Treatment for Multiple Myeloma

There are more treatment options for multiple myeloma than ever before. No matter what type of treatment you need, multiple myeloma specialists at Fred Hutchinson Cancer Center will work closely with you, your family and each other to get you back to health. 

Smoldering, or indolent, myeloma doesn’t cause symptoms, and patients with this condition may not need treatment right away. People who have active, or symptomatic, myeloma will be treated by our experienced, compassionate team.  

As you go through treatment, your needs may change. Your care team at Fred Hutch is with you each step of the way. For example, we will help you cope with any side effects you have. We may suggest adding a new therapy that was just approved. Even after your multiple myeloma treatment is done, we will keep seeing you to protect your health over the long term.

Treatment Plan

Multiple myeloma treatment at Fred Hutch is highly customized for each patient’s needs. 

How Do We Create Your Treatment Plan?

Your Fred Hutch hematologist-oncologist works with an entire group of multiple myeloma specialists. They include other hematologist-oncologists, radiation oncologists, pathologists, nephrologists, cardiologists, spine specialists, transplant specialists and researchers who are all looking for better ways to treat this disease.

Every week, this team gathers in a meeting to discuss their patients’ treatment plans. This meeting is called a tumor board. This approach means each patient benefits from the experience of the whole group.

With support from the larger team, your physician will:

  • Decide if your disease needs treatment now, or if watchful waiting is best
  • Talk about the standard therapies
  • Check if any clinical trials match your needs, so you can think about joining them

Your hematologist-oncologist will walk you through the treatment plan that the tumor board has recommended for you. You will have a chance to share your personal preferences and options, and you will decide together what happens next.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many things, including:

  • If your multiple myeloma is asymptomatic (also called smoldering or indolent) or symptomatic
  • If your multiple myeloma is high-risk or standard 
  • If you have had treatment for multiple myeloma in the past
  • Your age and overall health
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What is the Standard Therapy for Multiple Myeloma?

Your treatment plan will be individual to you and your unique circumstances, but physicians often use a combination of chemotherapy, blood and marrow transplant, immunotherapy and radiation therapy to treat multiple myeloma.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Our patients can also choose to have promising new multiple myeloma therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.

Treatment Process

The main goal of multiple myeloma treatment is to get rid of or reduce the number of myeloma cells in your body. This lets us stop or slow down your disease, stop or reduce complications and help you feel better and live a longer, healthier life. We choose, combine and schedule your treatments based on what will work best for your unique case. Your care team will make sure you understand each type of treatment and all of your choices.


The most common treatment to control myeloma cells is chemotherapy. This is often followed by a blood or marrow transplant for younger patients and then long-term maintenance therapy in the form of low-dose chemotherapy.

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow).

Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Usually, chemotherapy for multiple myeloma involves a combination of oral medications (that you take by mouth) and injections.

You will get infusions in a special area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will also watch over you during the treatment. They will deal with any medical issues that come up and help keep you comfortable.

Common forms of chemotherapy can be used alone or in combination with other medicines. They include dexamethasone (steroids), lenalidomide, bortezomib, carfilzomib, daratumumab, elotuzumab and cyclophosphamide. 

Your physician may recommend high-dose chemotherapy with melphalan and an autologous stem cell transplant (using your own stem cells). 

Learn More About Chemotherapy

Blood or Marrow Transplant

A blood or marrow transplant resets your body’s ability to make healthy blood cells. Researchers right here at Fred Hutch pioneered this form of treatment.

Your physicians may recommend an autologous stem cell transplant after your first therapy for multiple myeloma. An autologous stem cell transplant is a transplant using blood-forming stem cells from your own body. This treatment can help patients live longer before a relapse happens, or before they need treatment for myeloma again. 

In some cases, your team may recommend a transplant using stem cells from a donor. This is called an allogeneic transplant.

A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, physician assistant or advanced registered nurse practitioner, pharmacist, registered dietitian, team coordinator and social worker.

Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today, we continue to improve transplant techniques and to develop new options.

Learn More About Blood and Marrow Transplants


Immunotherapies are treatments that use the power of your immune system to fight your cancer. CAR T-cell therapy is one common example.

Today, there are two FDA-approved CAR T-cell therapies for multiple myeloma offered at Fred Hutch. Our physicians and scientists are also studying immunotherapy and bispecific antibodies for multiple myeloma in clinical trials. 

One of our latest clinical trials is looking at the side effects and best dose of BCMA CAR T-cells in patients with multiple myeloma that is positive for B-cell maturation antigen (BCMA-positive multiple myeloma, or BCMA+ multiple myeloma) that has come back or does not respond to treatment.

Learn More About Immunotherapy

Radiation Therapy

Your doctor may also recommend radiation therapy, which uses high-energy X-rays to kill cancer cells. It is highly effective and works well for most myeloma patients.

In multiple myeloma, radiation therapy is used to treat myeloma tumors or a plasmacytoma (a single area of myeloma activity), painful areas of bone damage that aren’t improving with other treatments, or areas where disease activity or damage is causing pressure on the spinal cord or a nerve.

Learn More About Targeted Therapy

Monitoring Your Health

While you are in active treatment, your multiple myeloma care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Supportive Therapies for Multiple Myeloma

Your care team may recommend bone-strengthening medications if you need them. Multiple myeloma can cause holes in the bones that can last even after the cancer is gone, so preventative bone strengthening can be helpful.

This may include: Bone-modifying agents: Zometa, Pamidronate, Denosumab

Possible Results of Treatment

Throughout treatment, your care team looks for signs that your multiple myeloma is responding to treatment. This is called the This is called the International Myeloma Working Group (IMWG) criteria. Unlike other cancer types that have separate stages, with myeloma, most patients will go through relapse at some point, so we think of your outcomes as falling somewhere in a range. The responses to chemotherapy include: 

  • Partial response
  • Very good partial response
  • Complete response
  • Stringent complete response
  • Minimal residual disease (MRD) negative stringent complete response

If you have a relapse, this is called disease progression. Along with relapse, you may also hear the word “refractory,” which means that the disease progression happened during your treatment or soon after treatment ended. 

Classifications include: 

  • Partial response
  • Very good partial response
  • Complete response
  • Stable disease
  • Disease progression
  • Relapsed/refractory
  • Minimum residual disease

What about “cured”? Physicians do not think of myeloma as curable, but it is treatable. Most patients are either on active therapy or being closely monitored.

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it may be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause as many side effects as standard chemotherapy. 

You are always at the center of everything we do. Multiple myeloma physicians, nurses and advanced practice providers are here to help prevent or relieve side effects of treatment. 

Get Help with Side Effects

Before you begin treatment, we talk with you in advance about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or message us in MyChart. We will make sure you know how to reach care providers at Fred Hutch after hours, if that’s when you need us. 

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of multiple myeloma treatment:

  • Unusual tiredness (fatigue)
  • Higher risk of infection (due to low levels of white blood cells or low immunoglobulins/ suppressed immune system)
  • Problems in your digestive tract, like sores in your mouth, nausea, vomiting, constipation or diarrhea
  • Peripheral neuropathy (weakness, numbness and pain, usually in the hands and feet)

“We see the patient on the day that they're meant to start treatment. That would also allow us to educate them on potential side effects to look out for. Typically, they'll meet with one of our pharmacists on that day as well — again, just for another layer of support and information.”

— Christen N. Martino, ARNP, lymphoma survivor

Supportive Care Services

Along with treating your multiple myeloma, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From registered dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is getting chemotherapy, a blood and marrow transplant, immunotherapy or radiation therapy, there are many ways you can help. Caregiving during active treatment for multiple myeloma often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Caregiving for Transplant Patients

Caregivers have a special role in blood and marrow transplants. This intense treatment involves strong chemotherapy with serious side effects. During the initial recovery period, which often takes at least a month, your loved one will need daily help. We have classes to help transplant caregivers get ready. During recovery, a transplant registered nurse is available by phone 24 hours a day, 7 days a week, to help you.

Continuing Care

When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your multiple myeloma. They will check your overall health and look for signs that your cancer may have come back (signs of recurrence). 

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your hematologist-oncologist will base your schedule on many things, including:

  • If your disease was smoldering (asymptomatic) or symptomatic
  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

After active treatments, most patients continue to have regular monitoring every month. 

What Happens at a Follow-up Visit

Follow-up for multiple myeloma usually means seeing your hematologist-oncologist regularly for a physical exam and having blood and urine tests to check your blood cell levels. If there are any changes, you might have tests to check the health of your bone marrow.  

Your physician will let you know if you need any imaging tests. You might have tests like a CT (computed tomography) scan or PET (positron-emission tomography) scan. These can help check for recurrence (the cancer has come back), but they also expose you to some radiation. Together, you and your doctor will decide on the benefits and risks.

Meet the Multiple Myeloma Care Team