Supportive (palliative) care for myeloma helps manage the complications of the disease and the adverse side effects of the drugs used for treatment, including:
- Bone Pain
- Kidney Function
- Peripheral Neuropathy
- Thrombosis and Embolism
- Hyperviscosity Syndrome
- Other Cancers
Bone marrow is constantly producing red blood cells, white blood cells and platelets. Interruption or inhibition of this crucial function is called “myelosuppression.” Chemotherapy agents, immunomodulatory drugs such as lenalidomide (Revlimid®) and proteasome inhibitors such as bortezomib (Velcade®) can cause myelosuppression. If not managed effectively, myelosuppression can be life threatening and interfere with treatment planning and quality of life.
- Low number of red blood cells (anemia): A reduction in the number of red blood cells can result in anemia, which can make patients feel extremely tired and experience shortness of breath.
- Low number of neutrophils, a type of white blood cell (neutropenia): Neutropenia can lead to serious infections that require antibiotic therapy and possibly hospitalization. Certain drugs, such as filgrastim (Neupogen®), pegfilgrastim (Neulasta®) or sargramostim (Leukine®), may be prescribed to treat neutropenia.
- Low number of platelets (thrombocytopenia): Patients who have low platelet counts may experience excessive bleeding from cuts or injuries and may need platelet transfusions.
For more, click here or view the free LLS fact sheet Side-Effect Management: Managing Low Blood Cell Counts.
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.
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
- Note: nonsteroidal drugs such as ibuprofen should be avoided in patients with myeloma, given the increased risk of kidney failure.
- Bisphosphonates pamidronate (Aredia®) and zoledronic acid (Zometa®) to help to alleviate bone pain and the risk of bone fractures
- Note: These drugs increase the risk of developing osteonecrosis of the jaw (ONJ). This treatment should be managed by an experienced oncologist and an oral surgeon and/or dental specialist.
- Denosumab (Xgeva®), a monoclonal antibody, to prevent bone fractures
- Surgical techniques to help with back pain
- Vertebroplasty involves inserting a chemical cement into the damaged or broken vertebrae through a catheter.
- Kyphoplasty involves inflating a balloon before stabilizing the area with the chemical cement.
Myeloma and its treatment can suppress parts of the immune system. To prevent infections:
- IV immunoglobulin therapy should be considered for frequent and life-threatening infections.
- Pneumococcal, influenza, and COVID-19 vaccines
- Prophylactic treatment against pneumocystis carinii pneumonia, herpes and fungal infections, if a high-dose drug regimen has been given.
- Herpes prophylactic treatment should for patients who are receiving proteasome inhibitors or daratumumab (Darzalex®), since they are associated with incidence of herpes zoster
View the free LLS fact sheet Side-Effect Management: Reducing Your Risk of Infection.
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, a procedure known as “plasmapheresis and exchange” may be helpful in limiting kidney damage. For example, it may be used for patients who have very recent or acute kidney failure due to high levels of antibody proteins in the blood. However, this approach is controversial. It provides temporary removal of proteins from the blood; however, they will accumulate again if the source of the problem (the myeloma) is not eliminated.
Drinking adequate amounts of water and other healthy fluids can flush the kidneys and help them filter impurities from the blood. It is also very important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), iodinated IV contrast and aminoglycoside antibiotics..
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 cancer treatments. 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.
For more, click here or view the free LLS fact sheet Side-Effect Management: Managing Peripheral Neuropathy (Nerve Damage).
The term “deep vein thrombosis (DVT)” refers to the condition caused by a blood clot that forms in the deep veins of the body, usually in the legs. A DVT can cause blood flow obstruction, pain and swelling. Patients who receive myeloma treatments that are associated with DVT risk are usually prescribed medication to reduce the likelihood of developing this condition.
Pulmonary embolism is a sudden blockage in a lung artery. In most cases, it happens when a blood clot breaks loose, travels through the bloodstream and lodges in the arteries of the lungs. Depending on the size and number of clots that reach the pulmonary arteries, a patient may experience chest pain, shortness of breath and other potentially severe or even life-threatening effects.
In addition to specific cancer treatments, other factors that can increase the risk of DVT include the presence of a central line (central venous catheter), decreased mobility, recent surgery, pregnancy, smoking, a prior history of DVT or a family history of blood-clotting problems.
For more, view the free LLS fact sheet Side-Effect Management: Managing Blood CLots and Deep Vein Thrombosis (DVT).
Occasionally, in some myeloma patients, the monoclonal protein level is so high that it makes the blood “viscous” (thick). This condition, called “hyperviscosity syndrome,” interferes with the blood flow and delivery of oxygen to the tissues. The circulation of the oxygen-carrying red blood cells slows down, and the work of the heart is increased by the difficulty of pumping blood throughout the body. This complication can lead to headaches, dizziness, weakness, fatigue, sleepiness, oozing from cuts and other signs and/ or symptoms.
Hyperviscosity syndrome is considered a medical emergency and requires urgent treatment with plasmapheresis and exchange, a procedure that rapidly reduces the concentration of monoclonal proteins in the blood. Chemotherapy is needed as well, since plasmapheresis does not reduce the number of cells that are producing these abnormal proteins. If the patient does not receive chemotherapy to kill the myeloma cells, they will continue to produce the abnormal proteins that, with time, will accumulate at high levels again.
In rare instances, monoclonal immunoglobulin (IgM) may congeal in the blood and lead to poor circulation, especially if the body is exposed to cold temperatures. This condition can cause joint pain, kidney problems, skin lesions and purpura (purplish or red-brown skin discoloration).
Myeloma patients have an increased risk of developing other types of cancer, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), especially after treatment with certain cytotoxic drugs. This rare complication occurs in a small number of patients.
For information about the drugs listed on this page, visit Drug Listings.
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