From the Guidelines
Multiple myeloma complications can be effectively managed with a combination of chemotherapy, immunomodulatory drugs, proteasome inhibitors, and stem cell transplantation, alongside supportive care measures such as bisphosphonates or denosumab to reduce bone-related complications and improve quality of life.
Multiple Myeloma Complications
Multiple myeloma complications include:
- Bone damage (fractures, bone pain)
- Kidney problems (renal failure)
- Anemia
- Infections
- Hypercalcemia
- Blood clotting issues These complications can lead to severe impairment of the quality of life of myeloma patients and may deteriorate their life expectancy, as noted in the European Myeloma Network guidelines for the management of multiple myeloma-related complications 1.
Management of Complications
Management involves treating the underlying myeloma with chemotherapy, immunomodulatory drugs, proteasome inhibitors, and stem cell transplantation when appropriate, alongside supportive care for specific complications.
- Bisphosphonates, such as pamidronate or zoledronic acid, are recommended to reduce bone-related complications and improve quality of life 1.
- Denosumab is also an option, particularly for patients with renal disease, as it has lower rates of renal toxicity compared to zoledronic acid 1.
- A baseline dental exam and monitoring for osteonecrosis of the jaw (ONJ) are recommended for all patients receiving bone-modifying agents 1.
- The frequency of dosing (monthly vs every 3 months) and duration of therapy should be based on individual patient criteria and response to therapy, with the option to continue beyond 2 years based on clinical judgement 1.
Additional Supportive Care Measures
Additional supportive care measures include:
- Low-dose radiation therapy for palliative treatment of uncontrolled pain, impending pathologic fracture, or impending spinal cord compression 1
- Monitoring for renal dysfunction with use of bisphosphonate therapy 1
- Patient education about the probable side effects of each drug, the drug combinations being used, and the supportive care measures required 1
From the Research
Multiple Myeloma Complications
- Multiple myeloma is a hematologic malignancy characterized by the presence of abnormal clonal plasma cells in the bone marrow, with potential for uncontrolled growth causing destructive bone lesions, kidney injury, anemia, and hypercalcemia 2.
- Approximately 73% of patients with multiple myeloma have anemia, 79% have osteolytic bone disease, and 19% have acute kidney injury at the time of presentation 2.
- The disease can cause various complications, including:
Risk Stratification
- The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, or p53 mutation is considered high-risk multiple myeloma 3, 4, 5.
- The presence of any two high-risk factors is considered double-hit myeloma, and three or more high-risk factors is triple-hit myeloma 3, 4, 5.
Treatment and Management
- Induction therapy consists of a combination of an injectable proteasome inhibitor, an oral immunomodulatory agent, and dexamethasone, followed by autologous stem cell transplantation and maintenance therapy with lenalidomide 2.
- In patients who are candidates for autologous stem cell transplantation, induction therapy consists of bortezomib, lenalidomide, dexamethasone (VRd) given for approximately 3-4 cycles followed by autologous stem cell transplantation (ASCT) 3, 4, 5.
- Standard-risk patients need lenalidomide maintenance, while bortezomib-based maintenance is needed for patients with high-risk myeloma 3, 4, 5.