If you experience severe back pain, loss of function in the lower extremities, and loss of bowel or bladder control, seek immediate medical evaluation. Tumors destroy bone tissue, including the bones of the spine (vertebrae). If severely damaged, the vertebrae can collapse and press on the spinal cord, causing the symptoms listed above. Similar disturbances in nerve function can occur elsewhere if tumors press on nerves in distant locations. Call your doctor and go to the hospital immediately if these symptoms occur.
Drink plenty of fluids and eat a balanced diet. Adequate hydration will help prevent acute kidney failure by diluting the circulating calcium. A balanced diet will help reduce the chance of infections.
Do not take any medications, including vitamins and herbal remedies, without telling your doctor. Prescription medications, as well as over-the-counter drugs, vitamins, and herbal remedies, may increase the severity of kidney damage, and could interact harmfully with the drugs prescribed to fight myeloma. Always check with the doctor who is treating you before taking any drug.
Remain active. Exercise and activity help keep bones stronger by slowing calcium loss. A brace, cane, or other assistive device can help make activities safer and more comfortable.
Avoid contact with people who have colds or other infectious diseases. Because patients with myeloma are more prone to infection, they should avoid crowds or contact with people who might pass on a cold or other contagious disease. Patients with myeloma are often vaccinated to decrease the chance of getting pneumonia (especially from the Streptococcus pneumonia bacteria).
Your doctor is the best source of information on the drug treatment choices available to you.
High-dose chemotherapy with an infusion of the patient’s own blood cells may be offered as an alternative treatment. In this procedure, patients receive conventional chemotherapy without melphalan (which can damage stem cells and myeloid growth factors). Doctors then take stem cells (immature cells that can grow into blood-forming cells) from the patient’s blood and freeze them for storage. In the next step, the patient receives high doses of chemotherapy, including melphalan, and then an infusion of the stored stem cells. A recent study found that patients who had this procedure had a better five-year survival rate than patients who had traditional chemotherapy (52% vs. 12%). However, with this therapy, it is difficult to totally rid the body of the tumor and to remove all of the myeloma cells from the blood.
Transplantation of marrow from a close relative (allogeneic transplantation) is another option. In some cases, genetically similar (allogenic) marrow transplantation from a close relative may be necessary. If successful, allogeneic transplantation can lead to longer remissions. However, it is hard to find the right genetic “match”, even among siblings, and even if a match is found, patients can still have adverse reactions to therapy. As many as 25% to 30% of patients die of these adverse reactions within 100 days after receiving the transplant.
Radiation may be used to treat a solitary tumor, to decrease the risk of a fracture at a specific site, or to reduce pain at a particular location, especially if there is painful spinal cord compression.
Patients with spinal cord compression may require surgery to prevent additional neurological problems.
Surgery may also be considered to stabilize the bones or to relieve pain.
The kidneys do not filter normally in 50% of patients with myeloma; 25% will develop chronic kidney disease. Because breakdown of bone tissue in patients with myeloma leads to increased levels of calcium circulating in the blood, it becomes more difficult for the kidneys to filter the blood properly. As a result, calcium deposits sometimes form in parts of the kidneys, reducing their effectiveness. Proteins called M proteins, which are produced by myeloma cells, also contribute to kidney failure, as does a build-up of uric acid in the blood (hyperuricemia).
A patient’s prognosis varies depending on how advanced the disease is, how fast the cancer cells are growing, and how well the kidneys are functioning. Patients receiving conventional chemotherapy typically survive from months to years, with an average survival rate of 2.5 to 3 years. At diagnosis, patients with stage 1A myeloma have an average survival rate of five years. For those with stage IIIB disease, average survival is 15 months. About 28% of patients with multiple myeloma now survive for five years, up from 24% during the 1970s. Approximately 15% of patients with multiple myeloma will die within three months of diagnosis.
Patients may have multiple episodes of remission and relapse. During relapses, patients generally experience a more rapid increase in M proteins. The initial remission usually lasts for a year, but subsequent remissions do not last as long. About half of the patients who relapse will respond to the same drug that produced the first remission.
A doctor will usually want to see a patient with multiple myeloma every one to two months to monitor the patient’s condition.
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