Supportive therapy for multiple myeloma

Multiple myeloma and its treatments can lead to other health problems. Doctors give supportive therapy to help prevent or control these problems.

Corticosteroids used to treat multiple myeloma are artificial steroid hormones. The corticosteroids most often used to treat multiple myeloma are prednisone and dexamethasone (Decadron, Dexasone). These drugs are often combined with chemotherapy to help chemotherapy work better and to lessen the side effects of chemotherapy. They are sometimes used alone if a person is too sick to take chemotherapy to help slow the growth of myeloma cells and lower the amount of M-protein in the blood. Corticosteroids can also help relieve pain and improve nerve function in people with spinal cord compression.

Multiple myeloma can destroy bone. This can cause bones to become weak and even break (called a fracture). Bisphosphonates are a class of drug that can slow down bone destruction and help keep bones strong. Bisphosphonates also help reduce bone pain and prevent high levels of calcium in the blood (called hypercalcemia) from bone destruction, which can lead to kidney failure.

Bisphosphonates are given about once a month for about 2 years. The most common bisphosphonates used in people with multiple myeloma are:

• pamidronate (Aredia)
• zoledronic acid (Zometa, Zoledronate)
• clodronate (Bonefos, Ostac)

If after 2 years the cancer is in remission, your doctor may stop bisphosphonate treatment. But if you are still having treatment for multiple myeloma after 2 years, you may get bisphosphonate treatment less frequently (for example, once every 3 months).

Bisphosphonates can lead to death of the jaw bone, a condition called osteonecrosis of the jaw. This is a rare side effect of bisphosphonates, and doctors don’t know why it happens. It is more common in people who have dental surgery such as tooth extractions or periodontal surgery such as implants. People should have a complete dental exam before taking bisphosphonates. It is very important for people with multiple myeloma who take bisphosphonates to have regular dental checkups. Dental or periodontal surgery should be done before taking bisphosphonates.

Learn more about bisphosphonates.

A drug called denosumab (Xgeva) may be used to reduce the risk of bone problems in people with multiple myeloma. It helps slow down or stop bone loss. Denosumab is a monoclonal antibody that finds and attaches to RANKL, which is a substance on the surface of bone cells. RANKL helps break down bones. When RANKL is targeted and blocked, bones are not broken down as quickly.

Denosumab can be used instead of bisphosphonates, such as zoledronic acid.

The most common side effect of denosumab is low levels of calcium in the blood. Other less common side effects include poor appetite, constipation or diarrhea, fatigue, muscle or joint pain, nausea and vomiting.

Erythrocyte growth factors are drugs that help the body make more red blood cells. The drugs include epoetin alfa (Eprex, Erythropoietin) and darbepoetin (Aranesp). These drugs help to treat anemia, a common problem that develops in people with multiple myeloma. Erythrocyte growth factors can help relieve the symptoms of anemia including weakness, dizziness and fatigue. They also improve a person’s hemoglobin level and quality of life. Erythrocyte growth factors can help a person avoid a blood transfusion.

People with multiple myeloma often develop infections. Antibiotics may be given to prevent and treat infections. People with multiple myeloma may also get immunoglobulins from a donor by vein to help boost antibodies in the blood to help fight infection. Your doctor may also recommend that you get vaccines to help prevent infections.

Plasmapheresis is a procedure that helps remove M-protein from the blood to treat hyperviscosity. An M-protein is an immunoglobulin that is found in high amounts in a person with multiple myeloma. Too much M-protein in the blood can cause the blood to thicken and prevent it from moving through the body properly. This condition is called hyperviscosity.

For more detailed information on specific drugs, go to sources of drug information.