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Treatment of Complications From Multiple Myeloma by Debra Wood, RN Deanna M. Neff, MPH

Medications

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medicines only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medicines may help to prevent, reduce, or manage side effects of treatment. Talk to your doctor about any symptoms that you have from either the treatment or the medicine.

Bisphosphonates

Common names include:

Pamidronate (Aredia)
Clodronate (Bonefos, Ostac)
Erythropoietin

Multiple myeloma often damages the bones. Bisphosphonates are used to prevent bone pain and fractures by helping the body restore and repair bone that has been damaged by the growth of myeloma cells.

Pamidronate is given as an injection. Clodronate is given daily by mouth. These drugs are used in addition to chemotherapy . Studies show they decrease the risk of bone pain and fractures by blocking the further breakdown of bone.

Possible side effects include:

Nausea or vomiting
Decreased appetite
Bone, joint, or muscle pain
Fever (pamidronate)
Stomach pain (pamidronate)
Difficulty sleeping (pamidronate)
Cough, runny nose (pamidronate)
Fatigue (pamidronate)
Headache (pamidronate)
Anemia (pamidronate)
Diarrhea (clodronate)
Low calcium levels (clodronate)

Opioids

Common names include:

Morphine (MS Contin, Avinza, Kadian)
Oxycodone (Roxicodone, OxyContin)
Fentanyl (Actiq, Duragesic)
Hydromorphone (Dilaudid)
Methadone (Dolophine, Methadone Diskets)

Multiple myeloma can result in chronic and severe back pain. To relieve pain, the doctor may prescribe opioids (also called narcotics). These are a class of drugs made from opium or a synthetic form of opium. They are an effective group of medicines if taken as prescribed and under a doctor's supervision.

Possible side effects include:

Sleepiness
Dizziness
Nausea or vomiting
Itchy skin

Serious side effects may include difficulty breathing and low blood pressure.

Other Treatments

Plasmapheresis

Plasmapheresis may be done if your blood has become too thick from the presence of abnormal antibodies created by multiple myeloma. Plasmapheresis is a process that separates the fluid part of the blood, called plasma, and removes it from your body. This part of the blood contains the abnormal antibodies.

During this procedure, two needles attached to a catheter tube are inserted into the veins. Blood is taken out of the body through one of the catheter tubes. It then goes into the apheresis machine. This machine works in one of two ways. In the first method, the blood cells may be separated from the plasma by spinning the blood at high speeds. The second method uses a special membrane. The membrane has tiny pores that only the plasma can pass through, leaving the blood cells behind.

Once in the machine, the blood cells are separated from the plasma. The blood cells are mixed with replacement plasma or a plasma substitute. The new mixed blood is then returned to the body through the other tube.

Plasmapheresis is used to help control symptoms of multiple myeloma. It is not a curative treatment, and its long-term benefits are not known.

Vertebroplasty and Balloon Kyphoplasty

Spinal compression fractures are a complication of multiple myeloma. This complication can result in severe back pain. During vertebroplasty , the doctor injects special bone cement into the broken vertebrae. In kyphoplasty, a balloon is used to expand the fractured area before injecting the cement. Both procedures restore some physical function of the spine and reduce pain.

References:

American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
Cancer Medicine. 5th ed. Hamilton, Ontario: BC Decker Inc; 2000.
Clodronate. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed March 4, 2010.
McGirt MJ, Parker SL, Wolinsky JP, et al. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine Journal. 2009;9(6);501:8.
McKoy K. Opioid abuse. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated January 1, 2010. Accessed February 22, 2010.
Morphine sulfate. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed March 4, 2010.
Multiple myeloma/other plasma cell neoplasms. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/myeloma . Accessed March 4, 2010.
Pamidronate. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed March 4, 2010.
Plasmapheresis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2009. Accessed March 4, 2010.
Rakel R. Bope E, ed. Conn's Current Therapy 2002. 54th ed. St. Louis, MO: WB Saunders Company; 2002: 439-443.
Spinal compression fracture treatment: vertebroplasty/kyphoplasty. Cedars Sinai website. Available at: http://www.csmc.edu/9466.html . Accessed February 22, 2010.
Vertebroplasty and kyphoplasty. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2009. Accessed March 4, 2010.
Washington University School of Medicine Department of Medicine. The Washington manual subspeciality series, hematology and oncology subspeciality consult series . St. Louis, MO: Lippincott Williams & Wilkins; 2008.

Last reviewed November 2012 by Mohei Abouzied, MD

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Treatment of Complications From Multiple Myeloma by Debra Wood, RNDeanna M. Neff, MPH