Your treatment pathway

The treatment and management of myeloma is very individual, just like the condition itself. Your treatment pathway may look different to someone else with myeloma. There are many factors that you and your haematologist will consider when making a decision about the treatment that’s best for you.

Making decisions about treatment

Not everyone diagnosed with myeloma will need to start treatment straight away. Your haematologist may talk with you about actively monitoring your myeloma and waiting until your myeloma markers have reached a level where it becomes necessary to start treatment or you develop a symptom of myeloma that can be addressed by starting treatment.

When you do begin treatment, it will usually be made up of a combination of two or three different medicines, called a treatment regimen. This helps to ensure that the myeloma cells are being targeted at different points of their life cycle to achieve the maximum response. The aim of treatment is to achieve maximum response without unacceptable side effects. 

There are many different types of treatments available on the Australian Pharmaceutical Benefits Scheme (PBS). There are also new treatments available through clinical trials and special access programs. 

Your haematologist will explain the treatment options available to you at diagnosis and at each relapse. There are many factors that you and your haematologist will consider when making treatment decisions, these include: 

• your personal preference due to circumstances and lifestyle
• availability of the treatment through the PBS, a clinical trial, or special access program 
• your current level of myeloma 
• your general health and age 
• any pre-existing health conditions you have 
• your response to any previous treatments 
• side effects you experienced with previous treatments 

Your treatment will usually include medicines to help control the myeloma itself, as well as supportive care treatments for other symptoms and complications caused by myeloma. 

Read more about supportive care treatment on our Supportive care treatments webpage.

How do I decide which treatment to have?

Making an informed choice about what treatment you will have is important, and you will usually be able to take some time to reach your decision.

When considering different treatment options, think about your personal priorities and lifestyle. Each treatment choice will have both benefits and difficulties, and it’s vital to discuss these openly with your haematologist. 

As part of your treatment decisions, it’s important for you to tell your haematologist what you want to achieve from treatment – and this won’t be the same for everyone. Do you want an intense treatment pathway with the goal to live as long as possible? Or would you prefer a less intense treatment option that might offer you a better quality of life, but not the best long-term survival? Once your haematologist knows the answers to these questions, they will be better able to recommend a treatment option that suits your goals. 

You might find it helpful to make a list of pros and cons of the different treatment options provided to you and take this with you to discuss with your haematologist. 

Should I get a second opinion?

There may be times when you or your haematologist feel that you would benefit from the opinion of another haematologist. 

This may be because there is a clinical trial available, you are eligible for a treatment that’s only offered in certain hospitals, or you might want to be sure that the treatment plan you’ve been recommended is the best option for you. 

Because myeloma accounts for less than 2% of cancers overall, and choosing the right treatment is sometimes complex, you may need a second opinion with a myeloma specialist  to ensure that your diagnosis is correct, the treatment plan is appropriate, and that all other options have been considered. 

Haematologists are generally happy for people to ask for a second opinion, and doing this will not offend them. Your current specialist or General Practitioner (GP) may be able to recommend another haematologist. 

It’s important to keep in mind that you will have a lot of contact with your treating team, so it’s vital you feel comfortable with them so that you can maintain a good therapeutic relationship.

Starting initial treatment

When you and your haematologist decide that it is time to start treatment, they will choose one of two different treatment pathways depending on whether or not you are eligible for autologous stem cell transplant (AuSCT). 

Generally, AuSCT is recommended as part of initial treatment for people who are aged under 70. Above this age, the toxicity of the procedure may outweigh the benefits. However, the decision to use AuSCT is more about your overall health than your age. 

To learn more about stem cell transplant and other myeloma treatments see our page Types of treatment.

Maintenance treatment

Maintenance treatment is treatment that aims to maintain or further deepen your response to a line of therapy. 

This might involve: 

• continuing with a current treatment regimen at a lower dose or with less frequent doses 
• starting a lower-dose treatment following HDT-AuSCT. 

It’s important to know that not all people will benefit from maintenance therapy. You and your haematologist will talk about balancing any benefits against possible side effects before making the best decision for your situation. 

Read more about treatment when myeloma returns on our When myeloma returns webpage.