0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:17
1036 Myeloma and Gammopathies■Cyclophosphamide-VAD (hyperCVAD), etoposide/dexamethasone/
ara-C/cisplatin (EDAP), high dose cyclophosphamide: responses but
myelosuppressive
■Dexamethasone, thalidomide, Bortezomib as single agents or in
combination: responses without significant myelosuppression
■Autologous stem cell tranplant: can prolong survival, but no cures
■Allogeneic transplant: responses from graft-versus myeloma effect,
but high related morbidity and mortalitySupportive Care
■Bone disease
➣Bisphosphonates in all patients with documented bone disease
including osteopenia
➣Bisphosphonates in smoldering or stage I disease in clinical trial
➣Bone survey yearly; bone densitometry or metabolic studies
reserved for clinical trial
■Radiation therapy
➣Low dose (20–30Gy) radiation therapy for palliation of uncon-
trolled pain, for impending pathologic fracture, or impending
cord compression
➣Consider impact on stem cell harvest
➣Orthopedic consultation for long bone fractures, bony compres-
sion of spinal cord or vertebral column instability
■Hypercalcemia
➣Hydration and steroids supplemented with furosemide, bispho-
sphonates, and/or calcitonin
■Hyperviscosity
➣Plasmapheresis as adjunctive therapy for symptomatic hypervis-
cosity
■Anemia
➣Consider erythropoietin for anemic patients
■Infection
➣Prophylactic antibiotics as adjunct to specific myeloma therapy,
i.e. dexamethasone
➣Intravenous immunoglobulin therapy only in the setting of recur-
rent life-threatening infection
■Renal dysfunction
➣Vigorous hydration
➣Avoid non-steroidal anti-inflammatory drugs and intravenous
contrast
➣Plasmapheresis and combination chemotherapy