Management of treatment complications and supportive care

Multiple myeloma patients usually present with complications related to the proliferation of clonal plasma cells or the toxic effect of monoclonal proteins [1]. Therapy is indicated when complications referred to as the CRAB criteria is present [2, 3]. These include hypercalcemia (C), renal insufficiency (R), anemia (A), and lytic bone lesions or osteoporosis (B), as defined by the myeloma working group [4]. In a study at the Mayo clinic, anemia was the presenting sign in 73% of the patients, lytic bone lesions 66 %, hypercalcemia 13 %, and renal insufficiency 19 % [5]. Although the definitive therapy for multiple myeloma is directed at the plasma cell malignancy, appropriate immediate intervention for these complications is essentially for the long-term outcome of these patients. The major cause of death in multiple myeloma patients is infection and renal failure and failure to reverse acute renal failure will significantly impact long-term survival [6]. Failure also to recognize and appropriately treat pathologic bone fractures and cord compression will have significant effect on quality of life, even with effective treatment of the multiple myeloma. The current armamentarium of drugs for the management of multiple myeloma is extensive and these have changed significantly over the last decade. The traditional agents such as alkylators, anthracyclines, and platinum [7–10] have given way to immunomodulatory drugs (Thalidomide, Lenalidomide, Pomalidomide) and the proteosome inhibitors Bortezomib and Carfilzomib [11–20]. In addition to the primary complications of multiple myeloma, all these drugs also do come with their own peculiar side effects which will have to be effectively monitored and managed during their use. Multiple myeloma patients are leaving longer and therefore their quality of life as they live with this disease should be optimized by effectively preventing, reducing, and managing complications associated with this disease [21]. This chapter will review complications associated with multiple myeloma and its management.