Myeloma chemotherapy depends on the general health of the patient and functioning of the kidneys and other vital organs of the body. This treatment aims at controlling the disease as long as possible, try to retain the quality of life and provide comfort to the patient. Multiple myeloma is very sensitive to chemotherapy drugs and hence this treatment is used commonly. It is can be given orally as well as intravenously.

One or more chemotherapy drugs are given every 3-4 weeks with a rest period in between. The doctors recommend blood tests for patients prior to the treatment to check the blood counts. The dose of the drugs is adjusted according to the results of the blood tests.

Normally this chemotherapy is done in an outpatient setting. However, if the infusion of one or some of the drugs takes a longer time, the patients might need to be hospitalized for some time.

Myeloma chemotherapy drugs include-

• melphalan
• cyclophosphamide
• doxorubicin
• idarubicin

Some drugs are given in the form of tablets or capsules. The drugs melphalan and cyclophosphamide are available in the form of tablets as well as injections. However, tablets are preferred as there are fewer side effects. They are given along with steroid tablets. The other drugs are given intravenously.

Biological therapy is a treatment wherein the anti cancer drugs affect the cell division process but each work works differently. The initial treatment of biological therapy for myeloma includes drugs like thalidomide and bortezomib.

Thalidomide is effective in treating myeloma. It stops the formation of new blood vessels. This reduces the supply of oxygen and nutrients to the cancer cells and the cancer cells eventually shrink and die. Thalidomide is available in the form of a tablet and is normally recommended daily. There are certain side effects of this drug. Some of them are constipation, drowsiness and risk of developing blood clots in the leg veins that is called deep vein thrombosis.

Thalidomide could also cause peripheral neuropathy i.e. tingling and numbness in hands and feet due to nerve damage. This would gradually disappear.

Thalidomide causes birth defects in a developing fetus, thus should not be given to pregnant women.

Bortezomib is a relatively new drug and is a proteasome inhibitor. Proteasomes are a group of enzymes in our body that function cell growth and functioning. This drug interferes with the proteasomes and in turn interferes with the growth of cancer cells.

This is recommended if a bone marrow transplant is not feasible for recurrent myeloma. This is given intravenously in four doses each with a gap of three weeks in between. This is also given along with a steroid.

Side effects of bortezomib are tiredness, nausea, diarrhea, peripheral neuropathy and a low platelet count.

Steroids help to destroy myeloma cells and enhance the effect of chemotherapy. Some common steroids used to treat myeloma are prednisolone and dexamethasone. They are usually taken as tablets or sometimes as liquid preparations.

They cannot be taken for a very long time as they cause side effects. They cause irritation to the stomach cells that leads to heartburn and indigestion. Other chemotherapy side effects are increased appetite, difficulty in sleeping, water retention, high blood pressure, high level of blood sugar, puffiness and weight gain.

Myeloma chemotherapy is effective as compared to other treatments. There are many new forms of chemotherapy and new drugs developed that destroy the cancer cells effectively. Some of them are still under clinical research.