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Multiple Myeloma

Multiple myeloma is a cancer of plasma cells, the white blood cells in bone marrow responsible for making antibodies. When plasma cells grow uncontrollably, they crowd out healthy blood cells, weaken bones, and produce abnormal proteins that can damage the kidneys. It is one of the more common blood cancers in adults, with incidence rising alongside ageing populations worldwide.

Cytoxan

Cyclophosphamide

50mg

Cyclophosphamide 50mg tablets, used in the management of malignant lymphoma, multiple myeloma and leukaemia. An alkylating agent that cross-links DNA.

From$2.63/ tabletView

Alkacel

Melphalan

2mg

Melphalan 2mg film-coated tablets, used in the management of multiple myeloma and ovarian cancer. A nitrogen mustard that cross-links DNA strands.

From$5.52/ tabletView

Thalix

Thalidomide

50 · 100mg

Thalix is thalidomide 50mg and 100mg hard capsules for multiple myeloma, an immunomodulator that is also anti-angiogenic.

From$1.73/ capsuleView

Lenalidomide Capsules

Lenalidomide

10mg

Lenalidomide 10mg hard capsules, used in the management of multiple myeloma and myelodysplastic syndromes. A thalidomide analogue and immunomodulator.

From$6.51/ capsuleView

Key points

  • Cancerous plasma cells crowd out healthy blood cells in the marrow, weaken bone and can release proteins that harm the kidneys.
  • The condition is often silent at first and may only come to light through an unexpected fracture or a sudden fall in haemoglobin levels.
  • Warning signs often include ongoing pain in the back or ribs, tiredness that will not lift, and a run of infections.
  • Treatment usually combines several drug classes, chosen according to disease stage and whether a stem-cell transplant is suitable, often including melphalan or cyclophosphamide.

How the Disease Presents

Early multiple myeloma is often silent. When symptoms do appear they typically cluster around what clinicians call CRAB: elevated Calcium, Renal (kidney) impairment, Anaemia, and Bone lesions. Patients may notice persistent bone pain (especially in the back or ribs), unusual fatigue, frequent infections, or thirst and frequent urination. Unexplained fractures or a sudden drop in haemoglobin are also common reasons the condition is first investigated.

Drug Regimens and the Medicines Behind Them

Treatment combines agents from several classes, usually in two- or three-drug regimens, and is tailored to transplant eligibility and disease stage. Melphalan is a long-established alkylating agent that remains the backbone of high-dose conditioning before stem-cell transplant. Cyclophosphamide is used in induction and salvage combinations. The immunomodulatory drugs thalidomide and lenalidomide have transformed outcomes over the past two decades; lenalidomide in particular is now standard in both newly diagnosed and relapsed settings. A broader overview of supportive and anti-cancer therapies is available in the oncology support category.

Bone-protective agents (bisphosphonates) and growth factors to manage anaemia are usually given alongside systemic treatment to reduce skeletal complications and maintain quality of life.

Further reading