Induction therapy is the first step in controlling newly diagnosed multiple myeloma and preparing patients for long-term remission.
Understanding Multiple Myeloma
Multiple myeloma is a cancer of plasma cells, a type of white blood cell found in bone marrow. These cells normally help fight infections, but in myeloma, they grow uncontrollably and produce abnormal proteins that can damage bones, kidneys, and the immune system. Patients often experience bone pain, fatigue, anemia, or recurrent infections. While there’s currently no cure, modern therapies can control the disease for years and induction therapy is the first and most crucial stage of treatment.
What Is Induction Therapy?
Induction therapy refers to the initial phase of treatment given to newly diagnosed multiple myeloma patients. Its goal is to reduce the number of myeloma cells quickly and effectively, relieve symptoms, and prepare eligible patients for stem cell transplantation (SCT). This phase often involves a combination of drugs including targeted therapy, immunomodulatory agents, corticosteroids, and sometimes monoclonal antibodies that work together to attack the cancer from multiple angles.
Goals of Induction Therapy :-
The main objectives of induction therapy are:
Achieve rapid disease control: Lower the cancer cell burden in the bone marrow.
Reduce symptoms: Relieve bone pain, fatigue, and other complications.
Improve organ function: Restore kidney and bone health affected by the disease.
Prepare for transplant: Make patients eligible for autologous stem cell transplant (ASCT) by achieving partial or complete remission.
Prolong remission: Help ensure longer disease-free intervals before maintenance therapy begins.
Common Drug Combinations Used in Induction Therapy
Induction therapy typically involves three or four drugs combined into a regimen. The most common regimens include:
VRd (Velcade + Revlimid + Dexamethasone)
Considered the gold standard for newly diagnosed patients.
Velcade (bortezomib) targets cancer cell proteins, Revlimid (lenalidomide) modulates the immune system, and dexamethasone reduces inflammation.
D-VRd (Daratumumab + Velcade + Revlimid + Dexamethasone)
Adds daratumumab, a monoclonal antibody that specifically targets myeloma cells, offering deeper and longer-lasting remission.
CyBorD (Cyclophosphamide + Bortezomib + Dexamethasone)
Commonly used for patients who cannot tolerate lenalidomide or are preparing for early stem cell collection.
KRd (Carfilzomib + Revlimid + Dexamethasone)
An alternative combination using a newer proteasome inhibitor (carfilzomib) for high-risk patients.
These regimens are personalized depending on the patient’s age, kidney function, cytogenetic risk profile, and overall health condition.
How Induction Therapy Works
Each component of induction therapy has a distinct function:
Proteasome Inhibitors (e.g., Bortezomib, Carfilzomib): Disrupt cancer cell growth and promote apoptosis (cell death).
Immunomodulatory Drugs (e.g., Lenalidomide, Thalidomide): Enhance immune system activity against cancer cells.
Corticosteroids (e.g., Dexamethasone): Reduce inflammation and directly kill myeloma cells.
Monoclonal Antibodies (e.g., Daratumumab): Target specific markers on myeloma cells, allowing the immune system to recognize and destroy them.
The combination creates a multi-pronged attack, leading to rapid disease reduction and symptom relief.
Benefits of Induction Therapy :-
Rapid Symptom Relief: Patients often feel improvement within weeks.
Better Transplant Outcomes: Increases the success rate of stem cell transplants.
Higher Remission Rates: Modern regimens achieve partial or complete remission in a majority of patients.
Improved Survival: Induction therapy significantly extends progression-free and overall survival.
Side Effects and Management
Like all cancer treatments, induction therapy can cause side effects. Common ones include:
Fatigue and weakness
Peripheral neuropathy (nerve pain or tingling)
Low blood counts (anemia, thrombocytopenia)
Increased infection risk
Gastrointestinal issues (nausea, diarrhea)
Doctors manage these effects through dose adjustments, supportive medications, and regular monitoring. Early reporting of side effects helps prevent complications and ensures smoother treatment.
The Future of Induction Therapy in Multiple Myeloma :-
The landscape of multiple myeloma treatment continues to evolve rapidly. New-generation therapies, such as CAR T-cell therapy, bispecific antibodies, and targeted precision drugs, are being integrated with induction regimens to enhance outcomes. Researchers are also studying ways to shorten induction duration and reduce toxicity while maintaining deep, durable responses. The ultimate goal is to turn multiple myeloma into a chronic, manageable condition with minimal disruption to quality of life.
Conclusion
Induction therapy remains the cornerstone of managing newly diagnosed multiple myeloma. By combining advanced drug therapies, it provides rapid disease control, prepares patients for transplant, and sets the foundation for long-term remission. With continuous medical progress and individualized treatment strategies, induction therapy offers hope and improved survival for people living with multiple myeloma marking the beginning of a carefully guided journey toward stability and better quality of life.