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How I use Bone Support
Abstracts Adverse events (AEs) of myeloma therapy are frequent, reduce the patient’s QoL and increase the risk for mortality. Present guidelines recommend preventive measures such as vaccination against influenza, heamophilus influenza and pneumococci, prophylactic antiviral prophylaxis in patients treated with proteasome inhibitors, high dose dexamethasone and ASCT. Antithrombotic prophylaxis is mandatory for patients with active disease treated with IMiDs particular in combination with dexamethasone. Prophylaxis of febrile neutropenia with G-CSF should be considered in patients with reduced bone marrow reserve on treatment with myelotoxic drugs. Patients on myeloma therapy should immediately consult their treating physician in case of sudden weakness, fever or other unusual discomfort. Instant start of antibiotic therapy is recommended in patients with insufficiently controlled myeloma and suspected bacterial infection. Viral infections should be considered in case of respiratory tract symptoms or unclear abdominal pain. Treatment of thromboembolic complications depends on their manifestation and severity and ranges from start of or adapting existing antithrombotic treatment to very rare cases with need for interventional embolectomy. Patients with preexisting arrhythmia are at risk for symptom worsening when treated with thalidomide or high dose dexamethasone and should be carefully monitored and implantation of a pacemaker may be required in some. Diarrhea can become a burdensome symptom during treatment with bortezomib or lenalidomide. Conventional treatment consists of loperamide. Recently, bile salt malabsorption was identified as possible cause of severe lenalidomide-associated diarrhea. Patients with this syndrome usually respond very well to cholevesalam, a lipid reducing drug which binds and neutralizes bile acids. In patients on bortezomib treatment, the risk for neuropathy (PNP) should be reduced by using sc. and when appropriate weekly administration. In case of PNP, timely dose reductions or treatment discontinuations should be implemented, because treatment of bortezomib induced neuropathy is unsatisfying. In patients on thalidomide treatment emphasis should be laid on early detection of PNP and on dose reduction or treatment discontinuation as required. In summary, adequate prevention and treatment of AEs improves Qol and reduces mortality and is an essential element in the management of patients with MM.
than 50% of patients present with, at least, one new SRE during subsequent relapses, leading to deterioration of quality of life (QoL). Imaging in relapsed/refractory myeloma: The IMWG has suggested that at relapse a skeletal survey using conventional radiography (WBXR) may be indicated to detect possible lesions at risk for fracture, while other imaging studies (CT, MRI, and PET-CT) that can detect soft tissue masses arising from bone lesions, or extramedullary disease may be indicated according to clinical circumstances. Whole body low-dose CT (WBLDCT) can detect more new osteolytic lesions compared to WBXR and the EMN has recently suggested that WBLDCT should substitute WBXR in centers with availability of both techniques. However, the value of WBLDCT has not been demonstrated in the RRMM. MRI and PET-CT can accurately detect new lesions, new extramedullary disease sites and bone plasmacytomas but their use in the RR setting has not been widely accepted outside of clinical indications. Current Treatment of Bone Disease in Relapsed/Refractory Myeloma: All RRMM patients with normal renal function should be treated with IV zoledronic acid or pamidronate, in addition to specific anti-myeloma therapy. Zoledronic acid should be given continuously in patients with active MM. In cases of osteonecrosis of the jaw (ONJ), bisphosphonates should be discontinued and can be re-administered, if ONJ has healed at the physician’s discretion. Low-dose radiation therapy (up to 30 Gy) can be used as palliative treatment for uncontrolled pain, for impending pathologic fracture or spinal cord compression (SCC). Upfront external beam radiation therapy should be considered for patients with plasmacytoma, extramedullary masses and SCC. Orthopedic consultation should be sought for impending or actual long-bone fractures, bony SCC, or vertebral column instability. Balloon kyphoplasty should be considered for symptomatic vertebral compression fractures (VCFs) and is the procedure of choice to improve QoL in patients with painful VCFs.
PS-038 How I use Supportive Care and Palliation F. Gay
Myeloma Unit, Division of Hematology, AOU Città della Salute e della Scienza, Torino, Italy
PS-037 How I use Bone Support
E. Terpos, E. Kastritis, M.A. Dimopoulos Department of Clinical Therapeutics, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
Bone disease in relapsed/refractory myeloma: Bone disease characterized by the presence of multiple osteolytic lesions and/or fractures is a common problem in patients with relapsed/refractory multiple myeloma (RRMM). In a series of our group with 176 patients at first relapse, 22% of patients presented with a new skeletal-related event (SRE), including a novel fracture (mainly in the vertebrae) and the need for radiation therapy. In total, more
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15th International Myeloma Workshop, September 23-26, 2015
New treatment options have significantly prolonged survival of myeloma patients, but the disease remains incurable. The majority of patients live with the burden of the disease and the treatment-related toxicities. Today, the traditional dichotomy cure vs comfort strategies to deal with cancer has been replaced by the cure AND comfort model, in which supportive care plays an essential role from diagnosis to end of life, when it becomes the most efficacious tool to improve patient quality of life. Palliative care is an approach that improves the quality of life of patients and their families facing the problems of life threatening illnesses, through the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care does not intend to hasten nor postpone death, but it helps patients to live as active as possible until death, and their families to cope with the illness and the
than 50% of patients present with, at least, one new SRE during subsequent relapses, leading to deterioration of quality of life (QoL). Imaging in relapsed/refractory myeloma: The IMWG has suggested that at relapse a skeletal survey using conventional radiography (WBXR) may be indicated to detect possible lesions at risk for fracture, while other imaging studies (CT, MRI, and PET-CT) that can detect soft tissue masses arising from bone lesions, or extramedullary disease may be indicated according to clinical circumstances. Whole body low-dose CT (WBLDCT) can detect more new osteolytic lesions compared to WBXR and the EMN has recently suggested that WBLDCT should substitute WBXR in centers with availability of both techniques. However, the value of WBLDCT has not been demonstrated in the RRMM. MRI and PET-CT can accurately detect new lesions, new extramedullary disease sites and bone plasmacytomas but their use in the RR setting has not been widely accepted outside of clinical indications. Current Treatment of Bone Disease in Relapsed/Refractory Myeloma: All RRMM patients with normal renal function should be treated with IV zoledronic acid or pamidronate, in addition to specific anti-myeloma therapy. Zoledronic acid should be given continuously in patients with active MM. In cases of osteonecrosis of the jaw (ONJ), bisphosphonates should be discontinued and can be re-administered, if ONJ has healed at the physician’s discretion. Low-dose radiation therapy (up to 30 Gy) can be used as palliative treatment for uncontrolled pain, for impending pathologic fracture or spinal cord compression (SCC). Upfront external beam radiation therapy should be considered for patients with plasmacytoma, extramedullary masses and SCC. Orthopedic consultation should be sought for impending or actual long-bone fractures, bony SCC, or vertebral column instability. Balloon kyphoplasty should be considered for symptomatic vertebral compression fractures (VCFs) and is the procedure of choice to improve QoL in patients with painful VCFs.
PS-038 How I use Supportive Care and Palliation F. Gay
Myeloma Unit, Division of Hematology, AOU Città della Salute e della Scienza, Torino, Italy
PS-037 How I use Bone Support
E. Terpos, E. Kastritis, M.A. Dimopoulos Department of Clinical Therapeutics, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
Bone disease in relapsed/refractory myeloma: Bone disease characterized by the presence of multiple osteolytic lesions and/or fractures is a common problem in patients with relapsed/refractory multiple myeloma (RRMM). In a series of our group with 176 patients at first relapse, 22% of patients presented with a new skeletal-related event (SRE), including a novel fracture (mainly in the vertebrae) and the need for radiation therapy. In total, more
e18
-
15th International Myeloma Workshop, September 23-26, 2015
New treatment options have significantly prolonged survival of myeloma patients, but the disease remains incurable. The majority of patients live with the burden of the disease and the treatment-related toxicities. Today, the traditional dichotomy cure vs comfort strategies to deal with cancer has been replaced by the cure AND comfort model, in which supportive care plays an essential role from diagnosis to end of life, when it becomes the most efficacious tool to improve patient quality of life. Palliative care is an approach that improves the quality of life of patients and their families facing the problems of life threatening illnesses, through the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care does not intend to hasten nor postpone death, but it helps patients to live as active as possible until death, and their families to cope with the illness and the