1 / 7

Myeloma Round Table

Myeloma Round Table . Beth Faiman MSN, APRN-BC, AOCN Nurse Practitioner, Cleveland Clinic Pre-Doctoral Fellow, Case Western Reserve . Hematologic events: Neutropenia and Thrombocytopenia . Neutropenia Functional neutrophils are critical to the immune system

zenda
Download Presentation

Myeloma Round Table

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Myeloma Round Table Beth Faiman MSN, APRN-BC, AOCN Nurse Practitioner, Cleveland Clinic Pre-Doctoral Fellow, Case Western Reserve

  2. Hematologic events: Neutropenia and Thrombocytopenia • Neutropenia • Functional neutrophils are critical to the immune system • Neutropenia can occur from treatment or the disease itself • Educate signs and symptoms of infection • Risk is primarily during times of low WBC or treatment with agents that lower immune function Miceli et al, 2008.

  3. Hematologic events: Neutropenia and Thrombocytopenia • Prophylactic antibiotic usage for neutropenia is controversial • Generally not done except during high-dose therapy (transplant setting) or if planned prolonged neutropenia in high-risk patients • Treatment • Colony-stimulating factors increase WBC • Sargramostim • Filgrastim • Peg-filgrastim • Treat the myeloma itself if disease related Miceli et al, 2008.

  4. Thrombocytopenia • Low blood platelets • May be a result of treatment of disease itself (marrow crowded out by atypical plasma cells • Signs: • Bleeding • Purpura • Petechiae • Diagnosis • Low Platelet count (normal 150-400) • Treatment • Watchful waiting • Treat disease • Platelet transfusion • Hold anti-myeloma therapy if indicated • Bortezomib, lenalidomide, etc. UTI = urinary tract infection; IVIG = intravenous immunoglobulin; PCP = pneumocystis pneumonia. Paradisi et al, 2001; Kollef, 2008; Gooskens et al, 2009; Ferguson et al, 2009; Pneumovax® prescribing information, 2009; Zostavax® prescribing information, 2009.

  5. Hypercalcemia and Bone Loss • Hypercalcemia in 15% of patients • Increased calciumlevels, dehydration can precipitate renal failure • Treat with pamidronate, hydration, treat the disease • Pathobiology: Malignant cells produce osteoclast- activating factors that destroy bone cells • Osteoclast stimulation leads to extensive osteolysis, severe bone pain, and pathologic fractures • Spinal cord compression • Plasmacytoma with significant bone destruction • Most visible aspect of myeloma • 80% of patients develop bone disease Roodman, 2008.

  6. Symptoms Altered LOC, constipation, coma Diagnosis: Confirm by measuring CSC mg/dL (4.0 – serum ALB g/dL) Serum calcium mg/dL + 0.8 Example Calcium = 11.0 mg/dL ALB = 3.0 mg/dL 4.0 - 3.0 = 1.0 Multiply (1.0) by 0.8, and add to the calcium of 11.0 CSC = 11.8 mg/dL Hypercalcemia of Malignancy LOC = level of consciousness; CSC = corrected serum calcium. Payne, 2004.

  7. Renal Dysfunction • Bence-Jones proteinuria: Incidence ~ 70% • Light chain Igs can precipitate and damage renal cells • Free light chains filtered in the nephron’s glomerulus, then absorbed and metabolized by proximal tubular cells • Heavy and light chains can cause renal tubular damage • sFLC assay more reliable than urine • ATN secondary to NSAIDS, dehydration, nephrotoxic agents (CT dyes) • Supportive therapy • Hydration, correct underlying cause with treatment • Avoid IV contrast and nephrotoxic agents (IV dyes, NSAIDS) • Plasmapheresis, dialysis ATN = acute tubular necrosis; NSAIDS = non-steroidal anti-anflammatory drugs. Rajkumar et al, 2001; Dimopoulos et al, 2008; Botchler et al, 2008; Wong et al, 2007.

More Related