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 and radiation therapy for bone pain and damage, and plasma exchange for dangerous levels of paraprotein in the blood.

Learn more about:

• Bisphosphonates
• Radiation therapy
• Plasma exchange

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Bisphosphonates

Bisphosphonates are a class of drugs that help to reduce bone pain by preventing further bone weakness or damage caused by myeloma cells. They also prevent a dangerous rise in the level of calcium in your blood.

You will need regular blood tests to monitor your calcium levels and kidney function before you are given bisphosphonates.

How they are given

Several different types of bisphosphonates are used for myeloma. They may be given as a daily tablet or a monthly injection into a vein.

Side effects

Stomach upset – You may feel sick and/or have constipation or diarrhoea for a few days.

Osteonecrosis of the jaw (ONJ) – This is an uncommon but severe side effect associated with prolonged bisphosphonate use. ONJ causes bone tissue of the jaw to break down, leading to pain and infection. See your doctor if you experience mouth ulcers or jaw problems while taking bisphosphonates.

Radiation therapy

Not all people with myeloma will need radiation therapy. When it is used, the aim is to relieve symptoms such as bone pain 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 will 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, which includes time setting up the machine, seeing the radiation oncologist and having tests. Radiation therapy may be given as a single dose, or as multiple smaller doses over several days or weeks. You will visit the radiation therapy centre for each of your radiation treatments, rather than staying overnight.

Side effects

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 side effects go away in time, usually within days to weeks of treatment finishing. Tell your radiation oncology team about any side effects, as there are ways to reduce any discomfort.

For more on this, see  Radiation Therapy, Palliative Care and Living with Advanced Cancer.

Plasma exchange

Plasma exchange may be used if the level of paraprotein in the blood is very high, making the blood thicker and slowing down circulation (hyperviscosity syndrome). This causes symptoms such as blurred vision and decreased alertness.

How it is given

The process begins with a needle being placed into a vein in each arm. Blood is slowly removed from one arm and then passed through a machine that separates it into each of the blood components. The plasma – the clear fluid part of the blood that 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 mixed together and returned to the body via the other arm.

This process usually takes a few hours and is not painful.