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. Myelosuppression can cause
- Anemia (low red blood cells). Symptoms of anemia include fatigue, shortness of breath, pale skin, and dizziness.
- Erythropoietin (EPO) Therapy: For severe anemia, EPO is the administration of an engineered form of the red blood cell growth factor called “erythropoietin” which may alleviate the anemia and decrease the need for blood transfusions. However, some studies suggest that treating anemia too aggressively 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.
- Neutropenia (low neutrophils, a type of white blood cell). Neutropenia can lead to serious infections that require antibiotic therapy and possibly hospitalization. Drugs, such as filgrastim (Neupogen®), pegfilgrastim (Neulasta®) or sargramostim (Leukine®), may be prescribed to treat neutropenia.
- Thrombocytopenia (low platelet counts). Patients who have low platelet counts may experience excessive bleeding from cuts or injuries and may need a platelet transfusion.
Click here to learn more about 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. 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.
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.
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. COVID-19 vaccines may also be recommended.
- 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.
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.
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.
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. 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 certain drugs. 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.
Patients receiving myeloma treatment associated with DVT risk, especially newly diagnosed myeloma patients, are usually prescribed medication (such as aspirin, warfarin (Coumadin®), or low-molecular-weight heparin) to reduce the risk of DVT. It is important for patients to discuss with their doctors the risk of DVT and ask which of the options to reduce this risk is best for them.
Occasionally, the concentration of monoclonal proteins in the blood of some myeloma patients is so high that it makes the blood “viscous” (thick), thereby interfering with the blood flow and delivery of oxygen to the tissues. This condition is referred to as “hyperviscosity syndrome.” 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 through the body. Symptoms include headaches, dizziness, weakness, fatigue, sleepiness, and oozing from cuts.
Hyperviscosity syndrome is considered a medical emergency and requires urgent treatment with plasmapheresis and exchange. This procedure rapidly reduces the concentration of monoclonal proteins in the blood. Chemotherapy is needed as well to prevent the complication from occurring again.
Rarely, monoclonal 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). Cryoglobulinemia is a rare condition.
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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