Treatment Pathway
Treatment of Multiple Myeloma
Multiple myeloma is a cancer of plasma cells in the bone marrow, causing bone pain, anemia, kidney damage, and recurrent infections. Symptoms arise from the accumulation of abnormal plasma cells.
ESMO (European Society of Medical Oncology)ASCO (American Society of Clinical Oncology)NCCNASH (Hematology)NICE Oncology Guidance
Managing Multiple Myeloma effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Multiple Myeloma can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓Multidisciplinary team (MDT) approach: oncology, surgery, radiotherapy, pathology, palliative care
- ✓Stage-appropriate intent: curative vs. palliative — informs treatment intensity and goals
- ✓Systemic therapy: chemotherapy, targeted therapy, immunotherapy (checkpoint inhibitors), hormone therapy
- ✓Surgical resection: primary curative approach for solid tumours when localised
- ✓Radiotherapy: definitive, adjuvant, or palliative depending on tumour type and stage
What to Do Now
- Learn your personal risk factors for Multiple Myeloma (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Multiple Myeloma
- Use our AI symptom checker to assess whether your symptoms fit an early Multiple Myeloma pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Multiple Myeloma-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Medications Used in Multiple Myeloma
Non-Pharmacological Management
- •Nutritional support: maintain weight and muscle mass; dietitian involvement
- •Physiotherapy and exercise oncology: reduced fatigue, improved outcomes
- •Psychological support: validated cancer-specific interventions (CBT, supportive psychotherapy)
- •Smoking cessation and alcohol reduction: reduces treatment toxicity and second primary cancers
- •Palliative care integration from diagnosis: symptom management, advance care planning
- •Fertility preservation: discuss before gonadotoxic therapy in reproductive age patients
- •Sun protection post-treatment: radiation-sensitised skin; immunosuppressed skin cancer risk
Treatment Goals
🎯Cure or long-term remission in localised and haematological malignancies
🎯Disease control: stable or partial response in metastatic/advanced settings
🎯Symptom palliation and quality of life preservation
🎯Overall survival and progression-free survival improvement
🎯Survivorship: management of long-term treatment sequelae
Monitoring Parameters
- ◆Tumour markers: PSA (prostate), CA-125 (ovarian), CEA (colorectal), AFP (liver) — at defined intervals
- ◆Imaging: CT/MRI/PET per tumour-specific response criteria (RECIST)
- ◆FBC: myelosuppression monitoring during chemotherapy — weekly during active treatment
- ◆Cardiotoxicity: LVEF monitoring with anthracyclines and trastuzumab (echo before, during, after)
- ◆Renal and hepatic function: before each chemotherapy cycle; drug dose adjustments
- ◆Peripheral neuropathy grading: platinum and taxane-based regimens
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Multiple Myeloma — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Multiple Myeloma combined with new relevant symptoms
- ⚠Sudden worsening of Multiple Myeloma symptoms despite established treatment
Escalation Criteria
- →Febrile neutropenia: broad-spectrum IV antibiotics within 1 hour of presentation; emergency
- →Progressive disease on first-line treatment → second-line regimen; clinical trial consideration
- →Oncological emergencies: spinal cord compression, SVC syndrome, tumour lysis syndrome → urgent oncology review
- →Deteriorating performance status → reassess treatment goals; palliative focus
Special Populations
Elderly: comprehensive geriatric assessment (CGA) before initiation; adjust for organ function and polypharmacy
Children: paediatric oncology specialist; growth/developmental monitoring; school integration
Pregnancy: individualised risk-benefit; most chemotherapy avoided in 1st trimester; tumour board involvement
Genetic cancer syndromes: BRCA/Lynch testing; cascade testing and family surveillance
Clinical Insights
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