NCCN Guidelines for Patients™: Multiple Myeloma
3.2 Systemic therapy
Systemic therapy is used to treat cancer throughout the
body. It is the primary treatment for multiple myeloma.
Primary treatment is the main treatment used to rid your
body of cancer. Systemic therapy for myeloma includes
chemotherapy, targeted therapy, and steroids. This is also
referred to as myeloma therapy.
When only one drug is used, it is called a single agent.
However, these drugs differ in the way they work, so often
more than one drug is used. A combination regimen is the
use of two or more drugs.
Maintenance treatment is given to keep the cancer
away when primary treatment has worked. If the primary
treatment fails, salvage therapy is the next treatment or
set of treatments given. Systemic therapy is also used for
maintenance and salvage therapy.
Targeted therapy is the use of drugs to treat cancer.
It stops the growth process that is very specific to
cancer cells. It is less likely to harm normal cells than
chemotherapy. Some targeted therapies treat myeloma
by stopping the growth of new blood vessels that feed
myeloma cells in the bone marrow. Targeted therapies
can also block signals from proteasomes that help the
myeloma cells grow and survive. A type of targeted
therapy called an immunomodulator stimulates the
immune system to find and attack cancer cells. See
Table 1 for a list of target therapy drugs.
Chemotherapy is the use of drugs to treat cancer. Many
people refer to this treatment as “chemo.” Chemotherapy
stops the growth process of cells in an active growth
phase. It does not work on cells in a resting phase.
Cancer cells grow fast, so chemotherapy works well to
stop new cancer cells from being made. Chemotherapy
can also affect normal cells. Some chemotherapy drugs
can also cause much damage to your bone marrow.
Chemotherapy is given in cycles of treatment days
followed by days of rest. These cycles vary in length
depending on which drugs are used. Often, the cycles
are 14, 21, or 28 days long. These cycles also give the
body a chance to recover before the next treatment. Most
of the chemotherapy drugs listed in Table 1 are liquids
that are slowly injected into a vein. Some are a pill that is
swallowed. The drugs travel in the bloodstream to treat
cancer throughout the body.
Steroids are a type of drug used to relieve inflammation,
but some steroids have anti-cancer effects. For myeloma,
steroids can be used alone to treat myeloma or used with
chemotherapy, targeted therapy, or both. See Table 1 for
a list of steroids used to treat myeloma.