NCCN Guidelines for Patients
Multiple Myeloma, Version 1.2014
Treatments for myeloma
You may be referred to an orthopedic surgeon to
help prevent or treat a bone fracture. Surgeons can
prevent bone fractures by placing a splint to support
the bone and hold it in place. Surgery for fractures in
the bones of the spine—called vertebrae—includes
two similar procedures called vertebroplasty and
Vertebroplasty is used to treat compression fractures
in the bones of the spine. A compression fracture is
a break in a bone caused by the collapse of bones
in the spine. This surgery involves injecting a type
of cement into the bones. The cement supports and
strengthens the bones for pain relief and to hold them
With kyphoplasty, a balloon-like device is placed
in the fractured vertebrae and then inflated. This
spreads out the vertebrae to restore the normal shape
and height of the spine. Then the balloon is removed
and a type of cement is injected to support the
vertebrae and hold them in place.
Bone damage can be painful. Radiation therapy can
be used to treat this pain. It is very helpful for large
bone lesions that may cause bone fractures.
Bone death causes calcium to be released into the
bloodstream. High levels of calcium are dangerous
for the kidneys. If this happens, you will be treated
with intravenous fluids and other drugs to help your
kidneys flush out the calcium.
Very high levels of M-proteins can cause the
blood to become very thick—a condition called
hyperviscosity—and damage the kidneys and other
organs. Blood thickness can be treated by filtering
blood through a machine to remove M-proteins. This
treatment is called plasmapheresis.
High levels of light chains can also damage the
kidneys. Free light chains combine with another protein
in the kidneys, which causes them to be too large to
pass through. The damage caused by this blockage is
called myeloma kidney. Prompt treatment of myeloma
is critical to preventing permanent kidney damage.
Myeloma cells may crowd out the normal blood
cells in the bone marrow and cause anemia—a
condition in which the number of red blood cells is
too low. Anemia can be treated with a drug called
erythropoietin. Erythropoietin stimulates the bone
marrow to make more red blood cells.
Myeloma and certain myeloma treatments can
increase the risk of infection. The risk of infection
can be reduced with vaccines for pneumonia, the flu,
and shingles. Shingles is an infection that causes a
painful skin rash and it is a side effect of bortezomib
and carfilzomib. Intravenous immunoglobulins may be
given to treat frequent, serious infections.
Some myeloma therapy drugs, specifically
thalidomide and lenalidomide, can cause serious
blood clots. Therefore, adjunctive treatment with
blood thinners may be given. Blood thinners are
medications that thin out the blood to reduce the risk
of blood clots.