Comment
Author: Admin | 2025-04-28
Of people who have been on the drugs for many years. (Chaudhry and Ruggiero 2007, 199-206; Ruggiero and Drew 2007, 1013-1021)The recommendations recently include reducing the utilization of these agents after 2 years of stable disease, and possibly not using them where there is no bone involvement. Dental exams before utilization, and routinely during use are advised.Therapy for the SpineAs the vertebral bodies become more involved with myeloma, small fractures, large lytic lesions, and compression (collapse) with significant pain may occur. Surgical procedures may be used to stabilize the worst areas, but non-surgical approaches have also been developed to stabilize the vertebrae, relieve pain, and prevent further compression.Vertebroplasty: : This is a procedure in which a radiologist or orthopedic surgeon inserts a needle under x-ray guidance into the bone and injects methylmethacrylate (similar to CorianTM), to help support the bone and relieve pain.Kyphoplasty: This is a similar procedure to vertebroplasty, but in this approach a balloon is used to open up more space in the vertebrae prior to the injection of the methylmethacrylate. Kyphoplasty helps to support bone structure and relieve pain but can also preserve and improve height. (www.Kyphon.com)Radiation: Although radiation is remarkably effective in controlling malignant plasma cells, it cannot be used for the entire body (except in the case of stem cell transplantation), and therefore must be used in specific locations. This modality of therapy is very effective in controlling localized pain caused by myeloma and in treating large plasmacytomas, especially in the sacrum. Any area of fracture should be treated with radiation as well, to control the cancer and promote healing. The number of doses may be as low as a single fraction or may range up to ten fractions.In the case of a Solitary Plasmacytoma, radiation is used as the sole treatment and should be increased to a maximum dose tolerated in order to potentially cure this myeloma variant.HypercalcemiaBone destruction and abnormal excretion of hormones by the myeloma cells can frequently cause high calcium or hypercalcemia. Symptoms of hypercalcemia include fatigue, altered mental status, gastrointestinal upset and weakness. Hypercalcemia can result in kidney failure and rarely heart rhythm abnormalities. The mainstay of treatment for hypercalcemia includes intravenous fluids with lasix, bisphosphonates, calcitonin injections and corticosteroids. Effective treatment of the myeloma will also help to improve the hypercalcemia and prevent its recurrence.Renal FailurePatients with myeloma often present with renal failure and the cause of the kidney
Add Comment