Canterbury DHB

Context

Specific Complications of Myeloma

In This Section

Bony or Nerve Compression Pain

Hypercalcaemia

Spinal Cord Compression

Infections

Renal failure

Bony or Nerve Compression Pain

The pain may reflect bone erosion or vertebral collapse, but nerve root or spinal cord compression by soft tissue infiltration without bony change can occur. Steroids and/or anti-inflammatories may be helpful, but Morphine is often required. A single fraction of localized radiotherapy can be used palliatively.

See Palliative Care Pain Guidelines Site.

For bone pain caused by local plasmacytoma, particularly when it is unresponsive to radiotherapy and controlled with analgesia, or bony strength is compromised, consider referral to Interventional Radiology Minimally Invasive Procedures for Pain team for consideration of cementoplasty or cryo-ablation.

Hypercalcaemia

The patient with hypercalcaemia may complain of nausea, vomiting, constipation, abdominal pain, thirst, and polyuria. Confusion and coma may supervene. This is a medical emergency. Usually admission is required if the calcium level is at 3.5 or higher.

Spinal Cord Compression

Consider if there is back pain, particularly if this radiates around to the front of the chest or abdomen. Any weakness or numbness, or unsteadiness when walking should be noted. Urinary disturbance or constipation may also occur.

Note: If spinal cord compression is thought to be a possibility, immediate MRI is essential. The difficulty lies in interpreting symptoms that may be rather vague or ill-defined. Close follow-up needed if MRI is not done. Consultant involvement essential.

Infections

Immunoparesis, neutropenia, chemotherapy all combine to greatly increase the risk of infection. Bacterial infections, e.g., pneumococcal are common at presentation. Subsequently viral and fungal infections are common. The patient needs to be informed of these risks and of the need to contact the Department if they become febrile and/or unwell.

Renal failure

This may be present at diagnosis or occur acutely if the patient is allowed to become dehydrated.

This is a difficult situation and confers a poor prognosis. However, careful fluid management to maintain a euvolaemic state and dialysis may reverse the acute renal failure. Renal function may return to normal if a good response is seen to chemotherapy.

Suitable chemotherapy in this situation consists of Dexamethasone 40 mg PO for 4 days, IV cyclophosphamide, bortezomib and/or thalidomide, VAD or ZDex.

About this Canterbury DHB document (5604):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

April 2016

Next Review:

September 2016

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5604