In the realm of multiple myeloma, the prompt recognition and management of infections play a pivotal role in reducing complications and optimizing outcomes | Image Credit: TinasheN-peopleimages – stock.adobe.com
The authors of a recent article underscore the significant impact on the quality of life of patients afflicted with multiple myeloma, characterized by a high symptom burden, typically older age at diagnosis, and treatment-related toxicities. They emphasize the critical importance of tailoring treatment to individual patients. In their study, they aim to provide practical recommendations focusing on the monitoring, prevention, and management of disease-related symptoms and treatment-induced toxicities to enhance the quality of patient care and outcomes.
According to the authors, striking a delicate balance between treatment effectiveness and tolerability is paramount for each patient. They advocate for vigilant monitoring of comorbidities, disease-related manifestations, and treatment side effects. They recommend a proactive approach that includes patient education, reinforcement of information, and heightened patient awareness to enable the early detection of adverse events, facilitating prompt therapeutic adjustments.
Common Complications Associated with Multiple Myeloma
- Infections
- Kidney damage
- Neurological issues
- Cardiovascular complications
- Hemostatic abnormalities
- Bone disorders
- Chronic and acute pain
- Metabolic irregularities
- Neuropsychiatric symptoms
- Ocular conditions
- Skin lesions
- Gastrointestinal problems
- Development of secondary malignancies
- Teratogenic risks
- Toxicities linked to autologous stem cell transplant
- Toxicities associated with T-cell engaging therapies
Patients with multiple myeloma, whose median age at diagnosis is 65 years and often exhibit a frail status, commonly experience a range of complications including infections, kidney damage, neurological issues, cardiovascular complications, hemostatic abnormalities, and bone disorders.
In the context of infections, it is crucial to acknowledge that the heightened susceptibility observed in individuals with multiple myeloma can be attributed to various factors such as the disease itself, patient-related factors, and treatment-related aspects including immune suppression, advanced age, comorbidities, and neutropenia. Recognizing risk factors like high tumor burden, low hemoglobin levels, and renal dysfunction is essential as it aids in customizing prophylactic interventions.
Regarding renal complications, initial evaluation should encompass assessing serum urea, creatinine, electrolyte levels, serum free light chain levels, urine protein electrophoresis, and 24-hour urine free light chain levels. Continuous monitoring should involve evaluating proteinuria to gauge treatment response and disease progression. Additional considerations include renal biopsy, nephropathy, and hypercalcemia.
Neurological manifestations such as hyperviscosity syndrome and central nervous system (CNS) involvement are prevalent in multiple myeloma. Clinicians must be vigilant for symptoms like dizziness, frequent headaches, tinnitus, and concentration difficulties indicative of hyperviscosity syndrome. In cases of CNS involvement, imaging studies like CT and MRI scans, along with cerebrospinal fluid analysis, are essential for timely intervention to prevent neurological deterioration and improve patient outcomes.
The authors also discuss cardiovascular implications associated with multiple myeloma, which can stem indirectly from the disease (e.g., through comorbidities like diabetes and obesity), directly (e.g., due to factors like hyperviscosity and high-output heart failure), or as a result of treatment toxicity from agents such as anthracyclines, alkylating agents, and immunomodulatory drugs. They recommend comprehensive cardiac assessments, identification of cardiac toxicity risk factors, screening for AL amyloidosis, and diligent monitoring and management during treatment.
Hemostatic abnormalities may manifest as thrombotic complications, particularly venous thromboembolism (VTE). Clinicians should consistently assess for risk factors including recent surgeries, trauma, previous VTE episodes, and heart conditions. Monitoring for hemorrhagic complications is equally crucial, often associated with disease progression, thrombocytopenia, abnormal coagulation test results, and a history of bleeding.
The authors highlight that bone complications in multiple myeloma primarily stem from plasma cell proliferation and alterations in bone remodeling, commonly resulting in bone pain. Management of this pain typically focuses on palliative measures aimed at stabilizing or enhancing patient quality of life. Palliative care strategies may involve antiresorptive therapy to prevent new lesions, radiotherapy, surgical interventions, corticosteroids, and pain relief measures. Additional options such as vertebroplasty and kyphoplasty can be considered for pain management related to vertebral collapse.
The guidance provided by the authors also encompasses discussions on chronic and acute pain, metabolic disorders, neuropsychiatric symptoms, ocular conditions, skin lesions, gastrointestinal issues, development of secondary malignancies, teratogenic risks, toxicities associated with autologous stem cell transplant, and toxicities linked to T-cell engaging therapies.
In conclusion, the authors stress the significance of promptly recognizing and managing infections in multiple myeloma to mitigate complications and enhance patient outcomes. They emphasize the necessity of personalized treatment and vigilant monitoring due to the substantial symptom burden and profound impact on quality of life resulting from the disease and its associated toxicities.
“Timely and appropriate intervention in response to treatment-related adverse events and worsening comorbidities should be guided by scientific evidence, consensus recommendations, and clinical expertise, holding immense importance for patients and their families,” they assert, “significantly influencing the prognosis and quality of life of those battling multiple myeloma on a daily basis.”
Reference
Geraldes C, Roque A, Sarmento-Ribiero AB, et al. Practical management of disease-related manifestations and drug toxicities in patients with multiple myeloma. Front Oncol. 2024;14:1282300. doi:10.3389/fonc.2024.1282300