Advances in treatment for multiple myeloma (MM) have greatly improved overall survival, and with more prolonged survival, quality of life is a treatment focus. Unfortunately, due to multiple treatments and continual maintenance therapy, survivors of MM are often exposed to cumulative toxicity, which can lead to oncologic emergencies (OEs).
In the Clinical Journal of Oncology Nursing, a multi-institutional team published a review and evidence-based recommendations for common OEs in MM, including myelosuppression, bone disease, and acute renal failure.
Myelosuppression is a decrease in bone marrow activity that results in lower blood counts, including anemia (decreased red blood cells), neutropenia (decreased white blood cells), and thrombocytopenia (decreased platelets). These can be severe and sometimes life-threatening conditions. The review article first offers diagnostic criteria for each condition before turning to prevention and maintenance. Using multiple levels of evidence, the authors provide specific recommendations for the treatment and prevention of each blood-level-based OEs.
Eighty percent of patients with MM have bone disease at the time of diagnosis, and even more will experience bone disease, often along with bone pain, during their disease. Two major OEs in this category are hypercalcemia of malignancy (HOM) and spinal cord compression. In HOM, bone malignancy causes calcium levels to rise above healthy levels. The review suggests a 3-pronged treatment approach to HOM, including calcitonin, hydration, and bisphosphonate therapy. Spinal cord compression in MM “can be caused by a destructive lesion involving the vertebrae or by an extra-osseous plasmacytoma,” the review authors write. If untreated, this can lead to back pain or even neurological deficits. This condition requires timely intervention to stop the progression. Here again, the authors present multiple levels of evidence for treatment for both bone-related OEs.
Because of the incidence of active infections and dehydration, as well as the use of nephrotoxic medications, acute renal failure is a concern for patients with MM. Other comorbidities like diabetes and hypertension increase the risk. When the kidneys fail, patients must undergo dialysis. Prolonged renal failure can lead to end-stage renal disease, which means a permanent need for dialysis. With prompt treatment, however, renal failure can be reversed. The review article ends with a thorough discussion of treatment modalities, potential risk factors, and ways to educate patients about renal disease.
The open-access review article can be read here. It contains a wealth of information about the conditions above for the health care provider and the patient.
Myelosuppression, bone disease, and acute renal failure: evidence-based recommendations for oncologic emergencies.