There are four main types of treatment for multiple myeloma: chemotherapy (including stem cell transplantation), radiation therapy, surgery and biologic therapy. Of these, surgery and radiation therapy are mainly for local symptoms, and biological therapy has yet to be clinically studied. Because the symptoms of multiple myeloma are often found throughout the body, the main treatment modality is still chemotherapy, including stem cell therapy.
How to find the most suitable chemotherapy regimen for myeloma patients?
When doctors develop a chemotherapy regimen for a patient, the first thing to consider is the patient’s prognosis. The prognosis, in layman’s terms, is whether the disease is curable, whether it is good, how the disease is progressing, etc. If the prognosis is better, then there is no need to take those strong chemotherapy regimens in the past; if the patient’s prognosis is not too good, then the intensity of chemotherapy should not be too weak.
Before treatment, doctors have to comprehensively assess the patient’s prognosis through various test results. These tests include the patient’s symptoms, albumin and other levels, as well as tests reflecting the genetic characteristics of tumor cells and molecular biological features, such as FISH tests and chromosomal genetic analysis to see if there are genetic mutations or chromosomal ectopics. Patients must have a systematic and detailed examination before treatment so that doctors can make a safe and effective chemotherapy regimen.
Secondly, another issue to be considered is whether the patient is suitable for autologous stem cell transplantation. If the age is below 60-65 years old and the physical condition allows, all patients should have autologous stem cell transplantation. Of course, age is not an absolute limiting factor, if the physical condition is better, the age can be relaxed appropriately. We will talk more about autologous stem cell transplantation later.
The suitability of autologous stem cell transplantation also determines the chemotherapy regimen. If the patient is suitable for transplantation, then a chemotherapy regimen containing a drug like Marfan should not be used because Marfan can affect the survival of normal stem cells.
What do I need to be aware of during chemotherapy for myeloma?
The main problems that patients tend to have during chemotherapy are infection and bleeding caused by granulocytopenia after chemotherapy. And there are corresponding relief measures to cope with these problems when they occur. Specifically as follows.
1、Gastrointestinal reaction is the most common symptom
Most of the chemotherapy drugs used will have varying degrees of nausea, vomiting, poor nausea, and some will have abdominal pain, diarrhea, and even intestinal mucosal necrosis and perforation. Therefore, give high calorie, high protein, high vitamin, light and easy to digest diet as the principle. Those who vomit intensely should be instructed to increase the amount of oral fluid, and intravenous rehydration if necessary.
2、Observation of chemotherapy drug rehydration
Attention should be paid to the protection of blood vessels during rehydration, and extravasation of drugs should be strictly prohibited. 0.9% saline should be used to flush the tube before each drip, and saline should also be used to flush the tube after use.
3、Bone marrow suppression is the most serious adverse reaction
The patient should be closely observed for bleeding spots on the skin, mouth, gums, etc. Also observe the color and amount of urine and stool, whether there is bleeding, and monitor the blood routine twice a week (according to the patient’s condition).
