2017 NCCN Hematologic Malignancies Congress: Managing Common Complications of Myeloma and Its Treatment
Multiple myeloma can manifest in a broad spectrum of clinical manifestations, but anticipation and comprehensive management of the adverse effects of myeloma and its treatment can improve patient outcomes, according to research presented by Kathleen Colson, RN, BSN, BS, of Dana-Farber Cancer Institute, Boston, at the National Comprehensive Cancer Network (NCCN) 12th Annual Congress on Hematologic Malignancies.
Supportive therapy for renal dysfunction should include hydration and avoidance of nonsteroidal anti-inflammatory drugs, as well as avoidance of intravenous contrast dye, as it can lead to contrast-induced nephropathy and nephrogenic systemic fibrosis in patients with impaired kidney function. Bisphosphonates inhibit bone destruction and are recommended for all patients with myeloma who have bone disease.
Daratumumab may cause severe infusion reactions in about half of patients who receive it, so when starting a patient on this monoclonal antibody, use caution and administer pre- and post-infusion medications to reduce this risk, suggested Ms. Colson. In clinical studies, premedicating patients with montelukast has been shown to reduce infusion reactions with daratumumab.
Additionally, myeloma patients may have a 15-fold increased risk for recurrent infections, and supportive therapy should include antibiotics and intravenous immunoglobulin therapy. “Consider pneumonia and influenza vaccines and prophylaxis for Pneumocystis carinii, fungal infections, and herpes zoster,” Ms. Colson recommended.