Module 3: Post-Treatment Maintenance, Relapsed or Refractory Disease, and Other Issues Related to Multiple Myeloma
Section 4: Complications of Treatment for Disease
What are the common complications in heavily treated patients (eg, myelodysplasia), and how can they be managed?
Dr. Robert Kyle: The most serious complication of long-term chemotherapy in patients with multiple myeloma is the development of myelodysplasia or acute leukemia. The first manifestation is the development of thrombocytopenia or neutropenia when it is not apparently related to treatment with an alkylating agent. Patients who develop cytopenias should have a bone marrow examination. Cytogenetic studies must also be performed because the vast majority of patients who have a chemotherapy-induced myelodysplastic syndrome will have typical chromosomal abnormalities that consist of monosomy 5 or monosomy 7.
Unfortunately, if a patient is diagnosed with myelodysplasia, there is no specific therapy. The physician is left to treat the patient symptomatically. If the patient goes on to develop overt acute leukemia, treatment is very unsatisfactory. The response rates are in the range of 25% to 30%, and, for those patients who respond, the duration of the response is unfortunately very short.
For patients who develop myelodysplasia or acute leukemia, one can consider an allogeneic transplant.
Maintenance Therapy | Relapse | Therapies for Relapsed or Refractory Disease | Complications of Treatment for Disease | Diseases Related to Multiple Myeloma