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Prevention and treatment of bone problems

Multiple myeloma often affects the bones, which can lead to bone pain, weakened bones, and increased risk of fractures, as well as other problems such as high calcium levels in the blood (hypercalcemia).

Bone problems from multiple myeloma can be prevented or treated in a number of ways, depending on the situation, including:

• Bone medicines such as bisphosphonates (pamidronate or zoledronic acid) or denosumab
• Pain medicines to help with bone pain
• Radiation therapy to areas of damaged bone
• Surgery to help prevent or treat fractures in bones weakened by myeloma

Prevention and treatment of infections

People with multiple myeloma often have low levels of the normal antibodies (immunoglobulins) needed to fight infection. This can lead to a weakened immune system and lung and/or sinus infections that keep coming back.

The level of antibodies in a person’s blood can be tested, and if it’s low, antibodies from donors can be given into a vein (IV) to raise the levels and help prevent infections. These antibodies are called intravenous immunoglobulin (IVIG). IVIG is often given once a month at first, but it may be given less often based on blood tests of antibody levels.

Antibiotics are often given during the first few months of treatment, either to help prevent infections or to treat existing infections.

Certain? vaccines are also often recommended to help lower the risk of some types of infections in people with multiple myeloma.

Treatment for low red blood cell counts

Some people develop low red blood cell counts (anemia) from multiple myeloma or its treatment. They might feel tired, lightheaded, or short of breath, especially when active. Anemia that’s causing symptoms can be treated with blood transfusions. These are often given on an outpatient basis.

Epoetin alfa (Epogen, Procrit, and other brand names) and darbepoetin alfa (Aranesp) are drugs that can help improve low red blood cell counts and reduce the need for blood transfusions in some people who are getting chemotherapy. But these drugs aren't used much in people with multiple myeloma because some studies have suggested people don't do as well on these medicines.

Treating hyperviscosity

In some people with multiple myeloma, certain myeloma proteins can build up in the blood, causing it to thicken and interfering with circulation. This is called hyperviscosity.

Plasmapheresis is a procedure that can be used to remove the excess myeloma proteins from the blood. Most often, this procedure is done through a large catheter (tube) placed in a vein in the neck, under the collarbone, or in the groin. This catheter is hooked up to a machine, and blood flows into the machine. The machine separates the blood cells from the blood plasma (liquid part of the blood), and then returns the blood cells to the patient, along with either a salt solution or donor plasma. The plasma that’s removed, which contains the abnormal antibody protein made by the myeloma cells, is discarded.

Although plasmapheresis lowers the abnormal protein level and can relieve symptoms for a time, it does not kill the myeloma cells. That means that without further treatment, the protein will just build up again. For this reason, plasmapheresis is often followed by chemotherapy or some other type of drug treatment to kill the cells that make the protein.