MM Care: Insights on Treatment and Complications

Multiple myeloma (MM) treatment and management are always changing. In this analysis, researchers address recurring problems and possible fixes to improve care for this patient population.

The authors of a new article in Frontiers in Oncology highlight the vital significance of customized therapy for patients with multiple myeloma (MM), given the disease’s high symptom burden, typical older age at diagnosis, and treatment-related toxicities, which have a profound impact on patient quality of life. To maximize the quality and outcomes of patient care, they intend to provide useful advice with this inquiry that focuses on the monitoring, prevention, and management of symptoms associated with disease and toxicities connected to therapy.

“A careful balance between treatment efficacy and its tolerability should be considered for every patient,” they write. “A close monitoring of comorbidities, disease-related manifestations, and treatment side effects is recommended, as well as a proactive approach, with reinforcement of information and patient awareness for the early recognition of adverse events, allowing prompt therapeutic adjustments.”

The most common complications seen in individuals with multiple myopathy (MM), whose median age at diagnosis is 65 years, and who typically exhibit fragile states, include infections, kidney damage, neurological symptoms, cardiovascular involvement, hemostatic problems, and bone disease.

It’s crucial to understand that, in the context of multiple myeloma (MM), aspects associated with the disease, the patient, and the treatment—such as immune suppression, age and comorbidities, and neutropenia, respectively—can commonly be linked to greater vulnerability to infections. Determining the risk variables that raise the chance of severe infections early on is also crucial. These risk factors include low hemoglobin, significant tumor burden, and renal failure. Combining the two approaches can make it easier to customize preventative care.

Urine protein electrophoresis, 24-hour urine-free light chain levels, serum urea, creatinine, electrolyte levels, and electrolyte levels should all be included in the initial patient evaluation when it comes to the kidneys. Renal biopsy, nephropathy, and hypercalcemia are additional consequences that should be monitored along with proteinuria to assess the patient’s response to medication and probable disease progression.

The central nervous system (CNS) involvement and hyperviscosity syndrome are typical neurologic symptoms of multiple sclerosis (MM) that physicians should be aware of. Frequent headaches, tinnitus, dizziness, and trouble focusing are common symptoms of hyperviscosity syndrome. The study’s authors point out that while CNS involvement is uncommon in MM, it usually happens when the disease is progressing. As a result, they stress the importance of cerebral spinal fluid analysis and CT and MRI imaging to preserve neurological function and improve patient outcomes.

The authors of the study then emphasized how cardiovascular involvement in multiple myeloma (MM) can be caused by treatment toxicity (anthracyclines, alkylating agents, and immunomodulatory drugs), direct correlation (hyperviscosity and high-output heart failure), or indirect correlation (some patient comorbidities, such as diabetes, obesity). The optimal patient cardiac evaluation, in their opinion, should comprise testing for probable AL amyloidosis, monitoring/management throughout treatment, assessment of cardiac function, and discussion of risk factors for cardiac toxicity.

Thrombotic problems, including venous thromboembolism (VTE), can result from hemostatic irregularities. Therefore, doctors should continuously check for risk factors, which include heart disease, trauma, recent surgery, and past VTE. As a hemostatic anomaly, hemorrhagic consequences are particularly worth keeping an eye out for. Typically, they occur when the disease progresses and are linked to thrombocytopenia, abnormal results from screening coagulation tests, and a history of bleeding.

The authors of the study point out that changes in bone remodeling and proliferation of plasma cells, which most often result in bone pain, are the main causes of bone disease problems associated with multiple myeloma. The main goal of palliative care is to stabilize or enhance the patient’s quality of life. In this context, radiation, surgery, corticosteroids, analgesics, and antiresorptive medication are sometimes used as palliative care to avoid the development of new lesions. For discomfort related to vertebral collapse, further options to think about include vertebroplasty and kyphoplasty.

Acute and chronic pain, metabolic issues, neuropsychiatric symptoms, ocular conditions, cutaneous lesions, gastrointestinal manifestations, second primary malignancies, teratogenic risk, toxicities related to autologous stem cell transplantation, and toxicities related to T-cell engaging therapies are among the other topics covered by the authors in this guidance.

Overall, the authors stress that early detection and management of infections is critical for MM to reduce the risk of complications and improve patient outcomes. They also stress the necessity of treatment personalization and monitoring due to the disease’s high symptom burden, significant impact on quality of life, and treatment-related toxicities.

“Rapid and appropriate intervention on treatment-related adverse events and on worsening of comorbidities should be based on scientific evidence, consensus recommendations, clinical experience, and is of extreme importance for patients and their families,” they conclude, “impacting the prognosis and quality of life of those who suffer daily with MM.”

For more information: Practical management of disease-related manifestations and drug toxicities in patients with multiple myeloma, Frontiers in Oncology, https://doi.org/10.3389/fonc.2024.1282300