Hamilton Regional Multiple Myeloma Support Group
Hamilton, Ontario, Canada


Home Page

Who We Are

Where We Meet

Upcoming Meetings

Past Meetings

Links

Supporting Each Other

 

 

 

 

 

                        MULTIPLE MYELOMA SUPPORT GROUP MEETING

                                                Saturday, November 14, 2009

SPEAKER:    Shannon Hilton

                        Registered Nurse in Hematology for 16 years

                        Juravinski Cancer Center

 

TOPIC:           A Nursing Perspective

 

 

Disease Update

Nursing

Treatment

 

 

DISEASE UPDATE

 

MM = cancer of plasma cells in the bone marrow

            - it is more common in men rather than women, black people rather than      

             white people, and older people rather than younger people.

 

Possible causes:  - radiation

                             -  environmental

                             -  genetic component

                             -  agent orange

 

PAIN

 

-from bone disease (most common presenting symptom)

-anemia & fatigue

- recurrent infection

-renal dysfunction

-hypercalcemia

-bone marrow involvement

-often no symptoms in early stages

 

DIAGNOSTIC TESTS

 

-complete blood counts

-blood chemistry - creatinine calcium

-skeletal survey (not a bone scan)

-MRI

-bone marrow aspirate & biopsy including cytogenetics

-B2 micro globulin

-C reactive protein

-Spep quantitative immunoglobulin

-24 hour urine for protein

-free light chain analysis

-vitamin D levels

-bone density

 

 

CRITERIA FOR POSITIVELY IDENTIFYIN MM

 

-Monoclonal plasma equal to or greater than 10%

-Monoclonal protein in serum/urine

-one or more crab -- C=calcium elevated

                                   R=renal dysfunction

                                   A=anemia

                                   B=bone disease

 

 

 

Normal        MGUS                     Asymptomatic       Active greater           Aggressive

Plasma cell  less than 10% PC   greater than 10%  than 10% + CRAB    PC   in

                                                                                                                  Peripheral Blood

 

 

GOALS OF MM THERAPY

 

Disease Control

Symptom Management

Maximize quality of life

 

RENAL ISSUES

 

-50% or higher have renal dysfunction

-10 - 20% require dialysis

-hydration & treatment usually improve renal function -fluids are pushed if the                patient is not on restriction

-avoid IV contrast & NSAIDs

-be careful with bisphosphonates

 

LOW BLOOD COUNTS

 

-bone marrow that is packed with MM doesn’t have room to make other blood cells

-marrow suppression from treatment will lower counts

-education about energy

RECURRENT INFECTION

 

-may have 15 fold increased risk

-with increased cells, WBC production is decreased

-normal immune role of plasma cell is lost

 

INFECTIONS

 

-good hand washing for visitors

-family should have flu shot

-if the family is sick, no hugging or kissing

-some patients will need antibiotics

-PCP prophylaxis

-if visitor is sick, No Visiting

 

 

HYPERCALCEMIA

 

-caused by increased osteoclast activity which causes breakdown of bone and releases calcium into the blood stream

-high blood calcium causes confusion, constipation, weakness, nausea, and kidney damage

-hydration and bisphosphonates needed

 

 

BONE INVOLVEMENT

 

-areas where fractures and damage can occur

-skull,  spine,  pelvis,  long bones

-spinal cord compression can occur

 

CONSTIPATION                                          DIARRHEA

 

-narcotics, anti nausea meds,              -antibiotics, C Diff & chemo can cause

Chemo and high calcium can cause         diarrhea

Constipation                                                   -lots of fluids as dehydration is bad

-fluids, dietary fibre                                        -brat diet if persistent

-activity                                                           -Bananas Rice Applesauce Toast

-bone meds

-avoid bulk laxatives

 

 

NEUROPATHY

 

-can be caused by MM proteins damaging nerve sheathes

-side effect of many MM treatments

-can affect sensory and motor function

-usually starts at extremities and works in

 

 

MYOPATHY

 

-use of long term steroids affects large muscles first

-important to engage activity and moderate exercise

 

 

HISTORICAL PERSPECTIVE

 

-1962  - oral melphalon and prednisone

-1984  - VAD

-1986  - high dose dexamethasone

-1996  - bisphosphonates

-1999  - high dose therapy autologous with stem cell support

              Thalidomide/Arsenic trioxide

-2000  - Mabs protease inhibitors & other imids

 

-bisphosphonates - inhibit bone destruction

                               - coat surface inhibiting bone resorption

 

 

BORTEZOMIB - VELCADE

 

-approved as a first line therapy (if transplant is not an option)

-approved as a second line therapy

-combination therapy

-maintenance therapy

-can be used when renal dysfunction is present

 

 

PERIPHERAL NEUROPATHY                               NEUROPATHIC PAIN  

 

-tingling                                                                       -severe leg/thigh pain

-numbness                                                                  -shooting leg pain

-burning (hands and feet)                                        -joint and muscle pain

-increased sensitivity to touch                           -muscles sensitive

 

 

NOVEL TREATMENTS FOR MM

 

-Thalidomide - first line

-prior to transplant

-commonly used with dexamethasone

-regimen not approved in Canada but is legally obtained in controlled amounts

-cost is NOT covered

-Revlamid - Lenalidomide

                  - second line treatment

                  - used also as maintenance

                  - used in combination with dexamethasone

**Dexamethasone carries with its use the possibility of an increased chance of developing diabetes.

 

 

Questions were taken and a discussion took place.

 

Lori thanked our speaker, Shannon.

 

                        Next Meeting - Saturday January 9, 2010

 

                                    5th Anniversary Celebration

 

                                                Pot Luck Social