You may be offered:

Radiotherapy
If you have areas of bone that are weak or causing pain, your doctor may suggest radiotherapy.

Radiotherapy uses radiation to kill cancer cells. For myeloma, It is given from outside the body – this is called external beam radiotherapy. A beam of radiation is aimed at the part of the body that needs treatment.

If your myeloma is all in one place, radiotherapy may be the only treatment required.

Your doctor will tell you how much radiotherapy you need, and how long the treatment will take. This varies greatly from patient to patient.

Standard chemotherapy
Chemotherapy uses special drugs to kill cancer cells.

There are several drugs for the doctor to choose from. A drug called Cyclophosphamide may be used. Often Melphalan is used, together with a steroid called Prednisolone. Sometimes, other drugs are used as well as these.

Drugs can be given in different ways – for example by injection, by mouth or as a drip. Your doctor will explain what needs to happen in your case. Treatment lasts for six months on average, but this can vary.

Intensive chemotherapy
A more intensive approach is to give chemotherapy drugs continuously over several days.

This may be done through a thin plastic tube called a Hickman line, which is put into a vein in the chest. Another method is to use a PICC line, which is fed through a vein in the arm and into a large vein in the chest. You have a local anaesthetic before the doctor or nurse puts the tube in place. The line is then connected to a small, portable infusion pump that delivers a controlled dose of drugs into the blood through the Hickman or PICC line. This means that you can have your chemotherapy at home.

The drugs used may well be Vincristine and Adriamycin, with a steroid called Dexamethasone. Together, these are called the VAD chemotherapy regimen.

Intensive chemotherapy is more likely to be offered to patients under the age of 60. It is given as several courses (or cycles) of treatment, usually over six months.

High dose chemotherapy with stem cell rescue
Some fitter patients who have responded well to initial chemotherapy may go on to have this treatment.

Chemotherapy can damage bone marrow and lead to problems such as anaemia, infections and bleeding. After standard or intensive chemotherapy bone marrow recovers on its own, but high dose chemotherapy does more damage, and bone marrow needs help to recover.

Before you have high dose chemotherapy your doctors will take some stem cells from you. These are stored, ready to give back to you afterwards. When they are put back into your body the cells start to grow and multiply again.

There are two ways of getting the stem cells. The most usual way is to get them from the blood. A special machine collects bone marrow cells that are circulating in the blood. This is called peripheral blood stem cell harvesting. Less usually, some bone marrow is removed. This is called bone marrow harvesting.

After the harvesting, you have your high dose of chemotherapy. Later your undamaged blood stem cells (or bone marrow) are given back to you through a drip.

The chemotherapy and stem cell rescue will involve a stay in hospital of two or three weeks.

This is an aggressive treatment and it is not right for everyone. Your doctor will tell you whether it may be suitable for you.

Surgery
Some patients have an operation to help strengthen weakened bones and prevent fractures.

Newer treatments
Doctors are looking at some new options, including the drug Thalidomide. Research is under way to find out how well these treatments work.

For example, Thalidomide might be able to stop cancers from developing new blood vessels. Without these, the cancers would not be able to get the food and oxygen they need to survive.

At the moment these newer approaches are not recommended as a first treatment, but they may be offered later on in the illness. Thalidomide, for instance, may also help to reduce some of the side effects of myeloma.

Clinical trials
Your doctor will tell you if there are any clinical trials you may be able to enter. A clinical trial is a study to investigate new approaches to treating and caring for those with cancer (and other illnesses).