Multiple Myeloma

Supportive Care

Living with multiple myeloma, managing side effects of treatment and coping with the emotions that accompany a chronic illness can be overwhelming. Supportive care, also called palliative care, is a group of resources, strategies and services designed to help ensure the best quality of life.

Before beginning treatment, if possible, discuss the following considerations with your health care team.

Medications

Antacids and/or acid reducers help prevent or treat gastrointestinal problems caused by treatments containing steroids. They may be prescribed or purchased over the counter. Some non-prescription medications and supplements may affect multiple myeloma treatments, so always check with your doctor first.

Antidepressants may help treat depression, anxiety and fatigue and help you cope emotionally with your diagnosis, symptoms and resulting life changes. They may also help treat chronic or neuropathic pain caused by the disease and/or its treatments.

Antiemetics may be prescribed to help prevent or reduce nausea and/or vomiting resulting from chemotherapy or other treatments.

Antimicrobials include antibiotic, anti-viral and antifungal medications that help prevent or treat infections. This disease and certain treatments can weaken or suppress the immune system, putting you at risk for frequent infections. Ask about typical signs to watch for, such as fever, and find out when to contact your health care team.

Blood thinners may help reduce the risk of developing blood clots when taking certain immunomodulatory drugs.

Bone-modifying agents help increase bone density. Myeloma cells may build up in the bone marrow, which can weaken bones, cause pain and increase the risk of fractures to spinal vertebrae, the skull, hips, ribs, shoulders and other bones. Bones damaged with lesions may become brittle and painful. These medications are also used to slow bone loss or breakdown and treat hypercalcemia (increased calcium in the blood).

Corticosteroids are often prescribed along with chemotherapy because they have anti-inflammatory effects, and some can help reduce nausea and vomiting caused by chemotherapy.

Erythropoiesis-stimulating drugs stimulate the bone marrow to produce more red blood cells and may be used to treat anemia. White blood cell growth factors help your body make more white blood cells. They may be used to treat neutropenia, a condition caused by a low white blood cell count that increases your risk of infection.

Procedures and Therapies

Intravenous fluids may be given in cases of dehydration caused by vomiting, diarrhea or mild hypercalcemia.

Intravenous immunoglobulin (IVIG), which is an infusion of antibodies, may be given to prevent or treat infections. Myeloma cells can decrease normal antibodies in the blood, weakening the immune system. IVIG helps replace those antibodies.

Kyphoplasty is a surgical procedure that may be used if a weakened vertebra collapses. Your doctor inserts a balloon in this area to make room to inject bone cement to stabilize the vertebra. During a vertebroplasty, your doctor inserts bone cement into a fractured vertebra to help stabilize it and prevent it from moving.

Occupational therapy (OT) may be helpful if physical activity and/or daily routines need to be modified due to pain or other limitations.

Physical therapy (PT) can help build and maintain muscle strength, improve balance and increase coordination. PT can also help relieve pain from peripheral neuropathy.

Plasmapheresis is used to treat blood that has become too thick from an overabundance of M-proteins, slowing circulation and increasing the risk of blood clots. Blood is filtered through a machine to remove extra plasma and antibody proteins. Normal blood cells are then returned to the body and may contain donated plasma or plasma replacement.

Transfusions inject blood, plasma or platelets intravenously (IV) and may be used for severe cases of anemia. A platelet transfusion may be given to prevent heavy bleeding from thrombocytopenia. Blood plasma may be transfused to help treat bleeding problems.

Healthy Lifestyle

Exercise and physical activity are important with your diagnosis. Weight-bearing exercise helps strengthen damaged bone. Improving your strength, flexibility and balance through targeted exercise helps reduce your risk of falls. Regular exercise is effective for managing fatigue and may also reduce pain from peripheral neuropathy.

Follow-up and ongoing care are crucial so your doctor can spot and treat complications or refractory or relapsed multiple myeloma as early as possible. You’ll receive a follow-up care plan with a schedule for ongoing treatments, upcoming appointments and recommended annual screenings for other cancers. You may want to request copies of all your tests, biopsies, surgeries, pathology and consultation notes to take with you to follow-up appointments.

Good nutrition gives your body essential nutrients to improve your health, better tolerate treatment-related side effects and help ward off additional illness. A registered dietician or nutritionist can work with you to create a balanced eating plan tailored to your dietary needs and preferences. Intravenous (IV) nutrient therapy may be advised if you cannot take in enough calories from food. Total parenteral nutrition (TPN), a type of intravenous feeding, may be necessary to help prevent malnutrition for stem cell transplant patients with acute Graft-versus-Host Disease.

Hydration is the adequate intake of liquids. Multiple myeloma can lead to dehydration, as can treatments causing vomiting and diarrhea, so efforts to stay well-hydrated are essential. A minimum goal is 12 to 16 cups of fluid daily - more if you’re experiencing vomiting or diarrhea.

 

 

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