eMedicine Specialties > Hematology > Plasma Cell Disorders

Multiple Myeloma: Follow-up

Author: Sara J Grethlein, MD, Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University
Coauthor(s): Lilian M Thomas, MD, Fellow, Department of Hematology/Oncology, State University of New York Upstate Medical University
Contributor Information and Disclosures

Updated: Nov 19, 2009

Follow-up

Further Inpatient Care

  • Patients with multiple myeloma may require hospitalization for the treatment of pain or bony pathology.

Further Outpatient Care

    • Patients with multiple myeloma are at high risk of infection, especially from encapsulated organisms. Vaccinations against pneumococcal organisms and influenza are recommended. Consider vaccinating patients against Haemophilus influenzae B. Consideration of the use of the herpes zoster vaccine should be given.

Inpatient & Outpatient Medications

  • Medications for the treatment of multiple myeloma include chemotherapy, zoledronic acid, pain medications, and erythropoietin.

Transfer

  • Patients with multiple myeloma who may have spinal cord compression need a rapid evaluation, which may necessitate urgent transfer to a center equipped with MRI for diagnosis or a center with a radiation oncologist for urgent therapy.

Deterrence/Prevention

  • No preventive measures for multiple myeloma are known.

Complications

  • Skeletal complications (eg, pain, hypercalcemia, pathologic fracture, spinal cord compression)
  • Infection
  • Anemia
  • Renal failure
  • Amyloidosis

Prognosis

  • Many schemas have been published to aid in determining the prognosis of patients with multiple myeloma. One schema uses CRP and beta-2 microglobulin.
    • If levels of both proteins are less than 6 mg/L, the median survival is 54 months.
    • If the level of only one component is less than 6 mg/L, the median survival is 27 months.
    • If levels of both protein values are greater than 6 mg/L, the median survival is 6 months.
  • Renal impairment (ie, stage B disease or creatinine level >2 mg/dL at diagnosis) is indicative of a poor outcome.
  • The prognosis for survival in unselected patients with multiple myeloma is 3 years (ie, median survival).

Patient Education

  • Patient education is very important in the management of multiple myeloma. The International Myeloma Foundation offers educational resources, a quarterly newsletter, and conferences. Patients or physicians can contact the International Myeloma Foundation by phone at (800) 452-CURE (800-452-2873) in the US and Canada or on the World Wide Web at International Myeloma Foundation.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider spinal cord compression in patients with multiple myeloma who report back pain, bowel or bladder control problems, or neuropathy; as many as 20% of patients with multiple myeloma may experience a spinal cord compression during the course of their illness
  • Failure to recognize that long-term neurologic function is directly related to the rapidity of the diagnosis and the institution of appropriate therapy for multiple myeloma
  • Failure to consider the risk of renal failure, especially in the setting of contrast medium injection for imaging studies. Take care to limit patients' exposure and maintain hydration.
  • Failure to inform patients of the risk of osteonecrosis of the jaw, which has been associated with bisphosphonate therapy in myeloma.

Special Concerns

  • Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare syndrome consisting of polyneuropathy, organomegaly, endocrinopathy, M protein deviations, and skin changes.
  • Amyloidosis is often secondary to multiple myeloma, but it may develop without multiple myeloma. Patients with amyloidosis typically lack sufficient numbers of plasma cells in the bone marrow or sufficiently high levels of M protein to meet the diagnostic criteria for multiple myeloma.
  • Indolent multiple myeloma is a subset of the disease in which patients have no (or very limited) bone disease, a performance status greater than 70%, a hemoglobin level greater than 10 g/dL, a calcium level within the reference range, a creatinine level less than 2 mg/dL, no infections, and low (ie, <7 g/dL for IgG, <5 g/dL for IgA) M protein levels.
  • Smoldering multiple myeloma is the same as indolent multiple myeloma, except that these patients have less than 30% plasma cells in their bone marrow, and they have no bone disease.
 


More on Multiple Myeloma

Overview: Multiple Myeloma
Differential Diagnoses & Workup: Multiple Myeloma
Treatment & Medication: Multiple Myeloma
Follow-up: Multiple Myeloma
Multimedia: Multiple Myeloma
References
Further Reading
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Keywords

multiple myeloma, myeloma, bone marrow malignancy, bone marrow cancer, myeloma multiple, plasma cell myeloma, Kahler's disease, Kahler disease, plasma cell dyscrasia, plasma cell leukemia, leukopenia, anemia, thrombocytopenia, bone pain, hypercalcemia, spinal cord compression, hyperviscosity, amyloidosis, renal failure, monoclonal gammopathy of unknown significance, MGUS,

M and P chemotherapy, leukemia, plasma cell leukemia, VAD chemotherapy, plasmacytoma, renal impairment, compression fracture of vertebral body, shingles, herpes zoster, Haemophilus infections, epistaxis, stroke, myocardial ischemia, myocardial infarction, carpal tunnel syndrome, meningitis, peripheral neuropathies, ecchymoses, purpura, macroglossia

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Contributor Information and Disclosures

Author

Sara J Grethlein, MD, Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University
Sara J Grethlein, MD is a member of the following medical societies: American Society of Hematology
Disclosure: Nothing to disclose.

Coauthor(s)

Lilian M Thomas, MD, Fellow, Department of Hematology/Oncology, State University of New York Upstate Medical University
Lilian M Thomas, MD is a member of the following medical societies: American College of Physicians and American Society of Clinical Oncology
Disclosure: Nothing to disclose.

Medical Editor

Koyamangalath Krishnan, MD, FRCP, FACP, Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Troy H Guthrie, Jr, MD, Director of Cancer Institute, Baptist Medical Center
Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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