Hematology focuses on diseases of the blood, bone marrow, and lymphatic system. Learn about the diagnosis and treatment of anemia, leukemia, and lymphoma.
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The landscape of Multiple Myeloma treatment has undergone a revolution in the last two decades. What was once a disease with limited options is now highly manageable with a diverse arsenal of targeted therapies. While myeloma is generally not considered “cured” in the traditional sense, modern treatments can induce deep, durable remissions that last for years. The strategy typically involves induction therapy to control the disease, followed by consolidation (often stem cell transplant) and long term maintenance. At Liv Hospital, we tailor these phases based on the patient’s age, fitness, and genetic risk profile.
The first goal is to rapidly reduce the number of tumor cells and reverse any organ damage. Standard care involves “triplet” or “quadruplet” regimens—using three or four drugs together.
Drugs like Bortezomib and Carfilzomib work by blocking the proteasome, the cell’s “garbage disposal” system. Myeloma cells produce so much protein that if their disposal system is blocked, they fill up with toxic waste and die.
Drugs like Lenalidomide and Pomalidomide work by boosting the immune system to fight the cancer and by cutting off the tumor’s blood supply (angiogenesis).
Dexamethasone is a steroid that is highly effective at killing myeloma cells and acts synergistically with other drugs to improve their performance.
Daratumumab and Isatuximab are antibodies that bind to CD38, a protein found on the surface of myeloma cells. They flag the cells for destruction by the immune system. Adding these to induction therapy is becoming the new standard of care.
For eligible patients (usually those under 70-75 with good organ function), a transplant is a standard part of treatment.
The transplant allows doctors to use a much higher dose of chemotherapy than would otherwise be safe, providing a deeper clean of the bone marrow.
After the transplant (or after induction for those who don’t have a transplant), patients are placed on maintenance therapy.
This usually involves a lower dose of an immunomodulator (like Lenalidomide) taken daily for an extended period, often until the disease progresses.
The goal is to keep the myeloma suppressed and prevent the dormant cells from waking up and multiplying.
Because myeloma almost always returns eventually, having a strategy for relapse is key.
If a patient stops responding to one drug, doctors switch to a different class of drugs or new generation agents (e.g., switching from Bortezomib to Carfilzomib).
This is a groundbreaking immunotherapy where T cells are collected from the patient, genetically engineered in a lab to recognize a specific target on myeloma cells (BCMA), and infused back into the patient. It acts as a “living drug” to hunt down cancer.
These are novel drugs (like Teclistamab) that attach to both the myeloma cell and a T cell, pulling them together so the T cell can kill the cancer.
Treating the cancer is only half the battle; protecting the organs is the other half.
Bisphosphonates (like Zoledronic acid) or Denosumab are given monthly to strengthen bones and prevent fractures.
Hydration is critical. Patients may need to avoid certain painkillers (NSAIDs) that harm kidneys.
Patients often take antiviral medications (to prevent shingles) and antibiotics during treatment. Vaccinations (flu, pneumonia, COVID 19) are essential.
Radiotherapy can be used locally to treat painful bone lesions that are not responding to systemic chemotherapy.
Therapies can cause specific side effects that require management.
Bortezomib can cause nerve damage. Dosage adjustments or switching to subcutaneous injections helps reduce this risk.
IMiDs increase the risk of blood clots. Patients are typically placed on blood thinners (aspirin or anticoagulants) as a preventative measure.
Managing anemia and maintaining light physical activity helps combat treatment related fatigue.
Send us all your questions or requests, and our expert team will assist you.
It refers to using three different types of drugs together (e.g., a proteasome inhibitor, an immunomodulator, and a steroid) to attack the cancer from multiple angles.
It is a serious procedure with risks of infection and fatigue, but it is a standard, safe treatment performed routinely in specialized centers with low mortality rates.
It varies, but many patients stay on maintenance therapy for several years or until the disease comes back or side effects become too difficult.
It is a new treatment where your own immune cells are genetically modified to become “super killers” that specifically target myeloma cells.
Some myeloma drugs (like Revlimid) increase the risk of blood clots, so blood thinners are prescribed to keep you safe during treatment.
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