The goal of chemotherapy is to induce a complete remission, or absence of multiple myeloma cells in the bone marrow.
Each type of drug kills cancer cells in a different way:
Traditional chemotherapy kills fast-growing myeloma cells, but the drugs can also harm normal cells that divide rapidly. A number of options for chemotherapy drugs are available, including melphalan, cyclophosphamide, and — less frequently — cisplatin, etoposide, doxorubicin, and liposomal doxorubicin. These are usually used in combination with other drugs.
Immunomodulatory Drugs (iMiDs): One type of novel therapy is treatment with pre-iMiD thalidomide and the iMiD lenalidomide. Both of these drugs have multiple effects that include directly killing the cancerous plasma cells as well as stimulating the immune system and acting directly on the bone marrow environment. These are usually used in combination with other durgs.
Proteasome inhibitors: Another type of novel therapy involves treatment with drugs called proteasome inhibitors, which block the abnormal proteins or enzymes that stimulate the growth of myeloma cells. Examples of these drugs include bortezomib and carfilzomib. These are usually used in combination with other drugs.
Steroids or glucocorticoids: Some steroids, such as dexamethasone and prednisone, have antitumor effects. Steriods can trigger the death of multiple myeloma cells. A steroid may be used alone, but usually it is combined with other drugs to treat multiple myeloma.