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Hamilton Regional Multiple Myeloma Support Group |
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MULTIPLE
MYELOMA SUPPORT GROUP MEETING Saturday,
November 14, 2009 SPEAKER:
Shannon Hilton Registered
Nurse in Hematology for 16 years Juravinski
Cancer Center TOPIC:
A Nursing Perspective Disease Update Nursing Treatment DISEASE
UPDATE MM = cancer of
plasma cells in the bone marrow - it is more common in men rather
than women, black people rather than
white people, and older people
rather than younger people. Possible
causes: - radiation - environmental - genetic component - agent orange PAIN -from bone
disease (most common presenting symptom) -anemia &
fatigue - recurrent
infection -renal
dysfunction -hypercalcemia -bone marrow
involvement -often no
symptoms in early stages DIAGNOSTIC
TESTS -complete blood
counts -blood
chemistry - creatinine calcium -skeletal
survey (not a bone scan) -MRI -bone marrow
aspirate & biopsy including cytogenetics -B2 micro
globulin -C reactive
protein -Spep
quantitative immunoglobulin -24 hour urine
for protein -free light
chain analysis -vitamin D
levels -bone density CRITERIA FOR
POSITIVELY IDENTIFYIN MM -Monoclonal
plasma equal to or greater than 10% -Monoclonal
protein in serum/urine -one or more
crab -- C=calcium elevated R=renal
dysfunction A=anemia B=bone disease Normal MGUS Asymptomatic Active greater
Aggressive Plasma
cell less than 10% PC greater than 10% than 10% + CRAB PC in Peripheral
Blood GOALS OF MM
THERAPY Disease Control Symptom
Management Maximize
quality of life RENAL ISSUES -50% or higher
have renal dysfunction -10 - 20%
require dialysis -hydration
& treatment usually improve renal function -fluids are pushed if the patient is not on restriction -avoid IV
contrast & NSAIDs -be careful
with bisphosphonates LOW BLOOD
COUNTS -bone marrow
that is packed with MM doesn’t have room to make other blood cells -marrow
suppression from treatment will lower counts -education
about energy RECURRENT
INFECTION -may have 15
fold increased risk -with increased
cells, WBC production is decreased -normal immune
role of plasma cell is lost INFECTIONS -good hand
washing for visitors -family should
have flu shot -if the family
is sick, no hugging or kissing -some patients
will need antibiotics -PCP
prophylaxis -if visitor is
sick, No Visiting HYPERCALCEMIA -caused by
increased osteoclast activity which causes breakdown of bone and releases
calcium into the blood stream -high blood
calcium causes confusion, constipation, weakness, nausea, and kidney damage -hydration and
bisphosphonates needed BONE
INVOLVEMENT -areas where
fractures and damage can occur -skull, spine,
pelvis, long bones -spinal cord
compression can occur CONSTIPATION DIARRHEA -narcotics,
anti nausea meds, -antibiotics, C Diff & chemo can cause Chemo and high
calcium can cause diarrhea Constipation -lots
of fluids as dehydration is bad -fluids,
dietary fibre -brat
diet if persistent -activity -Bananas
Rice Applesauce Toast -bone meds -avoid bulk
laxatives NEUROPATHY -can be caused
by MM proteins damaging nerve sheathes -side effect of
many MM treatments -can affect
sensory and motor function -usually starts
at extremities and works in MYOPATHY -use of long
term steroids affects large muscles first -important to
engage activity and moderate exercise HISTORICAL
PERSPECTIVE -1962 - oral melphalon and prednisone -1984 - VAD -1986 - high dose dexamethasone -1996 - bisphosphonates -1999 - high dose therapy autologous with stem
cell support
Thalidomide/Arsenic trioxide -2000 - Mabs protease inhibitors & other imids -bisphosphonates
- inhibit bone destruction - coat surface inhibiting bone
resorption BORTEZOMIB -
VELCADE -approved as a
first line therapy (if transplant is not an option) -approved as a
second line therapy -combination
therapy -maintenance
therapy -can be used
when renal dysfunction is present PERIPHERAL
NEUROPATHY NEUROPATHIC PAIN -tingling -severe leg/thigh pain -numbness -shooting leg pain -burning (hands
and feet) -joint
and muscle pain -increased
sensitivity to touch -muscles sensitive NOVEL
TREATMENTS FOR MM -Thalidomide -
first line -prior to
transplant -commonly used
with dexamethasone -regimen not
approved in Canada but is legally obtained in controlled amounts -cost is NOT
covered -Revlamid -
Lenalidomide - second line treatment - used also as maintenance - used in combination with
dexamethasone **Dexamethasone
carries with its use the possibility of an increased chance of
developing diabetes. Questions were
taken and a discussion took place. Lori thanked
our speaker, Shannon. Next
Meeting - Saturday January 9, 2010 5th Anniversary Celebration Pot Luck
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