• Treatment of Complications From Multiple Myeloma

    Medications

    The information provided here is meant to give you a general idea about each of the medications 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 medications 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.
    Medications 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 medication.

    Bisphosphonates

    Common names include:
    • Pamidronate
    • Clodronate
    • 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. They work 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—hypocalcemia (clodronate)

    Opioids

    Common names include:
    • Morphine
    • Oxycodone
    • Fentanyl
    • Hydromorphone
    • Methadone
    Multiple myeloma can result in chronic and severe back pain. To relieve pain, the doctor may prescribe opioids. They are an effective group of medications if taken as prescribed and under a doctor's supervision. Your doctor will monitor you while you are taking them.
    Possible side effects include:
    • Constipation
    • Sleepiness
    • Lightheadedness
    • 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 blood components, including the fluid part of the blood (plasma) that contains the abnormal antibodies.
    Blood is taken out of the body through one of two tubes. It is spun in a machine that separates plasma from the rest of the blood. 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. Results are not permanent, but the process can be repeated if needed.
    Vertebroplasty and Balloon Kyphoplasty
    Spinal compression fractures are a complication of multiple myeloma. This complication can result in severe back pain. During vertebroplasty, a special bone cement is injected 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

    Bisphosphonates for treatment and prevention of osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 15, 2016. Accessed May 6, 2016.

    McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J. 2009;9(6):501-508.

    Multiple myeloma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 7, 2016. Accessed May 6, 2016.

    Opioid abuse or dependence. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 30, 2015. Accessed May 6, 2016.

    Spinal compression fractures. Cedars Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Programs-and-Services/Imaging-Center/For-Physicians/Interventional-Neuroradiology/Spinal-Compression-Fractures.aspx. Accessed May 6, 2016.

    Treatment option overview. National Cancer Institute website. Available at: http://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq. Accessed May 6, 2016.

    Revision Information

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