Multiple Myeloma: Treatment and Medications

Being the second most common type of blood cancer, 5-6% of the world population is diagnosed with Multiple Myeloma every year. The survival rate is around 54% with proper treatment. Over the years, with the advancement of medical science, the survival rate for this disease has increased considerably to 74% for those who are diagnosed at the earliest stage. It is most likely to occur in adults and senior citizens and scarce in case of teenagers as well as young adults. 

Multiple Myeloma is the cancer of plasma cells. Upon developing this condition, the plasma cells in the bone marrow become cancerous and start multiplying. As a result of this, they produce an abnormal antibody (protein). This disorder also leads to the plasma cells outnumbering the healthy blood-forming cells and cause a shortage of RBC. The platelet count in the body also becomes low, which can cause increased bleeding. Apart from this, Multiple Myeloma also causes Leucopoenia where normal white blood cells decrease in number. Lastly, it can bring damage to the bones, immune system and kidneys. 

SYMPTOMS OF MULTIPLE MYELOMA 

• Bone pain- Pain in the spinal cord and chest area
• Digestion problems leading to constipation or nausea
• In the early stages, one may experience loss of appetite
• Uncontrollable thirst most of the time 
• Anaemia 
• Fatigue
• Numb feeling in the arms and legs
• Confusion or mental fogginess 

CAUSES OF MULTIPLE MYELOMA 

At present, scientists and researchers have not been able to hit bull’s eye on what triggers this disease. However, the beginning point is marked with the birth of the abnormal plasma cells that start reproducing rapidly in the bone marrow. Not only this, but unlike the healthy cells, they don’t perish after a certain time. Instead, they continue living indefinitely and keep on multiplying. Certain progress has been made in this case with the recent findings on how particular DNA alterations (mutations) can make the plasma cells cancerous. 

• The oncogenes present in the DNA promote abnormal cell growth. 
• The absence of tumor suppressor genes can also contribute to developing this condition.
• A few numbers of cases are also caused by being exposed to high doses of radiation. Working frequently with chemicals like asbestos, benzene, or pesticides can increase the chances of getting this disease. 
• According to surveys and researches, Multiple Myeloma is seen to develop in men more than in women by a small percentage. 

TREATMENT OF MULTIPLE MYELOMA 

If you have been diagnosed with Multiple Myeloma, several treatments can cure the condition. Depending upon your condition and current stage, the standard treatment options are as follows-

• Targeted Drug Therapy– In this case, the focus is laid on the cancer cells with specific abnormalities that help them survive. The specific drugs like Velcade and Kyprolis aim at blocking actions of a substance in myeloma cells that is responsible for the breakdown of proteins. This type of therapy may be conducted through a vein in the arm or pill form. 
• Biological Therapy– The main agent that will fight the malignant myeloma cells is the immune system. The drugs work towards making the immune system cells more active to identify as well as attack the cancer cells. Biological therapy is conducted in pill form.
• Chemotherapy– It is the most effective form of treatment to kill fast-growing cancer cells. The drugs for chemotherapy can be injected in the body through veins or taken in pill form. 
• Corticosteroids– In this process, the prednisone and dexamethasone help to enhance the immune system so that the inflammation is controlled within the body. They are active against myeloma cells and can be taken in both pill form or administered through the veins. 

• Bone Marrow Transplant– Also known as the stem cell transplant, this process involves replacing the diseased bone marrow with that of a healthy one. Before the bone marrow transplant, high doses of chemotherapy drugs are mandatory to destroy the diseased bone marrow. 
• Radiation Therapy– Utilizing beams of energy such as X-rays and protons, radiation therapy helps to kill the myeloma cells. It is a quick process to destroy the cancerous cells and stop their growth in a specific area of the body. 

MEDICATIONS USED TO TREAT MULTIPLE MYELOMA

LENALIDOMIDE: 

It is a promising new drug that works alone as well as combined with other drugs to destroy the myeloma cells effectively. Proper treatment can lead to overall survival, event-free survival and progression-free survival.

The correct dosage and detailed procedure to use Lenalidomide

Whether you have been prescribed the Lenalidomide 25 mg or 10 mg, or any other strength, it must be consumed at the same time each day. You are free to take it with or without food. It is very important to follow the guidelines and instructions mentioned on the label as well as in the prescription. 

Preventive measures 

• Handle the capsules safely because the medicine inside it is not at all safe for coming in direct contact with skin. Dispose of off a broken capsule immediately, if found any. 
• If you miss one dose or have been late for more than 12 hours, do not intake two capsules at the same time. 
• Refrain from donating blood or sperm if you are under Lenalidomide therapy. In fact, wait for 4 weeks after you have completed your dosage for any such activities. 
• Make sure not to let anyone else come in contact with your blood or semen by any means while you are undergoing this drug therapy. 
• A lot of patients show allergic reactions to this medicine. In that case, seek emergency medical attention. Common symptoms include difficulty in breathing, throat swelling, skin pain, rash and peeling blisters. 

If you are pregnant, it is strictly advised to stay off this medicine. It has been seen to have severe defects on the life of the baby; in extreme cases, death. That is why it is best to use birth control or terminate the pregnancy if it is mandatory for you to undergo this treatment. 

Some of the Common Side Effects of using Lenalidomide-

• Nausea and vomiting 
• Unusual tiredness and fatigue
• Swollen glands
• Muscle pain and cramps
• Blood in urine and stools 
• Fever, cough and chills
• Irregular heartbeat
• Loss of appetite
• Cold sores and unusual blisters 

POMALIDOMIDE: 

This drug treatment for Multiple Myeloma is conducted through pill form. It is recommended for patients who have undergone at least two therapies before that include Lenalidomide as well as a proteasome inhibitor. 

 The Correct Dosage and Detailed Procedure to use the Pomalidomide

Pomalidomide is used in combination with dexamethasone from Day 1 to Day 21 if the 28-day cycles until signs of progression are shown. Have one capsule (swallow with water) each day at the same time, with or without food. 

 Preventive Measures  

• It is best not to involve in hazardous or tiring activities while you undergo this drug therapy. Driving is strictly prohibited as well.
• Do not let your skin come in direct contact with the medicines inside the capsules. Wash your skin with soap and water if anything like this takes place. 
• You must store the capsules in room temperature, away from light and direct source of heat. 
• Avoid donating blood or sperm while you are undergoing therapy. 

 Some of the Common Side Effects of using Pomalidomide 

• Flu-like symptoms such as fever, chills, cold sores, stuffy nose
• Swollen glands
• Nausea and indigestion problems leading to constipation and diarrhoea 
• Skin rash
• Difficulty in breathing 

CARFILZOMIB: 

This anti-cancer drug works as a selective proteasome inhibitor. This is an intravenous drug that is prescribed in combination with Dexamethasone or Lenalidomide after at least one previous therapy. Not only this, but this drugtherapyis shown to treat refractory or relapsed Multiple Myeloma. 

The correct dosage and detailed procedure to use Carfilzomib

Carfilzomib injection is used alone or in combination with Dexamethasone and Lenalidomide. It is given by a medical health professional like a doctor or nurse. It doesn’t take more than 10 to 30 minutes. Doctors usually go with the 2 days in a row per week method that lasts for 3 weeks. After that, comes a 12-days rest period followed by once a week for 3 weeks. Blood tests and diagnosis will be carried out in between to observe your body’s reaction to the therapy. 

 Preventive Measures 

• Make sure to determine whether you are allergic to Carfilzomib before you start therapy. 
• Upon 24-hours of starting treatment, the patient is likely to experience certain life-threatening symptoms. That’s why they have prescribed a set of medication before the injection. 
• Patients with a history of cardiovascular diseases must confirm with their physician whether it is safe to undergo this treatment. 
• Carfilzomib has an immense negative impact on pregnant and breastfeeding women. 

 Some of the Common Side Effects of Carfilzomib

• Swelling of feet 
• Muscle spasm
• Nausea
• Chest pain
• Blood in urine and stool
• Shortness of breath
• Flu-like symptoms
• Seizures 

BORTEZOMIB:

The novel first-in-class proteasome inhibitor is one of the most efficient drugs used for treating Multiple Myeloma. Bortezomib injection is given to patients who are in a relapsed state and post-transplant state. They can also be effective for patients who aren’t viable candidates for transplantation.

The correct dosage and detailed procedure to use Bortezomib

At a concentration of 1mg/mL or 2.5mg/mL, Bortezomib is injected in the vein subcutaneously by a medical professional. Doses may vary according to the seriousness of your condition. 

 Preventive Measures 

• It is important to change the injection site each time so that the skin injury is lessened considerably. 
• Drink plenty of fluids to avoid dehydration while you undergo this drug therapy. 
• Determine whether you are allergic to the ingredients.
• Limit alcoholic beverages and refrain from smoking cannabis while you are under the influence of this drug. 
• Don’t come in contact with people who are carriers of contagious injections. 
• It is not suitable for pregnant women to consider this drug therapy. 

 Some of the Common Side Effects of Bortezomib

• Cardiac and pulmonary toxicity
• Gastrointestinal problems leading to nausea or constipation
• Urine inflammation. Bloody urine and painful urination
• Light-headedness 
• Muscle spasm
• Unusual weight gain

CARMUSTINE: 

This is an intravenous drug that is given in combination with prednisone or alone. Suitable for treating both relapsed and refractory Multiple Myeloma, Carmustine works by blocking DNA repair in tumor cells to destroy them.

The correct dosage and detailed procedure to use Carmustine

Usually, a 61.6-mg single dose is given once in every six weeks to adults. It can vary according to your medical state. Before stem cell or bone marrow transplant, Carmustine injection is also given to decrease the WBC count in the body, which suppresses immune response against the transplant. 

Preventive Measures 

• This drug causes fetal harm and gives rise to pregnancy complications. 
• Based on the nadir blood counts, the doctor might recommend a dosage reduction after every session. 
• If you are developing symptoms for aseptic meningitis, consult your doctor. 

 Some of the Common Side Effects of Carmustine

• Skin necrosis
• New primary malignancy
• Leucopenia (After long-term treatment)
• Hallucinations 
• Development of hypothyroidism
• Nausea, vomiting, abdominal pain 

MELPHALAN: 

This alkalizing agent works by destroying the cancer cells as well as curbing them from multiplying further. This drug is also infused in the body before stem cell transplant to stop the immune system from rejecting the donor cells. 

The correct dosage and detailed procedure to use Melphalan

In older patients, the standard oral treatment is Melphalan combined with prednisone. Depending on your body weight and medical condition, the dose may vary. A typical schedule is 6mg per day. For the Melphalan injection, Melphalan 50 mg powder and solvent is required. The intravenous treatment is suited for younger patients. 

Preventive Measures 

• Avoid going near people with contagious infections. 
• Check with your dentist to find out about other ways of cleaning teeth. The traditional ways of using a brush or flossing need to be avoided for the time being. 
• You need to be careful while shaving or using sharp objects. Cuts and injuries are to be avoided strictly. 
• Contact your doctor in case of unusual bleeding or allergic reactions. 

Some of the Common Side Effects of Melphalan

• Chronic cough
• Chest pains
• Mouth ulcers, sores and white spots on lips
• Abdominal pain
• Blurred vision
• Dark urine
• Body swelling 
• Difficulty in breathing 

DARATUMUMAB: 

This prescription drug is not a part of chemotherapy. It is a form of targeted antibody therapy that helps to slow down the process of multiplication of cancer cells by attaching itself to the Myeloma cells and enabling the immune system for this killing them. 

The correct dosage and detailed procedure to use Daratumumab

Daratumumab injection can be given to people who have been diagnosed with Multiple Myeloma at the early stages or to patients who have undergone one or two treatments before this. It can be used alone or by combining with other injections, as per the situation. Mention may be made of the fact that Daratumumab cost is usually quite high- $ 590 for 5mL. 

Preventive Measures

• Consider a thorough medical check-up before you decide to undergo this treatment to determine if you are allergic to the ingredients. 
• If you are taking other prescriptive drugs, it is suggested to mention them to your doctor. 
• The patient is prohibited from consuming alcohol or smoking the entire time. 

 Some of the Common Side Effects of Daratumumab

• Breathing troubles 
• Body aches
• Facial swelling
• Sore throat
• Nausea 

BOTTOM-LINE

The above-mentioned drugs are seen to work effectively in curing Multiple Myeloma in adults and children. It is imperative to follow the prescription and instructions stated by your doctor. Refrain from sharing the medicines with anyone, even if they have developed a condition similar to yours. Regular check-ups and blood tests are also conducted to notice how your body is responding to drug treatment. All Multiple Myeloma medications are available at Ikris pharma at cost-effective prices.

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Disclaimer: The aforesaid information is only for information purpose.