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Disease Complications

Myeloma can lead to other mild to serious health complications and side effects:

Fatigue

One of the most troublesome complaints reported by myeloma patients is fatigue. Fatigue can be caused by many factors, including disease-related anemia, treatment and medication side effects, physical immobility, sleep disturbance, nutritional deficits, depression, stress and anxiety. Each individual's fatigue should be evaluated and management strategies implemented to alleviate or improve fatigue-causing or fatigue-related issues.

A helpful strategy to keep a consistent energy level while dealing with fatigue may be to pace daily activities and take planned rest periods throughout the day. Support, compassion and understanding of self and from loved ones are key elements in managing fatigue successfully.

Infections

Your infection risk increases when myeloma prevents your white cells from making antibodies to fight infection and keep your immune system working properly. Add chemotherapy, which is toxic to both normal blood cells as well as myeloma cells, and normal cells are eliminated from the bone marrow. Follow your doctor's instructions for avoiding infections. He or she may sometimes prescribe antibiotics as a preventive measure. You may also receive regular gamma globulin preparations, but this is less common because of their serious health risks.

Bone Pain

Expanding myeloma tumors, fractures and collapsed bones in the back pressing on nerves can cause bone pain. To ease pain, your doctor may subscribe medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics, depending on your pain's severity. Download or order The Leukemia & Lymphoma Society's free booklet Pain Management.

Bone Damage

If you're suffering from disabling back pain, the minimally invasive surgical procedures vertebroplasty and kyphoplasty may offer relief by relieving nerve compression. Compression fractures in the small bones in your spine (vertebrae) usually cause the pain.

Kidney Damage

High levels of Bence Jones protein in the urine can interfere with healthy kidney function as can excess calcium in the blood (called hypercalcemia) and uric acid in the urine (hyperuricemia). Both are conditions common to myeloma. Your doctor will regularly monitor your kidney function. In rare cases, you may experience kidney (renal) failure. You doctor may use a procedure called plasmapheresis and exchange to limit kidney damage, although there's some controversy among doctors about whether this procedure is effective. Dialysis may sometimes be needed as well. However, successful myeloma treatment often improves or restores healthy kidney function.

Hyperviscosity Syndrome

Some myeloma patients may experience hyperviscosity syndrome, a medical emergency, in which blood thickens, leading to inadequate blood flow. The heart has to work harder to pump blood. If you develop hyperviscosity syndrome, you must undergo urgent treatment with plasmapheresis and exchange. You'll also need chemotherapy to kill the cells that produce M protein and prevent hyperviscosity syndrome from recurring.

Cryoglobulinemia

If your body is exposed to cold temperature, there's a slight risk that the M protein in your blood can congeal, leading to poor circulation. This can lead to joint pain, kidney problems, skin lesions and purpura (purplish or red-brown skin discoloration). Cryoglobulinemia is a rare condition.

Acute Myeloid Leukemia

Myeloma patients have an increased risk of developing acute myeloid leukemia (AML), especially after being treated with cytotoxic anticancer drugs. AML development, however, is a rare occurrence.

Osteonecrosis of the Jaw

Patients who take bisphosphonates such as pamidronate (Aredia®) and zoledronic acid (Zometa®) may be susceptible to a type of jawbone damage called osteonecrosis of the jaw (ONJ). ONJ is rare. It occurs when bones in the jaw begin to break down and die. Before you begin any treatment with bisphosphonates, get any needed dental work completed and a dental exam. Your oncologist should coordinate closely with an oral surgeon or dental specialist to manage your bisphosphonate treatment. ONJ treatment may include antibiotics, oral rinses and removable mouth prostheses. Occasionally, minor surgery is needed to remove injured tissue and reduce sharp bone edges.

Peripheral Neuropathy

Temporary or ongoing numbness, tingling, burning, weakness and pain in your hands or feet are symptoms of peripheral neuropathy, which occurs when the nerves to your peripheral nervous system are damaged.

Myeloma contributes to the damage if backbones weaken and press on nerves. Certain anticancer drugs, such as vincristine (Oncovin®), bortezomib (Velcade®), thalidomide (Thalomid®) and lenalidomide (Revlimid®), can cause the condition as well. Let your doctor know immediately if you experience any symptoms common to peripheral neuropathy. He or she can adjust your medication to relieve the condition.

Myelosuppression

The bone marrow is constantly producing red cells, white cells and platelets. Interruption or inhibition of this crucial function is called "myelosuppression." Chemotherapy agents and immunomodulatory drugs, including Velcade® and Revlimid®, can cause myelosuppression. If not managed effectively, myelosuppression can be life-threatening and interfere with treatment planning and quality of life. A reduction in red cells can result in anemia, which can make patients feel extremely tired and experience shortness of breath. When the number of neutrophils, the primary type of white cells, is lowered, the resulting condition is called "neutropenia," which can lead to serious infections that require patients to receive antibiotic therapy and possibly be hospitalized. Drugs such as filgrastim (Neupogen®), pegfilgrastim (Neulasta®) or sargramostim (Leukine®) may be prescribed to treat neutropenia. When myelosuppression causes the depletion of platelets in the blood, the resulting condition is called "thrombocytopenia." With low platelet counts, patients may experience excessive bleeding from cuts or injuries and may need a platelet transfusion.

Thrombosis and Embolism

Deep vein thrombosis (DVT) occurs when a blot clot develops in a vein deep in your body, usually in the legs. DVT can cause pain and swelling in the affected limb. If the clot breaks away, it can travel to your lungs or pulmonary arteries and become a pulmonary (lung) embolism, which can be life threatening.

Myeloma patients risk developing DVT and pulmonary embolism as a result of treatment with drugs such as thalidomide (Thalomid) and lenalidomide (Revlimid) combined with corticosteroids like dexamethasone (Decadron®) and liposomal doxorubicin (Doxil®). Combining Thalomid or Revlimid and Decadron with red cell growth factors like epoetin alfa (Procrit®) or darbepoetin alfa (Aranesp®) may further increase risk. Myeloma patients are typically prescribed a blood thinner, such as aspirin, warfarin (Coumadin®) or heparin to reduce risk.

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last updated on Friday, March 16, 2012
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