33 NCCN Guidelines for Patients ® : Multiple Myeloma, 2019 3 Myeloma treatments Adjunctive treatment and supportive care Adjunctive treatment and supportive care Adjunctive treatment is another treatment given at the same time as the main (primary) cancer treatment. It is given to “assist” the main treatment by improving its safety or how well it works. For myeloma, adjunctive treatment includes supportive care to manage the symptoms of myeloma and side effects of myeloma treatment. It is an important part of overall myeloma treatment. Some of the ways to treat the health problems caused by myeloma and myeloma treatment are described on the next pages. Bone damage Multiple myeloma often weakens and destroys bones. This can lead to problems such as bone pain, bone fractures, and compression of the spine. There are medicines that can help strengthen bones and reduce the risk of bone problems, such as fractures. Drugs called bisphosphonates are one type of medicine that can improve bone health. They are given as a liquid that is injected into a vein— called an IV (intravenous) infusion. Pamidronate disodium (Aredia ® ) and zoledronic acid (Zometa ® ) are bisphosphonates commonly used with multiple myeloma therapy. A different type of drug called denosumab (XGEVA ® ) can help prevent serious bone problems in people with multiple myeloma. Denosumab is given as a shot (injection) under the skin every four weeks. NCCN experts recommend that either bisphosphonates or denosumab be given to all patients receiving primary treatment for myeloma. Denosumab is a better choice than bisphosphonates for people whose kidneys don’t work well. Bisphosphonates and denosumab can cause side effects, such as osteonecrosis of the jaw. It is very important to see your dentist before starting this kind of treatment. It is also very important to have good dental care before and during treatment with these medicines. You may be referred to an orthopedic surgeon to help prevent or treat a bone fracture. Surgeons can prevent bone fractures by placing a rod to support the bone and hold it in place. Surgery may be used to treat fractures in the bones of the spine—called vertebrae . Two similar procedures that may be used are vertebroplasty and kyphoplasty. 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 in place. 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. Kidney damage Myeloma cells cause calcium to be released from the bone into the bloodstream. A high level of calcium in the blood is dangerous for the kidneys. If this happens, you will be treated with IV 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. This is called hyperviscosity . Very thick blood can damage the kidneys and other organs. It can be treated by filtering blood through a machine to remove M-proteins. This treatment is called plasmapheresis .