Deep vein thrombosis (DVT and Pulmonary embolism (PE) are
the most common types of thromboembolism or thrombosis (blood clots).The risk of developing a blot
clot is increased in any patient with cancer for a number of reasons. Cancer
cells, including myeloma cells, release substances that may promote
thrombosis.MM patients may be less
active, may require hospitalization, often have other chronic illnesses such as
diabetes, coronary artery disease or high blood pressure hypertension), and commonly receive medications to
treat these chronic diseases which can increase the risk of developing a blood
clot.Surgical procedures such as
placement of a central venous catheter may also increase the risk. Some
patients may have a family history which puts them at increased risk of
thromboembolism.Smoking, obesity and a
sedentary lifestyle may also increase the risk of a blood clot.
Prevention of thromboembolism
The best strategy to reduce the risk of thromboembolism is to screen each patient carefully
for individual and disease related risk factors.Patients with any type of cancer, including
MM are considered to have one risk factor as a result of the diagnosis
itself.Treatment for MM with certain
drugs such as thalidomide, lenalidomide or doxorubicin may increase the risk of
thrombosis, particularly when combined with higher doses of dexamethasone (4
days in a row followed by 4 days off).Reducing the dexamethasone dose to once weekly has been shown to
decrease the risk of thrombosis while providing effective MM treatment.Effective treatment of the MM may reduce
the risk of thrombosis.
Notifying your health care provider for any symptoms that
may indicate thromboembolism such as painful swelling in an extremity (DVT) or
rapid onset of chest pain and shortness of breath (PE) will allow immediate
treatment and can reduce the risk of more serious complications.Daily physical activity, avoiding sitting for
long-periods of time, regular review of medications, weight loss and smoking
cessation can also reduce the risk of thrombosis.
Sandra E. Kurtin, RN, MS, AOCN, ANP-C
Hematology/Oncology Nurse Practitioner
Arizona Cancer Center
Clinical Assistant Professor of Nursing
Clinical Assistant Professor of Medicine University of Arizona Tucson, Arizona
Editor's Note: Use of any medications, even "over the counter" non-prescription medications and/or dietary supplements should always be discussed with your health care professional before taking any action.
Monitoring for infection is crucial for people with MM. For many people, their MM diagnosis came after experiencing pneumonia, shingles or some other infection. Myeloma compromises the immune function by disturbing the normal production of infection fighting antibodies. Therapies to treat myeloma also have the potential to compromise a person's ability to fight infection. As a result of compromised immune function, people are at risk of infection that could result in hospitalization or even death.
Awareness -Infections can occur from sources you already have in your body. For example, varicella zoster, or "shingles", is the reactivation of the herpes virus that causes Chicken Pox. Once exposed, the virus remains in our body for a lifetime. At times of immune compromise, it can become active. Infections can also be acquired from other people, food and water sources and environmental contaminants.
Prevention - There are ways to protect against infection. The simplest but most valuable is hand washing. It sounds too easy to be true, but hand washing with soap and water or liquid anti-septic solutions can reduce your exposure risk. At times when you know you are at greater risk due to treatment, avoid large crowds. When on treatment, your health care provider may prescribe preventative antibiotics. It is a common practice for patients receiving bortezomib (Velcade) to take an antiviral medication such as acyclovir to prevent "shingles".
Action - You are your own best advocate. If you develop any symptoms that indicate you have an infection, you should contact your health care provider. Symptoms may include fever, shaking chills, sore throat, diarrhea, sinus drainage or productive cough that is green in color, or shortness of breath. Skin wounds that are red, tender or have drainage may be infected. Shingles becomes active in a nerve track (dermatome) and tends to be a painful, red rash that has pimples, or fluid filled pustules. Often times the start of this rash is mistaken for a spider bite, but instead of getting better, it worsens. The earlier treatment is started, the better chance there is to reduce long term pain issues. Always contact your health care provider if you have any symptoms that may indicate an active infection.
Teresa Miceli, RN BSN OCN
BMT Nurse Coordinator
Mayo Clinic - Rochester
neuropathy is a change in feeling in the hands, fingers, legs, toes, or other
body parts. It can be a symptom of myeloma or related to the use of medications
used to treat myeloma, such as thalidomide (Thalomid) or bortezomib
(Velcade). Taking care of peripheral neuropathy is very important and requires
that you pay careful attention to any symptoms and discuss them fully with your
health care provider. There are two types of peripheral neuropathy which most
often affects myeloma patients - sensory, motor.
of sensory peripheral neuropathy include numbness, tingling, numbness or pain in
the hands or feet, trouble hearing or ringing or buzzing in the ears, or
weakness all over. Symptoms of motor peripheral neuropathy include trouble
fastening buttons, difficulty opening jars or trouble walking.
should always inform your healthcare provider if you experience any of these
symptoms. They may modify your treatment plan if these symptoms occur. Your
healthcare provider may also prescribe pain medications, physical therapy, or
suggest other measures such as nutritional supplements such as folic acid,
B-complex, or amino acid supplements. You should always check with your
healthcare provider before taking any new medications or