELCADE can cause damage to the nerves, a condition called peripheral neuropathy. You may feel muscle weakness, tingling, burning, pain, and loss of feeling in your hands and feet, any of which can be severe. Tell your doctor if you notice any of these symptoms. Your doctor may change the dose and/or schedule of VELCADE, or stop it altogether. If you have peripheral neuropathy before starting VELCADE, your doctor could consider giving you VELCADE subcutaneously.
  • Low blood pressure. VELCADE can cause a drop in blood pressure. Tell your doctor if you have low blood pressure, feel dizzy, or feel as though you might faint. If you are taking drugs that lower blood pressure, your medications might need to be adjusted. If you are not drinking enough liquids, your doctor may need to administer IV fluids.
  • Heart problems. Treatment with VELCADE can cause or worsen heart rhythm problems and heart failure. Your doctor may closely monitor you if you have, or are at risk for, heart disease. Tell your doctor if you experience chest pressure or pain, palpitations, swelling of your ankles or feet, or shortness of breath.
  • Lung disorders. There have been reports of lung disorders in patients receiving VELCADE. Some of these events have been fatal. Tell your doctor if you experience any cough, shortness of breath, wheezing, or difficulty breathing.
  • Liver disease. If you have liver problems, it can be harder for your body to get rid of VELCADE. VELCADE has caused sudden liver failure in patients who were taking many medications or had other serious medical conditions. Symptoms of liver problems include a yellow discoloration of the eyes and skin (jaundice) and changes in liver enzymes measured in blood tests. Your doctor will closely monitor you if you have liver disease. In patients with moderate or severe liver disease, VELCADE should be started at a lower dose. Additional dose adjustments may be made based on your tolerance of the drug.
  • Gastrointestinal problems. VELCADE treatment can cause nausea, vomiting, diarrhea, and constipation. If your symptoms are severe, your doctor may recommend IV fluids and/or medications.
  • Neutropenia (low levels of neutrophils, a type of white blood cell) and thrombocytopenia (low levels of platelets). VELCADE can cause low levels of white blood cells (infection-fighting cells) and/or platelets (clot-forming cells). You will have regular blood tests to check your cell counts during your treatment with VELCADE. If the number of these cells is very low, your doctor may change the dose and/or schedule of VELCADE. If your white blood cells become low, you can be at higher risk for infections. Tell your doctor if you develop a fever or believe you have an infection. If platelets become very low, there is an increased risk of bleeding. Your doctor may recommend a platelet transfusion. There have been cases of bleeding in the stomach, bowels, and brain during treatment with VELCADE.
  • Tumor lysis syndrome (TLS). TLS can occur with cancer treatments, and your doctor will be monitoring your blood and urine for any signs of this syndrome. If you develop TLS, your doctor will take appropriate steps to treat it.
  • Reversible posterior leukoencephalopathy syndrome (RPLS). There have been reports of a rare, reversible condition involving the brain, called RPLS, in patients treated with VELCADE. Patients with RPLS can have seizures, high blood pressure, headaches, tiredness, confusion, blindness, or other vision problems. Treatment with VELCADE should be stopped in cases of RPLS.

More than 30% of patients receiving VELCADE have experienced the following side effects: thrombocytopenia, neutropenia, nausea, peripheral neuropathy, neuralgia (nerve pain), pyrexia (fever), diarrhea, anemia, leukopenia (low levels of white blood cells), decreased appetite, fatigue, constipation, vomiting, dehydration, dyspnea (difficulty breathing), cough, asthenia (low energy), insomnia (trouble sleeping), peripheral edema (swelling of the limbs), and headache.

What other information should you discuss with your doctor?

Women should avoid becoming pregnant or breastfeeding while being treated with VELCADE. Discuss with your doctor when it is safe to restart breastfeeding after finishing your treatment.

You should also tell your doctor if you:

  • Have kidney disease. If you are on dialysis, your doctor will administer VELCADE after the dialysis procedure.
  • Are taking medication for diabetes. VELCADE can affect your blood glucose levels. Your doctor may require close monitoring of your blood glucose levels and change the dose of your diabetes medicine while you are being treated with VELCADE.
  • Have liver disease.
  • Are using medicines like ketoconazole (an antifungal), ritonavir (an antiviral), and rifampin (an antibiotic), which will require close monitoring during treatment with VELCADE.
  • Are using any other medications (including over-the-counter drugs), herbal or dietary supplements, or holistic treatments. St. John’s Wort should be avoided.
  • Develop a rash of any type while receiving VELCADE.

The side effects of VELCADE may impair your ability to drive or operate machinery.

These are not all of the possible side effects with VELCADE. It is important to always contact your doctor if you experience any side effects while on VELCADE. If you have any questions about VELCADE, contact your doctor.

Please click here for the full Prescribing Information for VELCADE, including Warnings and Precautions.

Page last updated 1/23/2012

Find coping strategies.
Important Safety Information
What is VELCADE® (bortezomib) used for?

VELCADE is approved for the treatment of patients with multiple myeloma (a cancer of the plasma cells). VELCADE is also approved for the treatment of patients with mantle cell lymphoma (a cancer of the lymph nodes) who have already received other treatments.

How is VELCADE administered?

VELCADE is prescribed by a physician experienced in the use of medications to treat cancer. It is administered by a healthcare professional as an injection into your vein (intravenously, or IV) or under your skin (subcutaneously). VELCADE must not be administered into your spinal fluid (intrathecally).

Who should not receive VELCADE?

Before you receive treatment with VELCADE, tell your doctor about all of your medical conditions. You should not receive VELCADE if you are allergic to bortezomib, boron, or mannitol.

What are the possible side effects of VELCADE?

VELCADE can cause serious side effects, including:

  • Peripheral neuropathy. VELCADE can cause damage to the nerves, a condition called peripheral neuropathy. You may feel muscle weakness, tingling, burning, pain, and loss of feeling in your hands and feet, any of which can be severe. Tell your doctor if you notice any of these symptoms. Your doctor may change the dose and/or schedule of VELCADE, or stop it altogether. If you have peripheral neuropathy before starting VELCADE, your doctor could consider giving you VELCADE subcutaneously.
  • Low blood pressure. VELCADE can cause a drop in blood pressure. Tell your doctor if you have low blood pressure, feel dizzy, or feel as though you might faint. If you are taking drugs that lower blood pressure, your medications might need to be adjusted. If you are not drinking enough liquids, your doctor may need to administer IV fluids.
  • Heart problems. Treatment with VELCADE can cause or worsen heart rhythm problems and heart failure. Your doctor may closely monitor you if you have, or are at risk for, heart disease. Tell your doctor if you experience chest pressure or pain, palpitations, swelling of your ankles or feet, or shortness of breath.
  • Lung disorders. There have been reports of lung disorders in patients receiving VELCADE. Some of these events have been fatal. Tell your doctor if you experience any cough, shortness of breath, wheezing, or difficulty breathing.
  • Liver disease. If you have liver problems, it can be harder for your body to get rid of VELCADE. VELCADE has caused sudden liver failure in patients who were taking many medications or had other serious medical conditions. Symptoms of liver problems include a yellow discoloration of the eyes and skin (jaundice) and changes in liver enzymes measured in blood tests. Your doctor will closely monitor you if you have liver disease. In patients with moderate or severe liver disease, VELCADE should be started at a lower dose. Additional dose adjustments may be made based on your tolerance of the drug.
  • Gastrointestinal problems. VELCADE treatment can cause nausea, vomiting, diarrhea, and constipation. If your symptoms are severe, your doctor may recommend IV fluids and/or medications.
  • Neutropenia (low levels of neutrophils, a type of white blood cell) and thrombocytopenia (low levels of platelets). VELCADE can cause low levels of white blood cells (infection-fighting cells) and/or platelets (clot-forming cells). You will have regular blood tests to check your cell counts during your treatment with VELCADE. If the number of these cells is very low, your doctor may change the dose and/or schedule of VELCADE. If your white blood cells become low, you can be at higher risk for infections. Tell your doctor if you develop a fever or believe you have an infection. If platelets become very low, there is an increased risk of bleeding. Your doctor may recommend a platelet transfusion. There have been cases of bleeding in the stomach, bowels, and brain during treatment with VELCADE.
  • Tumor lysis syndrome (TLS). TLS can occur with cancer treatments, and your doctor will be monitoring your blood and urine for any signs of this syndrome. If you develop TLS, your doctor will take appropriate steps to treat it.
  • Reversible posterior leukoencephalopathy syndrome (RPLS). There have been reports of a rare, reversible condition involving the brain, called RPLS, in patients treated with VELCADE. Patients with RPLS can have seizures, high blood pressure, headaches, tiredness, confusion, blindness, or other vision problems. Treatment with VELCADE should be stopped in cases of RPLS.

More than 30% of patients receiving VELCADE have experienced the following side effects: thrombocytopenia, neutropenia, nausea, peripheral neuropathy, neuralgia (nerve pain), pyrexia (fever), diarrhea, anemia, leukopenia (low levels of white blood cells), decreased appetite, fatigue, constipation, vomiting, dehydration, dyspnea (difficulty breathing), cough, asthenia (low energy), insomnia (trouble sleeping), peripheral edema (swelling of the limbs), and headache.

What other information should you discuss with your doctor?

Women should avoid becoming pregnant or breastfeeding while being treated with VELCADE. Discuss with your doctor when it is safe to restart breastfeeding after finishing your treatment.

You should also tell your doctor if you:

  • Have kidney disease. If you are on dialysis, your doctor will administer VELCADE after the dialysis procedure.
  • Are taking medication for diabetes. VELCADE can affect your blood glucose levels. Your doctor may require close monitoring of your blood glucose levels and change the dose of your diabetes medicine while you are being treated with VELCADE.
  • Have liver disease.
  • Are using medicines like ketoconazole (an antifungal), ritonavir (an antiviral), and rifampin (an antibiotic), which will require close monitoring during treatment with VELCADE.
  • Are using any other medications (including over-the-counter drugs), herbal or dietary supplements, or holistic treatments. St. John’s Wort should be avoided.
  • Develop a rash of any type while receiving VELCADE.

The side effects of VELCADE may impair your ability to drive or operate machinery.

These are not all of the possible side effects with VELCADE. It is important to always contact your doctor if you experience any side effects while on VELCADE. If you have any questions about VELCADE, contact your doctor.

Please click here for the full Prescribing Information for VELCADE, including Warnings and Precautions.