Treatment Options for Plasma Cell Neoplasms

Multiple Myeloma
Isolated Plasmacytoma of Bone
Extramedullary Plasmacytoma
Waldenström Macroglobulinemia (Lymphoplasmacytic Lymphoma)
Monoclonal Gammopathy of Undetermined Significance
Refractory Plasma Cell Neoplasms

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Patients without symptoms may not need treatment. When symptoms appear, the treatment of multiple myeloma may be done in phases:

Induction therapy: This is the first phase of treatment. Its purpose is to reduce the amount of disease, and may include one or more of the following:

• Corticosteroid therapy.
• Thalidomide or lenalidomide therapy.
• Targeted therapy with a proteasome inhibitor (bortezomib).
• Chemotherapy.

Clinical trials of different combinations of treatment should be considered.

Consolidation chemotherapy: This is a type of high-dose chemotherapy often given as the second phase of treatment, and may include either:

• autologous stem cell transplant, in which the patient's own stem cells are used; or
• allogeneic stem cell transplant, in which the patient receives stem cells from a donor.

Maintenance therapy: After the initial treatment, maintenance therapy is often given to help keep the disease in remission for a longer time. Several types of treatment are being studied for this use, including:

• Chemotherapy.
• Biologic therapy.
• Corticosteroid therapy.
• Thalidomide therapy.

Supportive care to treat bone problems and amyloidosis may include:

• Bisphosphonate therapy to slow bone loss and reduce bone pain. See the following PDQ summaries for more information about bisphosphonates and problems related to their use:
  • Pain
  • Oral Complications of Chemotherapy and Head/Neck Radiation
• Radiation therapy for tumors of the spine.
• Chemotherapy to reduce back pain from osteoporosis or compression fractures of the spine.
• Chemotherapy and corticosteroid therapy to treat amyloidosis.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with multiple myeloma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Standard treatment of isolated plasmacytoma of bone is usually radiation therapy.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with isolated plasmacytoma of bone. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Standard treatment of extramedullary plasmacytoma may include the following:

• Radiation therapy to the tumor and nearby lymph nodes.
• Surgery, usually followed by radiation therapy.
• Watchful waiting after initial treatment, followed by radiation therapy, surgery, or chemotherapy if the tumor grows or causes symptoms.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with extramedullary plasmacytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment of Waldenström macroglobulinemia may include the following:

• Plasmapheresis and chemotherapy.
• Chemotherapy with one or more drugs.
• Watchful waiting.
• Targeted therapy with a monoclonal antibody (rituximab).
• Biologic therapy.
• A clinical trial of stem cell transplant.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with Waldenström macroglobulinemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment of monoclonal gammopathy of undetermined significance (MGUS) is usually watchful waiting, which will include regular blood tests to check the level of M protein in the blood.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with monoclonal gammopathy of undetermined significance. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment of refractory plasma cell neoplasms may include the following:

• Watchful waiting for patients whose disease is stable.
• A different treatment than previously given. (See Multiple Myeloma treatment options.)

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with refractory multiple myeloma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.