Treatment of the complications of multiple myeloma
- S Vincent Rajkumar, MD
S Vincent Rajkumar, MD
- Edward W. and Betty Knight Scripps Professor of Medicine
- Mayo Clinic
Patients with multiple myeloma frequently develop complications related to their disease, including hypercalcemia, renal insufficiency, infection, and skeletal lesions, which require specific treatment in addition to therapy directed at the malignant clone [1,2]. Some of these problems are discussed in detail elsewhere within UpToDate, but will be briefly reviewed here.
The importance of these complications was highlighted in a study of death within 60 days of diagnosis in patients with myeloma entering onto the United Kingdom's Medical Research Council (MRC) trials. The incidence of early death was 10 percent, with the most common contributors being bacterial infection (50 percent) and renal failure (28 percent) .
Treatment of the complications of multiple myeloma will be reviewed here. The uses of chemotherapy and hematopoietic cell transplantation in the treatment of multiple myeloma are discussed separately, as is the diagnosis of multiple myeloma. (See "Overview of the management of multiple myeloma" and "Clinical features, laboratory manifestations, and diagnosis of multiple myeloma".)
Hypercalcemia is present in over 10 percent of patients with myeloma at the time of diagnosis and may require emergent treatment. Patients with hypercalcemia may be asymptomatic or complain of a variety of symptoms such as anorexia, nausea, vomiting, polyuria, polydipsia, increased constipation, weakness, confusion, or stupor. Hypercalcemia can also contribute to the development of renal insufficiency. (See "Clinical features, laboratory manifestations, and diagnosis of multiple myeloma", section on 'Hypercalcemia' and "Clinical manifestations of hypercalcemia".)
In most patients with myeloma the diagnosis of hypercalcemia does not require measurement of the ionized calcium. However, if a patient presents with an elevated serum calcium level but no associated symptoms, the ionized calcium should be measured to confirm hypercalcemia prior to the initiation of treatment since rarely the monoclonal protein binds to calcium . The treatment of hypercalcemia depends upon the calcium level, the rapidity with which it developed, and the patient's symptoms. In general, the following approach may be considered:
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- RENAL INSUFFICIENCY
- SKELETAL LESIONS
- Prevention of skeletal events
- Treatment of fractures
- Pain control
- - Pharmacologic therapy
- - Kyphoplasty and vertebroplasty
- - Radiation
- Cord compression
- HYPERVISCOSITY SYNDROME
- INFORMATION FOR PATIENTS