Chemotherapy and Drug Therapy

The main treatment for active myeloma is systemic drug therapy (meaning the drugs travel through the bloodstream to kill malignant cells). The initial therapy, or “induction therapy,” for myeloma usually includes a combination of targeted agents and/or standard chemotherapy. This therapy is often followed by stem cell transplantation in eligible patients.

Common drugs combinations for people with newly diagnosed myeloma include:

  • Dara-VRd: daratumumab, bortezomib, lenalidomide, dexamethasone  
  • Isa-VRd: isatuximab, bortezomib, lenalidomide, dexamethasone  
  • Dara-KRd: daratumumab, carfilzomib, lenalidomide, dexamethasone  
  • Dara-CyBorD: daratumumab, cyclophosphamide, bortezomib, dexamethasone  
  • Dara-Rd: daratumumab, lenalidomide, dexamethasone  
  • VRd: bortezomib, lenalidomide, dexamethasone
  • KRd: carfilzomib, lenalidomide, dexamethasone 

After induction, patients who are eligible for autologous stem cell transplant will have stem cells removed from their blood or bone marrow. When possible, enough stem cells should be collected for two transplants in case there is a second transplant at a later date.

Patients who are not eligible for a transplant typically continue with the same drugs used during induction. The goal is to deepen the gains made with the initial cycles of therapy before starting maintenance therapy. 

Drugs Used for Myeloma Treatment

Drugs regularly used to treat myeloma either alone or in combination with other drugs include: 

  • Proteasome Inhibitors
    • Bortezomib (Velcade®)
    • Carfilzomib (Kyprolis®)
    • Ixazomib (Ninlaro®)
  • Immunomodulatory Drugs (IMiDs)
    • Lenalidomide (Revlimid®)
    • Pomalidomide (Pomalyst®)
  • Monoclonal Antibodies
    • Elotuzumab (Empliciti®)
    • Daratumumab (Darzalex®)
    • Daratumumab and hyaluronidase-fihj (Darzalex Faspro®)
    • Isatuximab-irfc (Sarclisa®)
    • Denosumab (Xgeva®)
  • Alkylating Agents (DNA-Damaging Drugs)
    • Melphalan hydrochloride (Evomela®)
    • Cyclophosphamide (Cytoxan®)
    • Melphalan (Alkeran®)
  • Selective Inhibitor of Nuclear Export (SINE)
    • Selinexor (Xpovio®)
  • Chimeric Antigen Receptor (CAR) T-Cell Therapy
    • Idecabtagene vicleucel (Abecma®)
    • Ciltacabtagene autoleucel (Carvykti™)
  • Corticosteroids
    • Dexamethasone
    • Prednisone
  • Bispecific B-cell maturation antigen (BCMA)
    • Teclistamab-cqyv (Tecvayli™)

Drugs used to fight myeloma-related bone disease

  • Bisphosphonates
    • Pamidronate (Aredia®)
    • Zoledronic acid (Zometa®)
  • Bone-modifying agent
    • Denosumab (Xgeva®)

For information about these drugs, visit Drug Listings.

Oral Therapy and Adherence 

Treatment methods for myeloma patients have changed a lot over the last several years. Today, some of the drugs used to treat myeloma are taken by mouth, which is called “oral treatment” or “oral therapy." “Adherence” means staying on a set plan or regimen, taking the medication as prescribed—on the right day and at the right time and reporting side effects to your doctor. Poor adherence to a prescribed oral drug regimen can result in the following: drug resistance; poor response to therapy; disease progression; increased doctor visits, laboratory tests and hospitalizations; and even death.

Download or order the following free LLS resources:

Maintenance Therapy

Maintenance therapy is the continued use of therapy to maintain the response obtained with induction therapy or stem cell transplantation. During maintenance therapy, medications are given at lower doses or with less frequency to keep the successful results of prior treatment going.

Lenalidomide (Revlimid®) is the preferred agent for post-transplant maintenance, based on the results of several clinical trials. It does not produce the neurotoxicity of other immunomodulatory drugs, such as thalidomide. However, lenalidomide appears to increase the risk for developing a secondary cancer during maintenance therapy, especially after transplantation or after therapy with a regimen that contains melphalan. More information is needed about the effects of maintenance therapy on overall survival, as well as second cancer risk.

Maintenance therapy with bortezomib (Velcade®) or ixazomib (Ninlaro®) is recommended for patients with certain cytogenetic abnormalities.

Maintenance therapy is intended to be continued over the long term. If, or when, there are signs and/or symptoms indicating disease progression, you and your doctor will discuss additional treatment. 

For information about other drugs and drug combinations used for myeloma treatment, access the free booklet, Myeloma.

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