Skip to main content

Advertisement

SpringerLink
Log in

Supportive Care in Multiple Myeloma

  • Multiple Myeloma (P Kapoor, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

As novel therapies are expanding the life expectancy of patients with multiple myeloma, appropriate supportive care has become critical in the management of these patients. This review aims to outline the key principles of supportive care of patients with myeloma, including management of bone disease, renal disease, anemia, peripheral neuropathy, infections, and venous thromboembolism.

Recent Findings

The results from large randomized, controlled trials on the use of high-cutoff hemodialysis in the removal of free light chains in renal disease and the use of levofloxacin in the prevention of infections have recently been published. These results, along with updated guidelines from professional societies on the use of bisphosphonates and erythropoietin stimulating agents, have provided guidance on more effective management strategies for myeloma patients.

Summary

Integration of these updated guidelines and supportive care strategies into clinical practice will help to ensure quality of life for patients with myeloma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. SEER stat fact sheets: myeloma. National Institutes of Health, NationalCancer Institute Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/statfacts/html/mulmy.html. Accessed 23 Dec 2019.

  2. Kazandijan D. Multiple myeloma epidemiology and survival, a unique malignancy. Semin Oncol. 2016;43(6):676–81.

    Article  Google Scholar 

  3. Shortt CP, Gleeson TG, Breen KA, McHugh J, O’Connell MJ, O’Gorman PJ, et al. Whole-body MRI versus PET in assessment of multiple myeloma disease activity. AJR Am J Roentgenol. 2009;192(4):980.

    Article  Google Scholar 

  4. Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B. Bisphosphonates in multiple myeloma: an updated network meta-analysis. Cochrane Database Syst Rev. 2017;12:CD003188.

    PubMed  Google Scholar 

  5. Mhaskar R, Redzepovic J, Wheatley K, Clark OA, Miladinovic B, Glasmacher A, et al. Bisphosphonates in multiple myeloma: a network meta-analysis. Cochrane Database Syst Rev. 2012;16(5):CD003188.

    Google Scholar 

  6. Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, et al. Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol. 2019;37(25):2270.

    Article  Google Scholar 

  7. Lacy MQ, Dispenzieri A, Gertz MA, Greipp PR, Gollbach KL, Hayman SR, et al. Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma. Mayo Clin Proc. 2006;81(8):1047.

    Article  CAS  Google Scholar 

  8. Kyle RA, Yee GC, Somerfield MR, Flynn PJ, Halabi S, Jagannath S, et al. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol. 2007;25(17):2464.

    Article  CAS  Google Scholar 

  9. •• Himelstein AL, Foster JC, Khatcheressian JL, Roberts JD, Seisler DK, Novotny PJ, et al. Effect of Longer-Interval vs Standard Dosing of Zoledronic Acid on Skeletal Events in Patients with Bone Metastases. A Randomized Clinical Trial. JAMA. 2017;317(1):48–58. A potentially practice-changing large phase III study that found non-inferiority when dosing zoledronic acid every 12 weeks when compared to the standard every 4 weeks.

  10. •• Raje N, Terpos E, Willenbacher W, Shimizu K, García-Sanz R, Durie B, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomized, controlled phase 3 study. Lancet Oncol. 2018;19(3):370. A large phase III study that found non-inferiority of denosumab when compared to zoledronic acid, and found significantly less renal adverse events in patients treated with denosumab when compared to zoledronic acid.

  11. Terpos E, García-Sanz R, Shimizu K, Willenbacher W, Glennane A, Dai T, Pasteiner W, Raje NS. Progression-free survival analysis of denosumab vs zoledronic acid in intent to transplant multiple myeloma patients based on treatment regimen and baseline characteristics. American Society of Hematology Conference; 2019 Dec 7–9; Orlando, FL; Abstract 606.

  12. Tsourdi E, Langdahl B, Cohen-Solal M, Aubry-Rozier B, Eriksen EF, Guañabens N, et al. Discontinuation of denosumab therapy for osteoporosis: a systematic review and position statement by ECTS. Bone. 2017;105:11–7.

    Article  Google Scholar 

  13. Huber FX, McArthur N, Tanner M, Gritzbach B, Schoierer O, Rothfischer W, et al. Kyphoplasty for patients with multiple myeloma is a safe surgical procedure: results from a large patient cohort. Clin Lymphoma Myeloma. 2009;9(5):375–80.

    Article  Google Scholar 

  14. Terpos E, Morgan G, Dimopoulos MA, Drake MT, Lentzsch S, Raje N, et al. International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. J Clin Oncol. 2013;31(18):2347.

    Article  CAS  Google Scholar 

  15. Heher EC, Rennke HG, Laubach JP, Richardson PG. Kidney disease and multiple myeloma. Clin J Am Soc Nephrol. 2013;8(11):2007–17.

    Article  CAS  Google Scholar 

  16. Manohar S, Nasr SH, Leung N. Light chain cast nephropathy: practical considerations in the management of myeloma kidney- what we know and what the future may hold. Curr Hematol Malig Rep. 2018;13(3):220–6.

    Article  Google Scholar 

  17. Hutchison CA, Cockwell P, Stringer S, Bradwell A, Cook M, Gertz MA, et al. Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. J Am Soc Nephrol. 2011;22(6):1129–36.

    Article  CAS  Google Scholar 

  18. Hutchison CA, Cockwell P, Moroz V, Bradwell A, Fifer L, Gillmore JD, et al. High cutoff versus high-flux haemodialysis for myeloma cast nephropathy in patients receiving bortezomib-based chemotherapy (EuLITE): a phase 2 randomised controlled trial. Lancet Haematol. 2019;6(4):217–28.

    Article  Google Scholar 

  19. Bridoux F, Carron PL, Pegourie B, et al. Effect of high-cutoff hemodialysis vs conventional hemodialysis on hemodialysis independence among patients with myeloma cast nephropathy: a randomized clinical trial. JAMA. 2017;318:2099–110.

    Article  Google Scholar 

  20. Tonia T, Mettler A, Robert N, et al. Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev. 2012;12:CD003407.

    PubMed  Google Scholar 

  21. Untch M, von Minckwitz G, Konecny GE, Conra U, Fett W, Kurzeder C, et al. PREPARE trial: a randomized phase III trial comparing preoperative, dose-dense, dose-intensified chemotherapy with epirubicin, paclitaxel, and CMF versus a standard-dosed epirubicin-cyclophosphamide followed by paclitaxel with or without darbepoetin alfa in primary breast cancer—outcome on prognosis. Ann Oncol. 2011;22(9):1999–2006.

    Article  CAS  Google Scholar 

  22. Bohlius J, Bohlke K, Castelli R, Djulbegovic B, Lustberg MB, Martino M, et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update. Blood Adv. 2019;3(8):1197–210.

    Article  Google Scholar 

  23. Ramchandren S, Lewis RA. An update on monoclonal gammopathy and neuropathy. Curr Neurol Neurosci Rep. 2012;12(1):102–10.

    Article  CAS  Google Scholar 

  24. Richardson PG, Briemberg H, Jagannath S, Wen PY, Barlogie B, Berenson J, et al. Frequency, characteristics and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib. J Clin Oncol. 2006;24(19):3113.

    Article  CAS  Google Scholar 

  25. Vij R, Wang M, Kaufman JL, Lonial S, Jakubowiak AJ, Stewart AK, et al. An open-label, single-arm, phase 2 (PX-171-004) study of single-agent carfilzomib and bortezomib-naïve patients with relapsed and/or refractory multiple myeloma. Blood. 2012;119(24):5661.

    Article  Google Scholar 

  26. Kumar SK, LaPlant B, Roy V, Reeder CB, Lacy MQ, Gertz MA, et al. Phase 2 trial of ixazomib in patients with relapsed multiple myeloma not refractory to bortezomib. Blood Cancer J. 2015;5:e338.

    Article  CAS  Google Scholar 

  27. Augustson BM, Begum G, Dunn JA, Barth NJ, Davies F, Morgan G, et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002—Medical Research Council Adult Leukaemia Working Party. J Clin Oncol. 2005;23(36):9219.

    Article  Google Scholar 

  28. Blimark C, Holmberg E, Mellqvist UH, Landgren O, Björkholm M, Hultcrantz M, et al. Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients. Haematologica. 2015;100(1):107.

    Article  Google Scholar 

  29. •• Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, et al. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicenter, double-blind, placebo-controlled, randomised phase 3 trial. Lancet. 2019;20(12):1760–72. A large phase III trial that demonstrated a survival benefit in patients receiving levofloxacin prophylaxis in patients with newly diagnosed multiple myeloma. This is potentially practice changing for clinicians.

  30. Chapel HM, Lee M, Hargreaves R, Pamphilon DH, Prentice AG. Randomized trial of intravenous immunoglobulin as prophylaxis against infection in plateau-phase multiple myeloma. The UK Group for Immunoglobulin Replacement Therapy in Multiple Myeloma. Lancet. 1994;343(8905):1059–63.

    Article  CAS  Google Scholar 

  31. Kristinsson SY, Fears TR, Gridley G, Turesson I, Mellqvist UH, Björkholm M, et al. Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma. Blood. 2008;112(9):3582.

    Article  CAS  Google Scholar 

  32. Larocca A, Cavallo F, Bringhen S, Di Raimondo F, Falanga A, Evangelista A, et al. Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide. Blood. 2012;119(4):933–9.

    Article  CAS  Google Scholar 

  33. Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AY, Arcelus JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline update. J Clin Oncol. 2019:JCO1901461.

Download references

Author information

Authors and Affiliations

  1. University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA

    Amy Guzdar

  2. University of California San Diego Department of Blood and Marrow Transplant, Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, San Diego, CA, 92037, USA

    Caitlin Costello

Authors
  1. Amy Guzdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caitlin Costello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caitlin Costello.

Ethics declarations

Conflict of Interest

Guzdar and Costello declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Multiple Myeloma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guzdar, A., Costello, C. Supportive Care in Multiple Myeloma. Curr Hematol Malig Rep 15, 56–61 (2020). https://doi.org/10.1007/s11899-020-00570-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-020-00570-9

Keywords

Search

Navigation