Why do myeloma patients have bone disease and what can be done to help heal a patient’s bones?
A majority of patients with multiple myeloma will develop a bone lesion (or a hole) during the course of their disease. The reason that this happens is that the myeloma cells, which take up space in bone marrow, are able to activate other bone cells that chew into the bone to make more space to grow. As bone is eaten away, this can lead to holes causing bone pain and bone fractures. Treating a patient with myeloma therapy helps to destroy the myeloma cells and decrease bone destruction. Also, myeloma doctors will prescribe a bone-strengthening drug—either Zometa (zoledronic acid) or Xgeva (denosumab)—to be given along with the main myeloma treatment. Zometa and Xgeva work to stabilize and strengthen the bone around the hole, but it will not make your hole disappear; that is, once you have a hole in your bone, it will stay there. Certain imaging tests can help doctors determine if a hole in a patient’s bone is a new, active site or whether it is a previously treated site.
Patients should take vitamin D and calcium supplements while they are on a bone-strengthening drug. Taking calcium supplements may seem odd considering that myeloma can cause high calcium levels in the blood (also known as hypercalcemia), but myeloma treatment will help to normalize calcium levels and the supplemented calcium is an ingredient that the bone-strengthening agents need to make proper bone. Over time, myeloma patients’ bones will strengthen, but aches and pains may linger for years. Exercise is also helpful to help make bones stronger and to strengthen the muscles that support the bones.
It is important to keep in mind that even after your bones heal and strengthen, you are still at an increased risk of experiencing a fracture, so be sure to be careful!
To learn more about bone health, please view our Fast Facts in Myeloma sheet Bone Health and Multiple Myeloma: What You Need to Know here.
Should a newly diagnosed patient get a COVID booster shot?
Yes. Myeloma patients are highly encouraged to receive the COVID vaccination and boosters (that is, at minimum the COVID vaccine + two boosters [four shots in total]) recommended by the government. Patients with multiple myeloma have a compromised immune system putting them at higher risk of a complicated course of COVID, if they were exposed, than individuals without myeloma. Discuss with your myeloma doctor the best timing for your vaccine since he or she may recommend holding a treatment dose to get the vaccine or getting the vaccine in between doses of treatment.
For more information about COVID and myeloma, please see our resources page here.
What is the best timing for testing for minimal residual disease (MRD) after an autologous stem cell transplant?
MRD testing is usually conducted at around 100 days (or 3 months) after a transplant. Some patients may not become MRD negative after a transplant, but they may after sometime while taking maintenance therapy. Some doctors may recommend a yearly bone marrow biopsy during maintenance therapy to determine if a patient remains MRD negative over a long period of time (sustained MRD negativity).
To learn more about MRD, please view our High Impact Topic video here.