Supportive care in multiple myeloma

Abstract

Multiple myeloma (MM) is the second most common hematologic malignancy, affecting more than 60,000 patients in the United States with 30,000 patients diagnosed in 2016 (Leukemia 28(5):981-992, 2014; ACS 2016, http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-key-statistics. MM is the most common malignancy to affect bone with 70% of patients presenting with bone disease at diagnosis, and up to 85% of MM patients will have bone complications over the course of their disease (Leukemia 28(2):398-403, 2014). In addition, approximately 20% of patients will have renal dysfunction and 5% will have clinically detectable neuropathy at diagnosis (Arch Intern Med 158(17):1889-1893, 1998; Best Pract Res Clin Haematol 18(4):673-688, 2005). Further, renal dysfunction and neuropathy can increase during the course of their disease secondary to toxicities associated with therapy for the bone disease, treatment of their MM, or disease progression. In addition, MM patients are at increased risk for thrombosis because of their underlying malignancy, as well as immunomodulatory therapies that enhance the risk of thrombosis (Leukemia 22(2):414-423, 2008). Erythropoiesis-stimulating agents can further exacerbate the incidence of thrombosis in MM patients. In this chapter, the underlying pathophysiology of bone, renal and neuropathic abnormalities associated with MM, current approaches to their treatment, and new therapies to prevent or treat the complications of MM therapies are discussed.