Supportive Treatments for People with Multiple Myeloma

If you have multiple myeloma, supportive treatments could help prevent or relieve some of your symptoms.

Supportive treatment is aimed at preventing or relieving symptoms, instead of treating the cancer directly. You might also hear it called palliative care, symptom management, or comfort care. This type of treatment is meant to improve comfort and quality of life, no matter the cancer stage or the goal of treatment.

People with multiple myeloma can often be helped by supportive care, regardless of what other treatments they are getting. Some of the more common types of supportive care are discussed below.

Prevention and treatment of bone problems

Multiple myeloma often affects the bones. This can lead to bone pain, weakened bones, and an increased risk of fractures. It can also cause other problems such as high calcium levels in the blood (hypercalcemia).

Bone problems from multiple myeloma can be prevented or treated in a number of ways, depending on the situation, including:

• Bone medicines such as bisphosphonates (pamidronate or zoledronic acid) or denosumab
• Pain medicines to help with bone pain
• Radiation therapy to areas of damaged bone
• Surgery to help prevent or treat fractures in bones weakened by myeloma

Prevention and treatment of infections

People with multiple myeloma often have low levels of the normal antibodies (immunoglobulins) needed to fight infection. This can lead to a weakened immune system and lung and/or sinus infections that keep coming back.

Intravenous immunoglobulin (IVIG)

The levels of antibodies in your blood can be tested. If these are low, antibodies from donors can be given into a vein (IV) to raise your levels and help prevent infections. These antibodies are called intravenous immunoglobulin (IVIG).

People who get certain medicines or CAR T-cell therapy to treat their myeloma are often given IVIG to help protect against infections. IVIG is usually given once a month at first, but it may be given less often based on blood tests of your antibody levels.

Antibiotics and vaccines

Antibiotics are often given during the first few months of treatment for multiple myeloma, either to help prevent infections or to treat existing infections.

Certain vaccines are also often recommended to help lower the risk of some types of infections in people with multiple myeloma.

Treatment for low red blood cell counts

Some people develop low red blood cell counts (anemia) from multiple myeloma or its treatment. If this happens to you, you might feel tired, lightheaded, or short of breath, especially when active. Anemia that’s causing symptoms can be treated with blood transfusions. These are often given on an outpatient basis.

Drugs called growth factors, like epoetin alfa (Epogen, Procrit, and other brand names) and darbepoetin alfa (Aranesp), can help improve low red blood cell counts and reduce the need for blood transfusions in some people who get chemotherapy. These drugs aren't used much in people with multiple myeloma because some studies have suggested people don't do as well on these medicines.

Treating hyperviscosity

In some people with multiple myeloma, certain myeloma proteins can build up in the blood, causing it to thicken and interfering with circulation. This is called hyperviscosity.

Plasmapheresis is a procedure that removes excess myeloma proteins from your blood. Most often, this is done through a large catheter (tube) placed in a vein in your neck, under your collarbone, or in your groin.

This catheter takes blood from your body and runs it through a machine. The machine separates the blood cells from the blood plasma (the liquid part of your blood, where the myeloma proteins are), and then returns the blood cells to your body, along with either a salt solution or donor plasma. The plasma that was removed is then discarded.

Plasmapheresis lowers the abnormal protein levels in your blood, and it can relieve your symptoms for a while. But it does not kill the myeloma cells. That means that without further treatment, the protein will build up again.

For this reason, plasmapheresis is often followed by chemotherapy or some other type of drug treatment to kill the cells that make the protein.