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Treating Bone Complications in Multiple Myeloma

Posted Aug 24 2008 1:49pm
ANNOUNCER: Multiple myeloma is a cancer that originates in the bone marrow. When it spreads and attacks the bone itself, it can cause extensive complications for those living with this disease. But doctors have several treatments available to help reduce and prevent these complications.

SUNDAR JAGANNATH, MD: Multiple myeloma is a blood cancer. It involves one of the white blood cells called plasma cell. When the cancer cells, the plasma cells grow rapidly inside the bone marrow, they can destroy the bone architecture internally.

Another way I would look upon this like termite growing inside wood. The cancer cells start growing inside, they eat the bone and cause the bone to get weak. Then even the day-to-day activity, the stress on the bone can cause fracture of the bone.

ANNOUNCER: Though other cancers can spread to the bone, the damage caused by multiple myeloma can be worse because it involves all the bones, where blood is being formed.

SUNDAR JAGANNATH, MD: In this particular cancer, the bone is eaten by the osteoclasts but there is no new bone formation or repair mechanism, because the repair mechanism is suppressed. Whereas in solid tumors such as breast cancer or lung cancer when they go to the bone and start growing there, they will cause bone destruction, but the body will normally try to wall off those cancer cells by producing new bone around them.

ANNOUNCER: When the disease begins to damage the bone, the first symptom is usually pain.

SUNDAR JAGANNATH, MD: The patient could have a cough or sneeze and can feel a sharp pain on the side of the chest due to a rib fracture. Or they could be lifting some weight and suddenly they have a severe back pain because of a compression fracture of the vertebra or the spine in the back.

ANNOUNCER: Managing pain is an important first step in treating multiple myeloma.

SUNDAR JAGANNATH, MD: The pain relief should be approached in two ways. One is to give immediate pain relief, episodic and you can do that by using codeine-morphine type in short acting form but if the patient has a constant back pain, unable to lie down, unable to sleep, unable to rest, then you want to make sure the patient gets 24 hour pain relief by using long acting pain medication.

ANNOUNCER: Other treatment options include: chemotherapy to treat the underlying cancer cells. Radiation therapy is sometimes used for a localized area where there is bone destruction and pain. But drugs known as bisphosphonates, are the mainstay of therapy to treat and prevent, further bone complications.

JAMES BERENSON, MD: Bisphosphonates are a class of drugs that shut down the cell that drives bone loss. That is called the osteoclast. So when that cell becomes inactive, the pac man if you will, that gobble up bone are no longer available to do that.

SUNDAR JAGANNATH, MD: These medications are given monthly intravenously. And when the patient takes this medication regularly over a period of two years or longer, these drugs actually get deposited in the bone.

But more important is it improves the quality of life of the patient, because with time over a period of administration, the bones get stronger, so they do not have additional bone pain and compression fracture.

JAMES BERENSON, MD: The main bisphosphonates used to treat myeloma patients in the U.S. are either pamidronate also known as Aredia, or now Zometa or zoledronic acid.

Aredia or pamidronate is given every 3 to 4 weeks over several hours. Recent studies with Zometa or zoledronic acid show that this can be safely administered in over simply 15 minutes.

SUNDAR JAGANNATH, MD: The advantage for this particular drug is the infusion time is reduced, especially when the patient's cancer is in remission and the patient's quality of life has improved and they are going about their day-to-day life. They don't have to come and spend a lot of time in a cancer center.

ANNOUNCER: As with many medications, there are some side effects with bisphosphonate therapy.

JAMES BERENSON, MD: The major side effects associated with bisphosphonates are in about ¼ of patients, following the first or second infusion only. They can have a flu-like symptom the next day. This only lasts a few hours and will go away with subsequent dosing.

SUNDAR JAGANNATH, MD: Then when you use these drugs over a period of time, we have to pay attention to the kidney function. Occasionally these drugs can damage the kidney and this can be easily recognized by periodically checking the amount of protein that is leaked by the kidney.

ANNOUNCER: For myeloma patients with severe bone complications, or imminent fractures, there are surgical options available.

JAMES BERENSON, MD: Importantly there are new surgical techniques that have been developed that have greatly increased the quality of life in patients with myeloma. Specifically the use of kyphoplasty, vertibroplasty as well as other surgical techniques, to prevent either fractures of the long bones or to treat them, have made a huge difference in the quality as well as the quantity of life of patients with myeloma.

ANNOUNCER: These treatments-medical and surgical, in addition to radiation therapy, offer hope that patients with multiple myeloma can be spared the debilitating effects of bone complications and so maintain a good quality of life, while fighting their disease.

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