Supportive Care: Managing Side Effects After Treatment

The treatment of multiple myeloma is focused on treating both symptoms and disease. The underlying disease is the increased number of abnormal plasma cells. A number of symptoms and medical problems result from the increased numbers of plasma cells, and from abnormal -- or monoclonal -- proteins. Specific treatments are available for several of the complications that result from multiple myeloma.

Complications

In 70 percent of multiple myeloma cases, the bones develop multiple holes. That's why the disease is called "multiple" myeloma. Doctors refer to the holes as "osteolytic lesions." These lesions cause the bones to be fragile and subject to fractures. They are caused by the rapid growth of myeloma cells, which push aside normal bone-forming cells, and prevent them from repairing general wear and tear of the bones. Under normal circumstances, cells called osteoclasts destroy dead and dying bone. Multiple myeloma causes increased numbers of these bone-destroying cells to be produced.

Multiple myeloma involving the bone can cause pain, fracture, and other significant problems. Managing this is an integral part of the overall treatment strategy. Your doctor's first objective will be to prevent new bone disease from developing, or existing bone lesions from progressing.

Bisphosphonate drugs can prevent the bone loss that results from bone lesions. They can reduce the risk of fractures and decrease pain. Bisphosphonate drugs that are FDA-approved for the treatment of cancer-related skeletal complications include Zometa® (zoledronic acid) and Aredia® (pamidronate). A benefit of zoledronic acid is that it can be administered in 15 minutes, as opposed to pamidronate, which takes several hours. Most patients find the former more convenient. With chronic use of bisphosphonates, a small fraction of patients may develop kidney compromise or osteonecrosis (bone destruction) in the jaw, and recommendations for treatment should be discussed with your doctor. 

Patients with progressive bone difficulty from multiple myeloma may experience worsening pain and/or fracture of the bone from the progressive cancer. Low-dose radiation therapy, as well as pain medication, can help control the pain from bone progression of multiple myeloma.

· Hypercalcemia - Many multiple myeloma patients develop an increased level of calcium in the bloodstream known as hypercalcemia. Hypercalcemia results from the destruction of bone from bone destroying lesions. It may also result from the development of generalized osteoporosis, in which all the bones have lost calcium and become soft and porous. In patients with multiple myeloma, hypercalcemia causes fatigue, lethargy, and other symptoms. Typically, hypercalcemia is treated with bisphosphonates and the drinking of ample fluids. Severe hypercalcemia is a medical emergency requiring immediate treatment.
· Anemia - Anemia is a common complication of multiple myeloma. Patients with anemia may experience tiredness, fatigue, shortness of breath, and/or a reduced tolerance for activity. Anemia resulting from multiple myeloma can often be treated with erythropoietin.
· Infections - The depletion of normal white blood cells puts you at increased risk for infection. If you experience recurrent infections, you may need to have your immunoglobulin levels replenished. Ask your physician about immunoglobulin replacement therapy.
· Kidney dysfunction - In 75 percent of patients, the plasma cells also produce proteins called "light chains" or "Bence Jones proteins" after the British physician who discovered them. These proteins may clog the kidney, damaging it, and ultimately causing it to fail. Hypercalcemia may make this worse because excess calcium in the blood causes fluid loss and dehydration. Because Bence Jones proteins are eliminated through urine, they may accumulate in the kidneys and cause kidney dysfunction. Therefore, it is important for you to drink enough fluids to help prevent kidney failure and to avoid using over-the-counter medications, such as NSAIDS (nonsteroidal anti-inflammatory drugs) that can worsen kidney function.