You may receive supportive (palliative) care to prevent or treat myeloma symptoms and the side effects of therapy. Supportive care can help with the following:
Managing Fatigue. Fatigue is one of the most common complaints reported by myeloma patients. It can be caused by many factors, including disease-related anemia, treatment side effects, physical immobility, sleep disturbances, nutritional deficits, depression, stress and anxiety. Each patient should be evaluated in order to identify the possible causes for the fatigue. Management strategies can then be implemented to alleviate the issues causing or related to fatigue. 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. For more on managing fatigue, click here.
Treating Anemia. Anemia is a condition caused by a low number of red blood cells. This makes it hard for the blood to carry oxygen. Patients with severe anemia can be pale, weak, tired and become short of breath. In some patients with severe anemia, the administration of an engineered form of the red cell growth factor called erythropoietin (EPO) may alleviate the anemia or decrease the need for blood transfusions. However, some studies suggest that correcting anemia too vigorously may increase the risk for blood clots. Also, in some forms of cancer, the use of EPO may be associated with a worse outcome, although this may not be the case in myeloma. Patients should discuss the risks and benefits of EPO therapy with their doctors.
Managing Bone Pain. Bone pain may occur because the growth of myeloma cells in the bone causes bone thinning and lesions. Patients may also experience pain that radiates from the back when the back bones (vertebrae) collapse and press on the nerves. Fractures of bones may also result in pain. Options to manage bone pain include:
- Pan medications, including narcotics. Of note: nonsteroidal drugs should be avoided in patients with myeloma, given the increased risk of kidney failure.
- Vertebroplasty and kyphoplasty are surgical techniques that may be used to help myeloma patients who have back pain. With vertebroplasty, a chemical cement is inserted into the damaged or broken vertebrae through a catheter. Kyphoplasty involves inflating a balloon before stabilizing the area with the chemical cement. These procedures relieve bone compression and may alleviate pain and reduce the amount of pain medication that the patient needs.
- The use of bisphosphonates (pamidronate [Aredia®] and zoledronic acid [Zometa®]) can help reduce bone pain and the risk of bone fractures. These drugs also prevent the elevated levels of calcium in the blood that result from bone destruction. These drugs increase the risk of developing osteonecrosis of the jaw (ONJ). ONJ causes part of the jaw bone to die, which can lead to pain, open sores and higher risk of tooth loss and infection. This treatment should be managed by an experienced oncologist, with close coordination between the oncologist and oral surgeon and/or dental specialist.
- Denosumab (Xgeva®) is a monoclonal antibody that has been approved to prevent bone fractures in myeloma patients.
Preventing Infections. Myeloma and its treatment can suppress parts of the immune system. To prevent infection
- IV immunoglobulin therapy should be considered for frequent and life-threatening infections.
- Pneumococcal and influenza vaccine should also be considered.
- Prophylactic treatment against pneumocystis carinii pneumonia, herpes and fungal infections is recommended if a high-dose drug regimen has been given.
- Herpes prophylactic treatment should be considered in patients who are receiving proteasome inhibitors or daratumumab (Darzalex®), since they are associated with incidence of herpes zoster.
Maintaining Kidney Function. Myeloma patients may have serious problems with their kidney function. Timely, adequate treatment of myeloma can improve kidney function and, potentially, even return it to normal in most cases. When this is not the case, some patients may end up needing dialysis support. In rare cases, when patients present with very recent or acute kidney failure, a procedure known as “plasmapheresis and exchange” may be helpful in limiting kidney damage, though this approach is controversial. The most important and successful treatment for kidney failure secondary to myeloma is to treat the myeloma itself without delay. Drinking adequate amounts of water and other healthy fluids can flush the kidneys and help them filter impurities from the blood.
Managing Peripheral Neuropathy. This is the term for damage to nerves of the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body and from the body back to the brain. There are several possible causes for this condition. It can be a result of the disease, or it can be a side effect of certain anticancer drugs. Other problems that can either cause or contribute to neuropathy include diabetes, nerve compression from vertebral fractures and vitamin deficiencies. Symptoms may include numbness, tingling, burning, coldness or weakness in the arms or legs. Patients who develop neuropathy while receiving chemotherapy should tell their healthcare providers immediately. Often, reducing the dosage of the drugs being used, or stopping them altogether, can alleviate the symptoms or even allow them to resolve completely. Since peripheral neuropathy can cause numbness and weakness in the arms and legs, you may be at increased risk of falls and injury. You can take steps to decrease the risk of injury. Click here for more.
Other Disease Complications. In addition to the symptoms addressed above, myeloma and myeloma treatment can cause other disease complications including myelosuppression, thrombosis and embolism, hyperviscosity syndrome, cryoglobulinemia, and Acute Myeloid Leukemia. Some disease complications may be considered medical emergencies. Click here to learn more about other disease complicatons related to myeloma.
For information about the drugs listed on this page, visit Drug Listings.
- Disease Complications
- Watch and Wait
- Managing Side Effects
- Integrative Medicine and Complementary and Alternative Therapies
Download or order The Leukemia & Lymphoma Society's free booklet, Myeloma.