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Protecting Your Body: Bone, Kidney, and Infection Care

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Myeloma patients must actively manage side effects by protecting kidneys (avoiding NSAIDs, hydrating), maintaining bone health (Zometa/Xgeva after dental clearance), and preventing infections (shingles prophylaxis, vaccines). Reporting neuropathy early is crucial to prevent permanent damage.

Key Takeaways

  • • Myeloma patients must strictly avoid NSAIDs like Ibuprofen to prevent kidney failure.
  • • Dental clearance is mandatory before starting bone-strengthening drugs like Zometa to prevent jaw necrosis.
  • • Patients on specific myeloma therapies require antiviral medication to prevent shingles.
  • • Early reporting of neuropathy symptoms allows for dose adjustments that can prevent permanent nerve damage.

Managing myeloma means managing the side effects and complications.

1. Bone Health

Myeloma weakens bones.

  • Meds: Zometa or Xgeva strengthen bones [1].
  • DENTAL ALERT: These drugs can cause Osteonecrosis of the Jaw (ONJ). You MUST have a dental exam and finish major dental work before starting these drugs [2].
  • Kyphoplasty: A procedure to cement and stabilize spinal fractures [3].

2. Kidney Protection

  • Hydrate: Drink 2-3 liters of water daily [4].
  • NO NSAIDs: Avoid Ibuprofen (Advil) and Naproxen (Aleve). They can cause kidney failure in myeloma patients [5]. Use Tylenol instead.

3. Infection Prevention

Treatments weaken your immune system.

  • Shingles: If taking Velcade, Kyprolis, or Darzalex, you MUST take an antiviral (Acyclovir/Valacyclovir) to prevent shingles [6].
  • Vaccines: Get your Flu, COVID, and Pneumonia shots. Avoid live vaccines [7].

4. Neuropathy

Velcade can cause nerve damage (tingling/pain).

  • Speak Up: If you feel tingling, tell your doctor. Lowering the dose can stop permanent damage [8].

Frequently Asked Questions

Can I take Ibuprofen or Aleve if I have myeloma?
Myeloma patients should generally avoid NSAIDs like Ibuprofen (Advil) and Naproxen (Aleve) because they can cause kidney failure. Acetaminophen (Tylenol) is typically recommended as a safer alternative for pain relief.
Why do I need a dental exam before starting bone medication?
Bone-strengthening drugs like Zometa and Xgeva can cause a serious side effect called Osteonecrosis of the Jaw (ONJ). Completing major dental work before starting treatment significantly reduces this risk.
Do I need to take medication to prevent shingles?
If you are taking Velcade, Kyprolis, or Darzalex, your immune system is weakened, increasing the risk of shingles. Taking an antiviral medication like Acyclovir or Valacyclovir prevents this reactivation.
What should I do if I feel tingling or neuropathy?
Report any tingling, numbness, or pain to your doctor immediately. Adjusting the dose of medications like Velcade can often stop the nerve damage from becoming permanent.
Which vaccines are safe for myeloma patients?
Patients are generally advised to get Flu, COVID, and Pneumonia shots to protect against infection. However, you should avoid "live" vaccines because your immune system may be compromised.

Questions for Your Doctor

  • • Have I received dental clearance to start Zometa?
  • • Should I take Acyclovir to prevent shingles?
  • • What pain relievers are safe for my kidneys?
  • • Am I up to date on vaccines (Flu, Pneumonia, Shingles)?

Questions for You

  • • Have I stopped taking NSAIDs?
  • • Am I drinking 2-3 liters of water a day?
  • • Am I reporting any tingling (neuropathy) immediately?

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References

  1. 1

    Multiple Myeloma: Diagnosis and Treatment.

    Michels TC, Petersen KE

    American family physician 2017; (95(6)):373-383.

    PMID: 28318212
  2. 2

    Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy.

    Laimer J, Hechenberger M, Müller D, et al.

    Future oncology (London, England) 2021; (17(21)):2705-2711 doi:10.2217/fon-2020-1240.

    PMID: 33880956
  3. 3

    The role of Vertebral Augmentation Procedures in the management of vertebral compression fractures secondary to multiple myeloma.

    Eseonu KC, Panchmatia JR, Streetly MJ, et al.

    Hematological oncology 2023; (41(3)):323-334 doi:10.1002/hon.3102.

    PMID: 36440820
  4. 4

    [Diagnosis and treatment of kidney involvement in plasma cell diseases : Renal involvement in multiple myeloma and monoclonal gammopathies].

    Gödecke V, Schmidt JJ, Bräsen JH, et al.

    Der Internist 2019; (60(1)):10-22 doi:10.1007/s00108-018-0538-7.

    PMID: 30635666
  5. 5

    Clinical profile of kidney involvement preceding diagnosis of multiple myeloma; a single center experience.

    Balwani MR, Gumber MR, Shah PR, et al.

    Journal of nephropharmacology 2016; (5(2)):98-101.

    PMID: 28197511
  6. 6

    Efficacy of Intermittent, Oral Famciclovir Prophylaxis for Bortezomib-Induced Herpes Zoster in Multiple Myeloma Patients.

    Zheng G, Guan F, Han X, et al.

    Frontiers in oncology 2022; (12()):843032 doi:10.3389/fonc.2022.843032.

    PMID: 35372089
  7. 7

    Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group.

    Raje NS, Anaissie E, Kumar SK, et al.

    The Lancet. Haematology 2022; (9(2)):e143-e161 doi:10.1016/S2352-3026(21)00283-0.

    PMID: 35114152
  8. 8

    High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation: A report of the Polish Myeloma Study Group.

    Hus I, Mańko J, Jawniak D, et al.

    Oncology letters 2019; (18(6)):5811-5820 doi:10.3892/ol.2019.10929.

    PMID: 31788054

This guide explains supportive care strategies for myeloma patients. It is for educational purposes and does not replace the specific treatment advice or medication protocols provided by your oncologist.

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