Controlling symptoms of myeloma

Anaemia means you have a low red blood cell count. This is quite common in people with myeloma. You may be given blood transfusions to increase your red cell count. If your anaemia is severe and keeps coming back despite transfusions, you may be treated with erythropoietin. This is a hormone which encourages the body to make more red blood cells. It is given as an injection under the skin, usually in the leg or in the abdomen.

Frequent infections are another common problem with myeloma. You will need antibiotics for infections. If you have a low white cell count, you may need to come into hospital when you have an infection so that you can be given antibiotics through a drip.

Bone damage is often associated with myeloma. Bisphosphonates are drugs that are used to treat this problem. These drugs bind to areas where bone has been destroyed. This slows down the damage that is caused by the myeloma cells. A 2010 Cochrane review showed that bisphosphonates reduce bone pain and reduce the risk of fractures in damaged bones. There are two main types of bisphosphonates that are used to treat myeloma patients

• Pamidronate (Aredia) and zoledronic acid (Zometa) are given as a drip into a vein once a month
• Sodium clodronate (Bonefos) is taken as tablets twice a day

You can read this review of bisphosphonates for myeloma in the Cochrane Library. It was written for researchers and specialists and so is not in plain English.

Radiotherapy can be used for areas of bone damage that are causing you pain. There is a limit to the amount of radiotherapy that you can have to any part of your body. So, if you have pain in an area where you have already had radiotherapy, you may not be able to have this treatment again.

Even with bisphosphonate treatment and radiotherapy, bone pain may still be a problem for some people with myeloma. A wide range of painkillers (analgesics) can be used to treat pain. There is information about cancer and pain control in the coping with cancer section of CancerHelp UK.

Tingling and numbness in your fingers and toes (peripheral neuropathy) can happen for several reasons in people with myeloma. It may be due to the myeloma itself or from other medical conditions. Or it may develop, or get worse, as a side effect of chemotherapy treatment (such as vincristine) or biological therapy (such as thalidomide or bortezomib).

Peripheral neuropathy can cause nerve pain, loss of sensation, a feeling of tightness and may affect your balance. It most commonly affects your feet and hands, but it may also affect nerves elsewhere in your body. Your doctor will be looking for signs of peripheral neuropathy during your treatment. You should always let your doctor know if you notice any new symptoms.

Your doctor can give you medicine to help with nerve pain. Doctors often use lower doses of antidepressant drugs and drugs that prevent fits (anti epileptics), as well as more common painkillers such as paracetamol. A cream called capsaicin may also be helpful.

Peripheral neuropathy from treatment is often temporary and improves once treatment stops or the dose of the drug is reduced. But unfortunately for some people the effects can be permanent. There is more information about peripheral neuropathy after treatment in our question and answer section of CancerHelp UK.

Vertebroplasty is a technique developed in France in the 1980s to help treat fractures caused by the bone thinning disease, osteoporosis. Fractures caused by myeloma put pressure on the spine and can be extremely painful. The bones of your spine (vertebrae) can collapse, causing the spine to change shape. It can become very curved - doctors call this kyphosis. So you may lose height. Vertebroplasty involves injecting special cement into the spine to strengthen it and reduce pain.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance on the use of vertebroplasty for treating fractures in people who have conditions of the spine that cause pain, including tumours. It says that vertebroplasty appears to be safe enough and works well enough for use in the NHS. But they add that it should only be considered if other ways of treating your pain don't work.

Balloon kyphoplasty is similar to vertebroplasty and treats fractures of the spine. For kyphoplasty, little balloons are put into the spine. They are slowly inflated so that the vertebra goes back to as near its normal height as possible. The special cement is injected into the space created by the balloon to strengthen the bone. Trials have shown that this technique can help relieve pain and restore some height.

The NICE guidance on the balloon kyphoplasty procedure for treating collapsed bones in the spine says that, as with vertebroplasty, it appears to be safe enough and works well enough for use in the NHS.

It is important that you understand the potential benefits and risks before you agree to treatment. And that the treatment should be discussed by a team of doctors including a spinal surgeon and a radiologist (a doctor trained in using X-rays and imaging). Doctors doing these procedures must be trained and experienced in using these techniques, and the results of treatment should be monitored.

As these treatments are relatively new, there aren't too many UK centres that can do this procedure. But it is becoming more widely available as more doctors are trained.

This is a common problem with advanced myeloma. It is caused by the increased amounts of immunoglobulin produced by myeloma cells. The thickened blood circulates around the body more slowly than normal. It can clog up small blood vessels and can cause symptoms such as confusion, dizziness and stroke-like symptoms. These symptoms are caused by the thickened blood blocking very small blood vessels in the brain.

Thickened blood can be treated by a procedure which is known as plasmapheresis. This is a similar process to having a stem cell collection. You will be connected to the plasmapheresis machine by 2 tubes similar to the infusion tubes used for drips. One tube takes your blood into the machine and the other returns it to your veins. The machine separates the blood cells from the blood plasma (the liquid part of the blood). The blood cells are returned to you. The plasma is replaced with a solution that is very similar to normal plasma. The immunoglobulin is in the plasma. So it is removed from your blood by the machine. You can have this treatment more than once if you need to.

People with myeloma can also be at an increased risk of developing blood clots for reasons such as a side effect of treatment, infection and being less mobile. If you are at an increased risk of developing blood clots you may have blood thinning medicines such as aspirin or warfarin.

The abnormal immunoglobulin may also cause kidney damage. The cells may damage the tubules in the kidney which filter urine. This can lead to a block in the flow of urine. High levels of calcium in the blood, due to myeloma bone disease, may also cause kidney damage. Some drugs such as non steroidal anti inflammatory drugs (NSAIDS), and bisphosphonates may also affect the kidneys.  Dehydration can make the situation worse, so it is important to drink as much fluid as you can.

The symptoms of kidney damage can include, thirst, loss of appetite, nausea and vomiting and either passing much more or much less urine than usual. You may also have swollen ankles or breathing problems. It is very important to let your doctor know of any new symptoms as soon as you notice them.

These are teams of doctors, nurses and other health professionals who specialise in controlling symptoms of diseases, especially cancer. You may be referred to the palliative care team if you have pain that is proving difficult to control. The team will advise on treatments or drugs that will control your symptoms.