Treatment of Complications From Multiple Myeloma

by Michael Jubinville, MPH

Medications

Here are the basics about each of the medicines below. Only the most common reactions are listed. Ask your doctor if you need to take any special steps. Use each of these drugs as advised by your doctor or the booklet they came with. If you have any questions, call your doctor.

Medicine may help to manage side effects of multiple myeloma (MM) and its treatment. Let your doctor know if you have any problems.

Bisphosphonates

Common names:

Pamidronate
Clodronate

Bisphosphonates make bones stronger which can help ease bone pain. Having stronger bones also lowers the risk of broken bones.

These drugs are often used with chemotherapy.

Some problems are:

Nausea or vomiting
Less hunger
Bone, joint, or muscle pain
With pamidronate:
- Fever
- Stomach pain
- Sleeping problems
- Cough, runny nose
- Feeling tired
- Headache
- Anemia
With clodronate:
- Diarrhea
- Low calcium levels—hypocalcemia

Opioids

Common names:

Morphine
Oxycodone
Fentanyl
Hydromorphone
Methadone

Opioids are used to ease back pain. Your doctor will keep track of you while you are taking them.

Some problems are:

Constipation
Sleepiness
Nausea or vomiting
Itchy skin
Breathing problems
Lightheadedness or fainting

Other Treatments

Plasmapheresis

Plasmapheresis is done to thin out the blood. MM causes abnormal proteins to buildup in the plasma making it thicker than normal. Plasma is the yellowish fluid found in the blood. This process is a way to separate the proteins from the plasma.

Blood is taken out of the body through 1 of 2 tubes. It is spun in a machine to separate it. The blood is mixed with replacement plasma or a plasma substitute and returned to the body through the other tube.

The process can be repeated if needed.

Vertebroplasty and Balloon Kyphoplasty

MM can cause the bones in the spinal column to weaken and press into each other causing back pain. During vertebroplasty, a special bone cement is placed into the broken bones. With kyphoplasty, a balloon is used to make room before placing the cement. Both procedures ease pain and return some physical function.

References:

Bone metastases: Bisphosphonate therapy. EBSCO Nursing Reference Center website. Available at: https://www.ebscoh.... Updated September 7, 2018. Accessed May 3, 2019.

Drug therapy for multiple myeloma. American Cancer Society website. Available at: https://www.cancer.org/cancer/multiple-myeloma/treating/chemotherapy.html. Updated January 3, 2019. Accessed May 3, 2019.

Michels TC, Petersen KE. Multiple myeloma: Diagnosis and treatment. Am Fam Physician. 2017;95(6):373-383A.

Multiple myeloma. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T116888/Multiple-myeloma. Updated March 29, 2019. Accessed May 3, 2019.

Multiple myeloma. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/multiple-myeloma. Updated May 2018. Accessed May 3, 2019.

Supportive care. Leukemia & Lymphoma Society website. Available at: https://www.lls.org/disease-information/myeloma/treatment/supportive-care. Accessed May 3, 2019.

Supportive treatments for patients with multiple myeloma. American Cancer Society website. Available at: https://www.cancer.org/cancer/multiple-myeloma/treating/radiation.html. Updated February 28, 2018. Accessed May 3, 2019.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq#_46. Updated April 9, 2019. Accessed May 3, 2019.

Last reviewed March 2019 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 5/3/2019

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