Comprehensive Management of Multiple Myeloma

Managing Multiple Myeloma Effectively

Therapeutic Approaches for Multiple Myeloma

Multiple myeloma is a type of blood cancer originating in the bone marrow, characterized by the rapid proliferation of malignant plasma cells. Treatment strategies aim to control disease progression and alleviate symptoms.

Chemotherapy
The primary treatment involves chemotherapy with alkylating agents like melphalan, cyclophosphamide, or chlorambucil combined with corticosteroids such as prednisone. These medications are typically given in cycles lasting 4 to 7 days, repeated every 4 to 6 weeks over 1 to 2 years. While these agents have similar effectiveness, resistance can develop, limiting their efficacy.

Typical dosages include: melphalan at 8 mg/m² daily, cyclophosphamide at 200 mg/m² daily, chlorambucil at 8 mg/m² daily, and prednisone ranging from 25 to 60 mg/m² daily. Cyclophosphamide is often preferred due to fewer side effects. The effectiveness of chemotherapy is indicated by improvements such as reduced bone pain, hypercalcemia, and anemia, though serum M protein levels may take 4 to 6 weeks to decrease.

Supportive Care
Managing hypercalcemia involves corticosteroids, hydration, and urine sodium elimination. To enhance corticosteroid effects, calcitonin may be added, and allopurinol used to prevent urate nephropathy. Adequate fluid intake facilitates calcium elimination. Patients are also monitored for urinary tract infections, common in this condition, and treated promptly.