Supportive treatment for myeloma
You may have some treatments that do not target the myeloma itself, but help to treat symptoms caused by the myeloma. Antibiotics and antiviral drugs may be given to prevent infections, and blood-thinning tablets or injections may be used to prevent blood clots.
Other supportive treatments may include bisphosphonates for bone protection, radiation therapy for bone pain and damage, and plasma exchange for dangerous levels of paraprotein in the blood.
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Bisphosphonates are a group of drugs that help strengthen bone and reduce bone pain by preventing further bone weakness or damage caused by myeloma cells. They also control high calcium levels in the blood.
You will need regular blood tests to monitor your calcium levels and kidney function before and while you are taking bisphosphonates.
How they are given
Several types of bisphosphonates are used for myeloma. Most commonly it is given by an injection into the vein. Less commonly, a bisphosphonate can be given by tablet.
Stomach upset – Bisphosphonates can cause stomach upset. You may feel sick and/or have constipation or diarrhoea for a few days.
Osteonecrosis of the jaw (ONJ) – An uncommon but severe side effect associated with long-term bisphosphonate use is osteonecrosis of the jaw or ONJ. This causes bone tissue in the jaw to breakdown, leading to pain and infection.
Practise good dental hygiene
It is important to visit your dentist for a check-up and have any invasive dental work done before you start treatment.
Keep up good dental hygiene by brushing and flossing twice daily, and see the dentist for yearly check-ups. If you need dental work during treatment, let your dentist know that you are taking bisphosphonates and ask your haematologist whether it’s possible to have a break in treatment.
If you have a tooth removed, you’ll have a break from bisphosphonates for 1–3 months until your gum is healed. This is to prevent ONJ.
Not all people with myeloma will need radiation therapy. It is used to relieve symptoms, such as bone pain, or to prevent bones from breaking, by reducing the number of myeloma cells in the bones.
Radiation therapy, also known as radiotherapy, uses a controlled dose of radiation to kill or injure cancer cells. The radiation is usually in the form of focused x-ray beams. Treatment is carefully planned to destroy the cancer cells while causing as little harm as possible to your normal tissue.
How it is given
You lie under a machine that delivers the radiation to areas with myeloma cells. Each treatment takes only a few minutes, but the first appointment can take 1–3 hours. Radiation therapy may be given as a single dose, or as multiple doses over several days or weeks. You will visit the radiation therapy centre for each of your radiation treatments, rather than staying overnight.
Radiation therapy can cause both immediate and delayed side effects. The most common side effect is tiredness. Other side effects will depend on the part of the body being treated. Most of these side effects go away within days to weeks of treatment finishing. Tell your radiation oncology team about any side effects you may have
For more on this, see Radiation therapy.
Immunoglobulin replacement therapy
The majority of people with myeloma have low levels of normal antibodies, which means they are more likely to get infections.
You may have a process called immunoglobulin replacement therapy (IRT) to boost your antibody levels and protect you against infections. Whether you need this therapy will depend on if you have had repeated infections and also on the level of any remaining normal antibodies in your blood.
How it is given
Immunoglobulin is produced from blood donor plasma and can injected into a vein (intravenously) or under the skin (subcutaneously). When delivered intravenously, each treatment takes 2–4 hours and most people receive one dose a month. When delivered subcutaneously, it takes about 30 minutes and is delivered by a pump or a slow injection.
Side effects are uncommon with IRT. Occasionally, some people experience a headache, low-grade fever, nausea, diarrhoea or an allergic reaction at the site of the injection. Side effects are more common with the first treatment and are temporary.
Plasma exchange may be used if the level of paraprotein in the blood is very high, making the blood thicker and slower to circulate. This causes symptoms such as blurred vision and confusion.
How it is given
A needle is placed into a vein in each arm. Blood is removed from one arm and passed through a machine that separates it into each of the blood components. The plasma, which contains much of the extra paraprotein, is removed and replaced with either plasma from a donor or a plasma substitute such as albumin (a blood protein). The blood is then returned to the body via the other arm. This process usually takes a few hours and is not painful.
Prof John Gibson, Haematologist, Institute of Haematology, Royal Prince Alfred Hospital and The University of Sydney, NSW; Dr Stephanie Anderson, Registrar, Institute of Haematology, Royal Prince Alfred Hospital, NSW; Tanya Carney, Consumer; Jacqui Keogh, NSW State Manager/Senior Myeloma Nurse NSW, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital, NSW; Rachel McCann, Myeloma Support Nurse NSW, Myeloma Australia; John McMath, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW.
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