0
No votes yet
Open Access Article
Article

Myelosuppression Associated With Novel Therapies in Patients With Multiple Myeloma: Consensus Statement of the IMF Nurse Leadership Board

Teresa Miceli
Kathleen Colson
Maria Gavino
Kathy Lilleby
CJON 2008, 12(3), 13-20 DOI: 10.1188/08.CJON.S1.13-19

Novel therapies for multiple myeloma include the immunomodulatory drugs lenalidomide and thalidomide and the proteasome inhibitor bortezomib, which have increased response rates and survival times. However, the agents can cause myelosuppression, which, if not managed effectively, can be life threatening and interfere with optimal therapy and quality of life. The International Myeloma Foundation's Nurse Leadership Board developed a consensus statement that includes toxicity grading, strategies for monitoring and managing myelosuppression associated with novel therapies, and educational recommendations for patients and their caregivers. Although anemia, neutropenia, and thrombocytopenia are expected side effects of novel therapies for multiple myeloma, they are manageable with appropriate interventions and education.

References 

Cleeland, C. S., & Wang, X. S. (1999). Measuring and understanding fatigue. <i>Oncology</i>, 13(11A), 91-97.

Fortner, B. V., Houts, A. C., & Schwartzberg, L. S. (2006). A prospective investigation of chemotherapy-induced neutropenia and quality of life. <i>Journal of Supportive Oncology</i>, 4(9), 472-478.

Fortner, B. V., Tauer, K., Zhu, L., Ma, L., & Schwartzberg, L. S. (2004). The impact of medical visits for chemotherapy-induced anemia and neutropenia on the patient and caregiver: A national survey. <i>Community Oncology</i>, 1(4), 211-217.

Foubert, J. (2006). Cancer-related anaemia and fatigue: Assessment and treatment. <i>Nursing Standard</i>, 20(36), 50-57.

Bertolotti, P., Bilotti, E., Colson, K., Curran, K., Doss, D., Faiman, B., et al. (2008). Management of side effects of novel therapies for multiple myeloma: Consensus statements developed by the International Myeloma Foundation's Nurse Leadership Board. <i>Clinical Journal of Oncology Nursing</i>, 12(3, Suppl.), 9-12.

Boyer, C. G. (2000). Chemotherapy-related anemia and fatigue in home care patients: A home care nurse's guide to recognition, assessment, and intervention. <i>Home Healthcare Nurse</i>, 18(4, Suppl.), 3-15.

Burney, K. Y. (2000). Tips for timely management of febrile neutropenia. <i>Oncology Nursing Forum</i>, 27(4), 617-618.

Cable, R., Carlson, B., Chambers, L., Kolins, J., Murphy, S., Tilzer, L., et al. (2002). <i>Practice guidelines for blood transfusion: A compilation from recent peer-reviewed literature.</i> Retrieved September 10, 2007, from <a target="_blank" href='http://www.redcross.org/services/biomed/profess/pgbtscreen.pdf'>http://w...

Celgene Corporation. (2007a). Revlimid® (lenalidomide) [Package insert]. Summit, NJ: Author.

Celgene Corporation. (2007b). Thalomid® (thalidomide) [Package insert]. Summit, NJ: Author.

Centers for Disease Control and Prevention. (1996). Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). <i>Morbidity and Mortality Weekly Report</i>, 45(RR11), 1-25.

Fukuyama, S. N., & Itano, J. (1999). Thrombocytopenia secondary to myelosuppression. <i>American Journal of Nursing, April</i>(Suppl.), 5-12.

Ghobrial, J., Ghobrial, I. M., Mitsiades, C., Leleu, X., Hatjiharissi, E., Moreau, A. S., et al. (2007). Novel therapeutic avenues in myeloma: Changing the treatment paradigm. <i>Oncology</i>, 21(7), 785-792.

Held-Warmkessel, J. (1998). Chemotherapy complications. <i>Nursing</i>, 28(4), 41-46.

Held-Warmkessel, J. (2000). Assessment of febrile neutropenic patients. <i>Clinical Journal of Oncology Nursing</i>, 4(4), 182-184.

Khorana, A. A., Francis, C. W., Culakova, E., Fisher, R. I., Kuderer, N. M., & Lyman, G. H. (2006). Thromboembolism in hospitalized neutropenic cancer patients. <i>Journal of Clinical Oncology</i>, 24(3), 484-490.

Kyle, R. A., Gertz, M. A., Witzig, T. E., Lust, J. A., Lacy, M. Q., Dispenzieri, A., et al. (2003). Review of 1027 patients with newly diagnosed multiple myeloma. <i>Mayo Clinic Proceedings</i>, 78(1), 21-33.

Lonial, S., Richardson, P. G., San Miguel, J., Sonneveld, P., Schuster, M., Blade, J., et al. (2007). Hematologic profiles with bortezomib in relapsed MM [Abstract PO-622]. <i>Haematologica</i>, 92(Suppl. 2), 159-160. Retrieved April 10, 2008, from http://www.haematologica.it/content/vol92/6_supplement_2/index.dtl <a target="_blank" href='http://www.haematologica.it/content/vol92/6_supplement_2/index.dtl'>http...

Lonial, S., Waller, E. K., Richardson, P. G., Jagannath, S., Orlowski, R. Z., Giver, C. R., et al. (2005). Risk factors and kinetics of thrombocytopenia associated with bortezomib for relapsed, refractory multiple myeloma. <i>Blood</i>, 106, 3777-3784.

Marrs, J. A. (2006). Care of patients with neutropenia. <i>Clinical Journal of Oncology Nursing</i>, 10(2), 164-166.

Millennium Pharmaceuticals, Inc. (2006). Velcade® (bortezomib) [Package insert]. Cambridge, MA: Author.

National Cancer Institute. (2006). <i>Common Terminology Criteria for Adverse Events v.3.0.</i> Retrieved December 28, 2007, from <a target="_blank" href='http://ctep.cancer.gov/forms/CTCAEv3.pdf'>http://ctep.cancer.gov/forms/C...

National Cancer Institute. (2007). Dictionary of cancer terms. Retrieved December 28, 2007, from <a target="_blank" href='http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=44173'>http://www.ca...

Nunez, A. M., & Liebman, M. C. (1999). Febrile neutropenia. <i>American Journal of Nursing</i>, 99(Suppl.), 9-12, 34-36.

Pandit, S. R., & Vesole, D. H. (2003). Management of renal dysfunction in multiple myeloma. <i>Current Treatment Options in Oncology</i>, 4(3), 239-246.

Rajkumar, S. V., Hayman, S. R., Lacy, M. Q., Dispenzieri, A., Geyer, S. M., Kabat, B., et al. (2005). Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. <i>Blood</i>, 106(13), 4050-4053.

Richardson, P. G., & Anderson, K. (2006). Thalidomide and dexamethasone: A new standard of care for initial therapy in multiple myeloma. <i>Journal of Clinical Oncology</i>, 24(3), 334-336.

Richardson, P. G., Hideshima, T., Mitsiades, C., & Anderson, K. C. (2007). The emerging role of novel therapies for the treatment of relapsed myeloma. <i>Journal of the National Comprehensive Cancer Network</i>, 5(2), 149-162.

Rome, S., Doss, D., Miller, K., Westphal, J., & the IMF Nurse Leadership Board. (2008). Thromboembolic events associated with novel therapies in patients with multiple myeloma: Consensus statement of the IMF Nurse Leadership Board. <i>Clinical Journal of Oncology Nursing</i>, 12(3, Suppl.), 21-27.

Smith, T. J., Khatcheressian, J., Lyman, G. H., Ozer, H., Armitage, J. O., Balducci, L., et al. (2006). 2006 update of recommendations for the use of white blood cell growth factors: An evidence-based clinical practice guideline. <i>Journal of Clinical Oncology</i>, 24(19), 3187-3205.

West, F., & Mitchell, S. A. (2004). Evidence-based guidelines for the management of neutropenia following outpatient hematopoietic stem cell transplantation. <i>Clinical Journal of Oncology Nursing</i>, 8(6), 601-613.

Zitella, L., Friese, C., Gobel, B. H., Woolery-Antill, M., O'Leary, C., Houser, J., et al. (2006). Putting Evidence Into Practice®: Prevention of infection. Retrieved September 10, 2007, from <a target="_blank" href='http://www.ons.org/outcomes/volume1/prevention.shtml1'>http://www.ons.or...

American Association of Blood Banks, America's Blood Centers, & American Red Cross. (2006). <i>Circular of information for the use of human blood and blood components.</i> Retrieved September 10, 2007, from <a target="_blank" href='http://www.aabb.org/Documents/About_Blood/Circulars_of_Information/coiwn...

Amgen Inc. (2007a). Aranesp® (darbepoeitin alfa) [Package insert]. Thousand Oaks, CA: Author.

Amgen Inc. (2007b). Epogen® (epoeitin alfa) [Package insert]. Thousand Oaks, CA: Author.

Bertolotti, P., Bilotti, E., Colson, K., Curran, K., Doss, D., Faiman, B., et al. (2007). Nursing guidelines for enhanced patient care. <i>Haematologica</i>, 92(Suppl. 2), 211.

Manochakian, R., Miller, K., & Chanan-Khan, A. A. (2007). Clinical impact of bortezomib in frontline regimens for patients with multiple myeloma. <i>Oncologist</i>, 12(8), 978-990.

Spivak, J. L. (1994). Recombinant human erythropoietin and the anemia of cancer. <i>Blood</i>, 84(4), 997-1004.

Turgeon-Lanes, P., & Randolph, S. (2000). Home care management of febrile neutropenia: Creating a pilot program. <i>Home Health Care Consultant</i>. 7(1), 1A-6A.