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Multiple Myeloma
Multiple myeloma is a life-threatening blood
cancer of plasma cells, a type of white blood
cell in the bone marrow that helps fight
infection. when plasma cells become cancerous
and multiply too quickly, they are called
myeloma cells.
Description
o A malignant proliferation of plasma cells
within the bone.
o Excessive numbers of abnormal plasma
cells invade the bone marrow and
ultimately destroy bone; invasion of the
lymph nodes, spleen, and liver occurs.
o The abnormal plasma cells produce an
abnormal antibody (myeloma protein of
the Bence Jones protein) found in the
blood and urine.
o Multiple myeloma causes decreased
production of immunoglobulin and
antibodies and increased levels of uric
acid and calcium, which can lead to
kidney failure.
o The disease typically develops slowly
and the cause is unknown.
Causes and Risk Factors
Experts aren’t sure what causes multiple
myeloma. But you’re more likely to get it if:
o You’re older than 65
o You’re male
o You’re African American
o You have a family member with it
o You’re overweight or obese
o You’ve been exposed to radiation
o You’ve had contact with chemicals used
in rubber manufacturing, woodworking,
or firefighting; or in herbicides
Signs and Symptoms
Signs and symptoms of multiple myeloma can
vary and, early in the disease, there may be
none.
When signs and symptoms do occur, they can
include:
o Bone pain, especially in your spine or
chest
o Nausea
o Constipation
o
o Mental fogginess or confusion
o Fatigue
o Frequent infections
o Weight loss
o Weakness or numbness in your legs
o Excessive thirst
Diagnosis
Your doctor may suspect multiple myeloma if
you have a blood test for something else and it
shows:
o Too much calcium in your blood
(hypercalcemia)
o Too few red blood cells (anemia)
o Kidney problems
o High total protein levels in your blood,
but low levels of one called albumin
(your doctor may say you have a
"globulin gap")
To confirm a diagnosis, you might have blood
tests including:
o A complete blood count (CBC).
o Blood urea nitrogen (BUN) and
creatinine.
Complications
o Bone problems
o Blood problems (anemia)
o Frequent infections
o Kidney damage
Assessment
1. Bone (skeletal) pain, especially in the
ribs, spine, and pelvis
2. Weakness and fatigue
3. Recurrent infections
4. Anemia
5. Urinalysis shows Bence Jones
proteinuria and elevated total serum
protein leel.
6. Osteoposis (bone loss and the
development of pathological fractures)
7. Thrombocytopenia and leukopenia
8. Elevated calcium and uric acid levels
9. Kidney failure
10. Spinal cord compression and paraplegia
11. Bone marrow aspiration shows an
abnormal number of immature plasma
cells.
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Interventions
1. Administer chemotherapy as prescribed.
2. Provide supportive care to control
symptoms and prevent complications
especially bone fractures,
hypercalcemia, kidney failure, and
infections.
3. Maintain neutropenic and bleeding
precautions as necessary.
4. Monitor for signs of bleeding, infection,
and skeletal fractures.
5. Encourage the consumption of at least 2
L of fluids per day to offset potential
problems associated with hypercalcemia,
hyperuricemia, and proteinuria, and
encourage additional fluid as indicated
and tolerated.
6. Monitor for signs of kidney failure.
Collect 24-hour urine as prescribed.
7. Encourage ambulation to prevent renal
problems and to slow down bone
resorption.
8. Administer IV fluids and diuretics as
prescribed to increase renal excretion of
calcium.
9. Administer blood transfusion as
prescribed for anemia.
10. Administer analgesics as prescribed and
provide non-pharmacological therapies
to control pain.
11. Administer antibiotics as prescribed for
infection.
12. Prepare the client for local radiation
therapy if prescribed.
13. Instruct the client in home care measures
and the signs and symptoms of infection.
14. Administer bisphosphonate medications
as prescribed to slow bone damage and
reduce pain and risk of fractures.
Medications
Which drugs your doctor chooses depends on
your age and how threatening your cancer is.
o Chemotherapy
o Corticosteroids
o Targeted therapies
o Immunomodulatory drugs
o Monoclonal antibodies
o Proteasome inhibitors
o Histone deacetylase (HDAC) inhibitors
o Interferon
Patient Care
Patient Care involves managing both the
disease and its symptoms. The current treatment
option includes watchful waiting (for early
multiple myeloma, also called MGUS
[monoclonal gammopathy of undetermined
significance]) corticosteroids, chemotherapy,
targeted therapy, HSCT. Multiple myeloma is
seldom cured, but treatment can relieve
symptoms, produce remission, and prolong life.
Ambulation and adequate hydration are used to
treat hypercalcemia, dehydration, and potential
renal damage. Weights bearing helps the bones
resorb some calcium, and fluids dilute calcium
and prevent protein precipitates from causing
renal tubular obstruction. Control of pain and
prevention of pathologic fractures are the other
goals of management. Analgesics, orthopedic
supports, and localized radiation helps reduce
the skeletal pain. Bisphosphonates, such as
pamidronate (Aredia), zoledronic acid (Zometa),
and etidronate (Didronel), inhibit bone
breakdown and are used for the treatment of
skeletal pain and hypercalcemia. They inhibit
bones resorption without inhibiting bone
formation and mineralization. They are given
monthly by IV infusion. Radiation therapy is
other important component of treatment,
primarily because of its effect on localized
lesions. Surgical procedures such as
vertebroplasty, may be done to support
degenerative vertebrae.