Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Fremont and San Leandro Medical Centers

Overview

Multiple myeloma is a cancer that results from the body making an abnormal population of a specific type of white blood cell known as a plasma cell. Normal plasma cells protect the body by making antibodies that kill bacteria and fight infections. In multiple myeloma, normal plasma cells undergo a genetic change and become abnormal. These abnormal cells produce specific proteins that build up and cause damage. 

After we have learned everything we can about your myeloma, we will discuss the treatment options and develop a plan that is right for you. Standard treatment options for multiple myeloma include watchful waiting, chemotherapy, corticosteroids, targeted therapy, radiation therapy, and stem cell transplantation. You may also receive treatment for myeloma-related complications, such as bone damage, kidney problems, and infections.

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Watchful Waiting

A condition known as smoldering myeloma refers to myeloma diagnosed at an early stage, before symptoms develop. This condition does not require immediate treatment. Instead, we closely monitor whether your disease progresses or you develop symptoms, such as bone pain or kidney problems.

This approach, known as watchful waiting, involves regular checkups every 3 to 6 months. Treatment starts when you begin to experience symptoms related to the disease. In some cases, multiple myeloma remains stable for a long time, and treatment may not be needed for years.

It can be difficult to know that you have cancer and not receive treatment. It is important to understand that sometimes watchful waiting is the best approach. Treating the cancer too early does not offer any benefits and would expose you to the unnecessary side effects of therapy.

We encourage you to talk to us about any concerns or fears you may have regarding watchful waiting.

Chemotherapy

You may receive one or more chemotherapy drugs to kill myeloma cells. Chemotherapy can be delivered in a vein, into the skin, or as a pill. Known as systemic chemotherapy, these drugs attack myeloma cells throughout the body. Chemotherapy is given in cycles over a period of months until the cancer stops growing and becomes stable. You may need additional chemotherapy if the cancer starts to grow again.

You may receive chemotherapy drugs in combination with other types of drugs. Chemotherapy is also used at high doses before a stem cell transplant.

Side effects
Chemotherapy can cause a variety of side effects, the severity of which depends on the type and dose of the drug as well as the length of time it is given. You may experience one or more of the following common side effects of chemotherapy:

  • Fatigue
  • Hair loss
  • Nausea and vomiting
  • Loss of appetite
  • Mouth sores
  • Low blood cell counts
  • Fever

Low blood cell counts are a special concern because they can put you at a higher risk of infections. We may give you drugs to boost your blood counts, antibiotics to prevent and treat infections, and transfusions of red blood cells and platelets. We have effective methods for preventing and managing chemotherapy side effects, which typically go away once treatment ends.

Additional References:

Corticosteroids

Steroids are well known for their ability to relieve swelling and inflammation, but steroids (also known as corticosteroids) are also capable of killing cancer cells. Corticosteroids are often given in combination with chemotherapy. An added benefit is that they help reduce the nausea and vomiting caused by chemotherapy.

Side effects
Corticosteroids can cause a variety of side effects, which include:

  • High blood sugar
  • Sleeping problems
  • Increased appetite
  • Swelling

These drugs can also increase the risk of infections if used for a long period of time because they suppress the immune system. Side effects typically go away once you stop taking the drug.

Targeted Therapy

Targeted therapy is a relatively new approach to treating cancer. It involves the use of drugs that target specific parts of the cancer cell.

Targeted drugs used to treat multiple myeloma are often given with chemotherapy and steroid therapy and include:

  • Immune-modulating drugs. These drugs kill myeloma cells using more than one approach. First, they strengthen the immune response to attack the tumor cells. Second, the drugs cut off the cancer’s blood supply, essentially starving the tumor of the nutrients and oxygen it needs to survive and grow.
  • Proteasome inhibitors. Proteasome inhibitors specifically target protein complexes called proteasomes, which can be found in both cancerous and healthy cells. Normally, proteasomes control cell function and growth by “digesting” damaged or unneeded proteins in cells. The proteasome inhibitor used to treat multiple myeloma blocks the proteasome from working and disrupts the process that keeps myeloma cells alive and growing.
Side effects

Because targeted drugs take aim specifically at cancer cells, there is less damage to the healthy cells. But targeted drugs used to treat multiple myeloma are not without side effects. Side effects of immune-modulating drugs include:

  • Fatigue and drowsiness
  • Numbness, tingling, or pain in the hands and feet caused by nerve damage (neuropathy)
  • Constipation
  • Increased risk of blood clots
  • Low blood cell counts
  • Birth defects if taken during pregnancy

For the proteasome inhibitor, side effects include:

  • Fatigue
  • Nausea and vomiting
  • Fever
  • Diarrhea
  • Constipation
  • Numbness, tingling, or pain in the hands and feet caused by nerve damage (neuropathy)
  • Loss of appetite
  • Increased risk of bleeding and bruising caused by low platelet counts

We will watch you closely for these and other side effects. Notify us as soon as you notice symptoms.

Radiation Therapy

Multiple myeloma can damage the bone, resulting in pain. Radiation may be used to relieve bone pain or to reduce swelling around the spine if the spinal bones weaken to the point where they collapse. Radiation therapy is also sometimes used to treat the entire body prior to a stem cell transplant. For patients with a condition known as solitary plasmacytoma, radiation therapy is usually the primary treatment.

Like other types of therapy, radiation therapy comes in a range of therapeutic options that are customized for your situation. The most common type is external-beam radiation therapy, which delivers radiation from a machine outside the body.

External-beam radiation therapy is the use of high-energy beams delivered through a linear accelerator (a large machine). It targets a precise location determined through an individualized CT planning simulation. Radiation therapy occurs daily during weekdays for up to 5 weeks, depending on the diagnosis and stage.

Radiation Therapy Side Effects

Because the radiation beam is often aimed at a specific part of the body, the side effects will depend on what area is treated. Possible side effects of radiation therapy include:

  • Hair loss.
  • Skin changes, such as redness.
  • Fatigue.
  • Nausea, vomiting caused by radiation to the upper abdomen (stomach area).
  • Bowel discomfort and diarrhea caused by radiation to the pelvis.
  • Dry, sore throat and difficulty swallowing caused by radiation to the chest and neck.
  • Dry mouth and lost of taste if the mouth is being treated. 
  • Tooth decay: Care of your teeth is very important during and after radiation therapy to the mouth, since the treatment can affect the integrity of your jaw as well as the saliva that protects your teeth. 

There maybe other side effects, depending on the location of the final radiation therapy fields, which is determined by the stage, extent of disease involvement, and other clinical factors such as swelling.

These side effects are short term and usually go away after treatment ends. Until then, we can help manage the side effects of radiation therapy so that they do not interfere with your quality of life. Other side effects, however, are not temporary and may cause problems months, years, or even decades after treatment. These are called late effects of radiation therapy and will be dependent upon the site of the radiation.

Stem Cell Transplantation

With a stem cell transplant, high doses of chemotherapy or, sometimes, whole-body radiation therapy will have first destroyed myeloma cells. The transplant then replaces blood-forming stem cells in the bone marrow, creating a healthy environment for blood cell production.

Stem cells are usually obtained from the circulating blood but may also come from a newborn’s umbilical cord and placenta, which are rich in blood stem cells. Depending on the source of the stem cells, there are 2 main types of transplant:

  • Allogeneic. Blood stem cells come from a related or unrelated donor whose tissue type matches your tissue type. The closer the match, the better the chance your body will accept the donor stem cells and start producing normal blood cells.
  • Autologous. This type of transplant uses your own blood stem cells. Following an initial course of treatment, your stem cells are collected from the blood and frozen for storage. You then receive high-dose treatment, after which we reinfuse the stem cells into your bloodstream.

Autologous transplantation is typically used to treat multiple myeloma. Allogeneic transplantation is rarely used. There are variations to the standard approach for an autologous transplant. In some cases, we give normal doses of chemotherapy after collecting stem cells and wait until your multiple myeloma comes back or gets worse before giving high-dose treatment and returning the collected stem cells. This is called delayed transplantation.

Another option is consecutive autologous transplantation. Called a double autologous transplant, a second transplant is typically done within a few months of the first transplant.

We will talk with you about the risks and benefits of stem cell transplantation and whether the treatment is right for you. In general, younger patients in good physical condition whose heart, lungs, and kidneys work well are good candidates for the procedure.

Side effects

Treating the bone marrow with high-dose chemotherapy or radiation can temporarily leave your body without its natural defenses. It can take several months for the bone marrow to recover. During that time, you are at increased risk of infection and bleeding.

A complication of allogeneic (donor) stem cell transplantation is graft-versus-host disease (GVHD). This happens when the donor stem cells identify your own body’s cells as foreign cells and start attacking tissues of the skin, digestive tract, and liver. Symptoms of GVHD include:

  • Skin rash
  • Yellowing of the skin and eyes
  • Nausea
  • Diarrhea
  • Fatigue and weakness

We will talk with you about what side effects to expect and how we plan to prevent or manage them.

Treating Complications

In addition to therapies that kill myeloma cells, you may need treatment to relieve symptoms caused by multiple myeloma. These treatments include:

  • Bone-strengthening drugs. Multiple myeloma destroys bone, causing it to become thin and weak. Bone-strengthening drugs, such as bisphosphonates, slow the breakdown of bone and increase bone density. This reduces bone pain and the risk of broken bones (fractures). Bone-strengthening drugs also help lower calcium levels because less calcium is released as less bone is destroyed. Although rare, bisphosphonates may cause serious harm to your jawbone if you have a dental procedure, such as removal of a tooth or a root canal. You should take care of any dental problems before starting treatment with a bisphosphonate.
  • Physical activity. Exercise can also keep bones strong, but be careful to avoid injury. Walking is an easy and safe weight-bearing exercise that can improve bone strength.
  • Surgery. Sometimes, myeloma cells weaken the spine to the point where the individual bones that form the spine collapse. Surgery may be needed to treat spinal fractures and relieve pressure on the spinal cord. Vertebroplasty and kyphoplasty are procedures that use bone cement to stabilize the spine.
  • Plasmapheresis. In rare cases, myeloma produces abnormal protein, which causes the blood to thicken, leading to inadequate blood flow. To help restore the flow of blood, a procedure called plasmapheresis is performed. Through this procedure, we are able to remove the abnormal M protein produced by myeloma cells.
  • Fluids. It is common for patients with multiple myeloma to have kidney problems, so it is important to drink 2 to 3 quarts of fluids a day. This helps flush the kidneys and allows them to get rid of waste from the blood. Intravenous fluids may also be needed to treat impaired kidney function and high levels of calcium in the blood.
  • Dialysis. If your kidneys fail, you may be treated with dialysis, a procedure that does the kidney’s job of filtering the blood.
  • Antibiotics and vaccines. Multiple myeloma causes a decrease in the number of healthy white blood cells that fight infection. This can leave you vulnerable to bacteria and germs. It is important to get vaccinated for the flu and pneumonia before starting treatment. If you develop a high fever or other signs of an infection, you may be treated with antibiotics. Sometimes, antibiotics need to be taken daily to prevent infections.
Additional References:

Measuring Response to Treatment

We periodically perform tests to check whether your multiple myeloma is responding to treatment. Knowing how well your cancer responds to therapy helps us determine whether we should continue with your current treatment, change the dose, or try another therapy that may be more effective.

You will likely continue to receive treatment until your cancer is stable and shows no signs of progressing. We call this the plateau phase. In some cases, treatment continues long-term to keep the cancer under control. This is called maintenance therapy.

Clinical trials

We are always looking for new and better ways to treat multiple myeloma. Clinical trials are research studies that test new treatments or procedures that may prove better than standard treatments. We will talk with you about whether a clinical trial may be right for you.

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