Cancer - Oncology

Treatment

At Mount Sinai, our comprehensive Multiple Myeloma Program provides the highest level of care for patients with myeloma and related diseases. We closely monitor you at all stages of disease to be sure to start treatment as soon as you need it and to get the best possible results.

The life expectancy and quality of life for patients with myeloma continues to steadily improve, thanks to research here at Mount Sinai and around the world. We are developing ways to manage the disease long-term, making possible lengthy disease-free remissions.

We personalize all treatment plans to your individual disease, paying particular attention to low-risk versus high-risk disease. Our goal is to destroy myeloma cells while sparing your normal, healthy cells and prevent recurrence, with minimal side effects.

We use advanced diagnostic testing, including next-generation sequencing, to distinguish between low- and high-risk diseases and determine the most appropriate precision-medicine treatment. Next-Generation sequencing enables us to understand exactly what is going on in your body by sequencing thousands to millions of DNA molecules simultaneously. It is revolutionizing personalized medicine.

Treatment options may include:

  • Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. We use a variety of chemotherapy agents such as melphalan, cyclophosphamide, vincristine, and doxorubicin.
  • Vaccine/immunotherapy can boost your T cells' natural ability to fight cancer. T cells are a type of white blood cell and part of the immune system, which fights disease. Researchers take T cells from the blood and (1) isolate the T cells that are most active against your myeloma or modify the genes in them to make them better able to find and destroy your myeloma cells, (2) grow large batches of these T cells in the lab, and (3) give the T cells back to you to fight the myeloma cells. Immunotherapy vaccines are unique to each individual patient. Video on Immunotherapy from the National Cancer Institute
  • Immunomodulatory agents (IMiDs) such as Revlimid (lenalidomide), Pomalyst (pomalidomide), and Thalomid (thalidomide) modulate the interactions between myeloma cells and the bone marrow microenvironment in which they grow and thereby decrease cell growth and survival.
  • Proteasome inhibitors block the action of proteasomes, cellular complexes that break down defective proteins.
  • Monoclonal antibodies are designed to bind to specific targets in the body. They can cause an immune response that destroys cancer cells and can “mark” cancer cells so it is easier for the immune system to find and destroy them. Monoclonal antibodies, including daratumumab and elotuzumab, are a type of targeted therapy.
  • Autologous stem cell transplantation is the most common type of transplant for myeloma. We collect some of your healthy stem cells, use high-dose chemotherapy to destroy malignant cells, and then infuse your own healthy cells back into you. The healthy stem cells travel to the bone marrow where they start producing new blood cells.

Clinical Trials

We have a robust program of clinical trials that feature novel therapies and agents. We will offer you the opportunity to participate in clinical trials when they are appropriate for your condition and overall health.

Treating Complications

We work closely with Mount Sinai specialists in other clinical services to manage complications of myeloma, such as bone fractures, spinal compression, and kidney and cardiac issues. For example, interventional neuroradiologists perform kyphoplasty and vertebroplasty to relieve pain, and improve mobility, overall function, and quality of life.

We can also offer bisphosphonates to strengthen bone and slow loss of bone mass. These drugs can slow down the progression of myeloma-related bone disease, decrease bone pain, and reduce incidence of fractures.

Supportive Care

Even when we provide the very latest in personalized medicine, you may find that your treatment has unpleasant side effects. Most are short-term and can be well managed. While side effects vary, the most common are fatigue, nausea, peripheral neuropathy (numbness and tingling from nerve damage, usually in the feet or hands), loss of appetite, low blood counts, fever, and increased risk for infection.

We do everything we can to help. We monitor you closely and provide supportive care treatments to manage and, whenever possible, prevent side effects.

Our supportive care team includes experts from across Mount Sinai’s clinical care network, including specialists in infectious diseases, nephrology, and other medical specialties as well as dieticians and social workers. Our team is here to help you through every phase of diagnosis, treatment, and follow-up care.