© 2010 Myeloma UK
Charity No: SC 026116
Myeloma UK,
Broughton House,
31 Dunedin Street,
Edinburgh EH7 4JG
What is meant by front-line treatment?
Front-line treatment is the initial treatment you will be given to reduce your myeloma. Your doctor will discuss your treatment options with you and you should both come to a decision about which treatments you will have. Generally, there are two main treatment options considered for front-line treatment. These are:
Your front-line treatment will depend on your myeloma and any symptoms and complications you may have. Your overall health, fitness and particularly your age will also play a part in the decision about front-line treatment.
What is chemotherapy?
The term chemotherapy is derived from the words 'chemical' and 'therapy' and is the name used to describe a range of treatments aimed at destroying cancer cells. Chemotherapy is also referred to as being cytotoxic, which means that it is toxic or poisonous to cells.
How does chemotherapy work in myeloma?
Chemotherapy interferes with the way that myeloma cells multiply and divide, and, in doing so, aims to stop or slow down their growth.
Cells that are in the process of rapidly dividing, such as myeloma cells, are more sensitive to the damaging effects of chemotherapy than normally dividing cells. Those cells damaged by chemotherapy die.
There are different types of chemotherapy treatments, grouped according to how they work. These groups include:
How is chemotherapy given?
Chemotherapy can be given using a variety of methods. Drugs such as cyclophosphamide, melphalan and vincristine are taken orally. This means that you may be able to have your chemotherapy at home. Other chemotherapy is given via intravenous injection, which is done at the hospital.
What are the potential side-effects of chemotherapy?
Each type of chemotherapy drug has its own side-effects and even the same type of drug can produce different side-effects in different patients. It is therefore difficult to predict precisely the side-effects that any one patient might have.
Some of the common potential chemotherapy side-effects include:
How do I know if chemotherapy is working?
You will have regular tests carried out to find out how you are responding to chemotherapy. The tests should include blood and urine sampling. Rarely you may get a bone marrow aspirate at the end of your course of chemotherapy. In addition, you may have X-rays and / or another kind of bone scan.
Signs that your chemotherapy treatment is working include:
What is melphalan?
Melphalan is an alkylating agent used to treat many different kinds of cancer. It works by damaging the DNA of cells that are dividing rapidly in the body. This will include myeloma cells and healthy cells, such as those lining the mouth and stomach.
How does melphalan work?
Melphalan works by directly damaging the DNA within the myeloma cells. This prevents the myeloma cells dividing and reproducing and can cause the myeloma cells to die.
How is it given?
Melphalan can be given orally in tablet form or intravenously. Melphalan can be given in different doses depending on how it is used in treatment. For example, very high doses of melphalan can be given intravenously before stem cell transplantation, but otherwise lower doses are commonly given by tablet. The dose, length of treatment and the number of cycles given will again depend on the patient’s personal situation and preferences.
Melphalan is also commonly given alongside or in combination with other drugs.
What are the potential side-effects of melphalan?
The most common side-effects of melphalan include:
What is cyclophosphamide?
Cyclophosphamide is an alkylating agent used to treat many different kinds of cancer. It works by damaging the DNA of cells that are dividing rapidly in the body. This will include myeloma cells and healthy cells, such as those lining the mouth and stomach.
How does cyclophosphamide work?
Cyclophosphamide works by directly damaging the DNA within the myeloma cells. This prevents the myeloma cells from reproducing and can cause the cells to die.
How is it given?
There are a number of different ways in which cyclophosphamide can be given. It is most commonly given in the form of tablets. It can also be given by an intravenous infusion through a vein.
Treatment is usually given as a course of several cycles over a few months. The dose, length of treatment and the number of cycles given will depend on the patient’s individual situation and preferences.
Cyclophosphamide has been shown to be effective at reducing the number of myeloma cells when given alone, but, in some patients, the response to the drug is improved when it is given in combination with other drugs.
What are the potential side-effects of cyclophosphamide?
Some of the most common cyclophosphamide side-effects include:
What are steroids?
Steroids are hormonal substances naturally produced in the body. There are many different types of steroid; those used in the treatment of myeloma are known as glucocorticoids. Examples include dexamethasone and prednisolone; these steroids can suppress the immune system and prevent inflammation.
How do steroids work?
Steroids are known to be effective at killing myeloma cells. While commonly used in combination with other treatments, steroids can also be used on their own as myeloma treatment e.g. for patients for whom chemotherapy is not recommended.
They can also be useful as an initial treatment for patients who have poor kidney function at diagnosis. Their ability to control myeloma activity without damaging the bone marrow is of great value.
As steroids are anti-inflammatory drugs, they can also help to reduce the pain associated with myeloma bone disease.
How are they given?
Steroids are given either in tablet form or intravenously. Tablets should be taken with food, usually breakfast, or milk to help protect the lining of the stomach from irritation. As the doses used in myeloma are often high, several tablets may have to be taken at once.
What are the potential side-effects of steroids?
Side-effects of steroids vary according to the dose, and each individual patient’s reaction to steroids may be different. It is important to remember that side-effects, if any, are temporary, can often be prevented or managed and should resolve when the steroids are stopped.
Common side-effects include:
Other less common side-effects include fluid retention and blurred vision.
It is best not to stop taking steroids suddenly and without advice from your doctor as withdrawal effects can occur, which may be associated with a drop in blood pressure, fever, weight loss, itchy eyes or skin, nausea or depression.
What is dexamethasone?
Dexamethasone is a steroid. Steroids are hormonal substances naturally produced in the body.
How does dexamethasone work?
Steroids are known to be effective at killing myeloma cells. While commonly used in combination with other treatments, steroids can also be used on their own as myeloma treatment, e.g. for patients for whom chemotherapy is not recommended.
They can also be useful as an initial treatment for patients who have poor kidney function at diagnosis. Their ability to control myeloma activity without damaging the bone marrow is of great value.
As steroids are anti-inflammatory drugs, they can also help to reduce the pain associated with myeloma bone disease.
How is dexamethasone given?
Dexamethasone may be given either orally or intravenously. It is most commonly given orally, as part of a combination of anti-myeloma treatment.
Tablets should be taken with food, usually breakfast, or milk to help protect the lining of the stomach from irritation. As the doses used in myeloma are often high, several tablets may have to be taken at once.
What are the potential side-effects of dexamethasone?
Side-effects of dexamethasone vary according to the dose, with increasing side-effects normally seen with higher doses. Each patient’s reaction to dexamethasone may be different, but side-effects are usually temporary and should resolve when the dexamethasone is stopped.
Common side-effects include:
What is prednisolone?
Prednisolone is a steroid. Steroids are hormonal substances naturally produced in the body.
How does prednisolone work?
Steroids are known to be effective in killing myeloma cells. While commonly used in combination with other treatments, steroids can also be used on their own as myeloma treatment, e.g. for patients for whom chemotherapy is not recommended.
They can also be useful as an initial treatment for patients who have poor kidney function at diagnosis. Their ability to control myeloma activity without damaging the bone marrow is of great value.
As steroids are anti-inflammatory drugs, they can also help to reduce the pain associated with myeloma bone disease.
How is prednisolone given?
Prednisolone may be given either orally or intravenously. It is most commonly given orally when part of a combination of anti-myeloma treatment.
Tablets should be taken with food, usually breakfast, or milk to help protect the lining of the stomach from irritation. As the doses used in myeloma are often high, several tablets may have to be taken at once.
What are the potential side-effects of prednisolone?
Side-effects of prednisolone vary according to the dose, with increasing side-effects normally seen with higher doses. Each patient’s reaction to prednisolone may be different, but side-effects are usually temporary and should resolve when the prednisolone is stopped.
Common side-effects include:
What is Velcade®?
Velcade is from a class of drugs called proteasome inhibitors.
How does it work?
Velcade is a proteasome inhibitor which targets part of the myeloma cell that is responsible for breaking down waste products. This is different to the way in which chemotherapy works. When the proteasome is blocked, the myeloma cannot remove waste products from the cell and this will cause it to die.
How is it given?
Velcade is given via an intravenous injection. It is given twice a week for two weeks with a one week rest period. This is considered one cycle. Response will be assessed after four cycles and the decision is then made whether or not to complete the maximum eight cycles.
What are the potentials side-effects of Velcade?
As with all medications, there is potential for people to experience some side-effects with Velcade.
The most common are:
Velcade can also cause a dip in blood pressure when standing up; this is known as postural hypotension and can cause sensations of dizziness or feeling faint. Any side-effects caused by Velcade should improve once the drug is reduced or stopped.
What is thalidomide?
Thalidomide Celgene™ (thalidomide) is known as an immunomodulatory drug, which means that it modifies the immune system.
How does it work?
Thalidomide is an immunomodulatory drug. This means that it works by modifying your immune system. The main function of the immune system is to fight disease and infection.
Thalidomide has been shown to have many mechanisms of action that may affect myeloma cell survival. However, the exact method by which myeloma cells are killed in an individual patient is not fully understood.
How is it given?
Thalidomide is given in capsule form. Thalidomide is known to cause sleepiness, so it is therefore recommended that it is taken in the evening and hour or so before going to bed.
What are the potential side-effects of thalidomide?
Thalidomide can have an effect on unborn babies. There is a strict risk management programme in place to ensure that this is prevented and everyone taking thalidomide will be asked to ensure that they use reliable contraception.
Other side-effects of thalidomide may include:
What is Revlimid®?
Revlimid® (lenalidomide) is a derivative of thalidomide and is also classified as an immunomodulatory drug.
How does it work?
Revlimid® is an immunomodulatory drug. This means that it works by modifying your immune system. The main function of the immune system is to fight disease and infection.
Revlimid® has been shown to have many mechanisms of action that may affect myeloma cell survival. However, the exact method by which myeloma cells are killed in an individual patient is not fully understood.
How is it given?
Revlimid® is given orally in capsule form and should be taken at the same time each day. It is given for 21 days of a 28 day cycle and is given until myeloma progression.
What are the potential side-effects of Revlimid®?
Revlimid® can have an effect on unborn babies. There is a strict risk management programme in place to ensure that this is prevented and everyone taking Revlimid will be asked to ensure that they use reliable contraception.
Other side-effects of Revlimid® may include:
Revlimid® can also lower blood counts; this will be monitored regularly each time a blood sample is taken.
What are bisphosphonates?
Bisphosphonates are drugs used to treat myeloma bone disease and hypercalcaemia, which can occur as a result of myeloma bone disease. Bisphosphonates can also help prevent or slow down myeloma bone disease.
How does it work?
Myeloma bone disease results from the myeloma cells in the bone marrow affecting the surrounding bone. Usually, the bones undergo a continuous cycle of bone remodelling where old bone is removed (or resorbed) by osteoclast cells and new bone is formed by osteoblast cells.
This process occurs in equilibrium so that the rate of old bone resorption is equal to the rate at which new bone is formed. When myeloma cells are present in the bone marrow, the myeloma cells stimulate the osteoclasts and reduce the number of osteoblasts. This results in a net loss of bone, i.e. more bone is resorbed than is formed.
Bisphosphonates work by inhibiting the activity of the osetoclasts and preventing the new loss of bone.
How are they given?
There are three bisphosphonates used to treat myeloma bone disease and reduce high calcium levels in the UK. Two are given by monthly infusion, Zometa® and Aredia®, and one by daily tablet, Bonefos®. Treatment choice is often down to doctor and patient preference but emerging data suggests that Zometa® not only reduces the extent of bone disease, but also improves survival in newly diagnosed myeloma patients. Therefore, newly diagnosed myeloma patients should be given Zometa®.
What are the potential side-effects of bisphosphonates?
Side-effects vary slightly between types of bisphosphonate but are all generally well tolerated. Any side-effects are usually mild and the most common ones are:
To ensure the safety and effectiveness of bisphosphonate drugs and to help protect the kidney, you need to make sure that you maintain a high fluid intake – drinking at least 3 litres of water per day.
It is important to remember that not everyone taking bisphosphonate drugs will experience these side-effects. However, if you have any of these side-effects you should discuss it with your doctor as they may be able to help limit the effects.
What is Zometa®?
Zometa® (also called zolendronic acid) is a type of drug called a bisphosphonate. Bisphosphonates are used to treat myeloma bone disease and hypercalcaemia, which can occur as a result of myeloma bone disease. Bisphosphonates can also help prevent or slow down myeloma bone disease. Recent research has shown that Zometa® can improve the survival benefit of newly diagnosed myeloma patients. This effect has not been observed for other bisphosphonate drugs.
How does it work?
Myeloma bone disease results from the myeloma cells in the bone marrow affecting the surrounding bone. Usually, the bones undergo a continuous cycle of bone remodelling where old bone is removed (or resorbed) by osteoclast cells and new bone is formed by osteoblast cells.
This process occurs in equilibrium so that the rate of old bone resorption is equal to the rate at which new bone is formed. When myeloma cells are present in the bone marrow, the myeloma cells stimulate osteoclast production and reduce the number of osteoblasts. This results in a net loss of bone, i.e. more bone is resorbed than is formed.
Bisphosphonates, and therefore Zometa®, work by inhibiting the activity of the osetoclasts and preventing the net loss of bone.
How is it given?
Zometa® is given as in intravenous infusion once a month. Intravenous infusion means that the drug is injected straight into a vein, typically in your hand or arm. The procedure will likely last between 15 and 30 minutes.
What are the potential side-effects of Zometa®?
Zometa® and bisphosphonates in general, are usually well-tolerated. Any side-effects are usually mild and the most common ones are:
What is Aredia®?
Aredia® (also called pamidronate) is a type of drug called a bisphosphonate. Bisphosphonates are used to treat myeloma bone disease and hypercalcaemia, which can occur as a result of myeloma bone disease. Bisphosphonates can also help to prevent or slow down myeloma bone disease.
How does it work?
Myeloma bone disease results from the myeloma cells in the bone marrow affecting the surrounding bone. Usually, the bones undergo a continuous cycle of bone remodelling where old bone is removed (or resorbed) by osteoclast cells and new bone is formed by osteoblast cells.
This process occurs in equilibrium so that the rate of old bone resorption is equal to the rate at which new bone is formed. When myeloma cells are present in the bone marrow, the myeloma cells stimulate osteoclast production and reduce the number of osteoblasts. This results in a net loss of bone, i.e. more bone is resorbed than is formed.
Bisphosphonates, and therefore Aredia®, work by inhibiting the activity of the osetoclasts and preventing the net loss of bone.
How is it given?
Aredia® is given as in intravenous infusion once a month. Intravenous infusion means that the drug is injected straight into a vein, typically in your hand or arm. The procedure will likely last between one and a half to two hours.
What are the potential side-effects of Aredia®?
Aredia® and bisphosphonates in general, are usually well-tolerated. Any side-effects are usually mild and the most common ones are:
What is Bonefos®?
Bonefos® (also called sodium clodronate) is a type of drug called a bisphosphonate. Bisphosphonates are used to treat myeloma bone disease and hypercalcaeimia which can occur as a result of myeloma bone disease. Bisphosphonates can also help to prevent or slow down myeloma bone disease.
How does it work?
Myeloma bone disease results from the myeloma cells in the bone morrow affecting the surrounding bone. Usually, the bones undergo a continuous cycle of bone remodelling where old bone is removed (or resorbed) by osteoclast cells and new bone is formed by osteoblast cells.
This process occurs in equilibrium so that the rate of old bone resorption is equal to the rate at which new bone is formed. When myeloma cells are present in the bone marrow, the myeloma cells stimulate osteoclast production and reduce the number of osteoblasts. This results in a net loss of bone, i.e. more bone is resorbed than is formed.
Bisphosphonates, and therefore Bonefos, work by inhibiting the activity of the osetoclasts and preventing the net loss of bone.
How is it given?
Bonefos® is given in tablet from and is taken once or twice a day.
What are the potential side-effects of Bonefos®?
Bonefos® and bisphosphonates in general, are usually well-tolerated. Any side-effects are usually mild and the most common ones are:
What is high-dose therapy and stem cell transplantation?
Initial treatment for the majority of newly diagnosed myeloma patients involves combinations of chemotherapy and chemotherapy-like drugs. These combinations, which are given in relatively low doses, provide an effective way of treating myeloma.
However, a major draw back of chemotherapy is the inability to give high doses safely. This is because high doses are very toxic to the blood-forming stem cells in the bone marrow.
High-dose therapy and autologous stem cell transplantation provides a solution to this problem. It involves giving initial treatment called induction treatment, followed by a high-dose of chemotherapy to kill the myeloma cells, and then giving back the patient’s own (autologous) previously collected healthy stem cells. This effectively ‘rescues’ the patient’s bone marrow, allowing blood cell production to continue.
High-dose therapy and autologous stem cell transplantation following induction treatment therefore has the ability to kill more myeloma cells than would be possible with lower doses of chemotherapy. This increases the likelihood of a longer remission and a better quality of life.
This treatment option is limited to younger and / or fitter patients. There are no rigid age cut-offs but patients over the age of 65 – 70 years old (i.e. older and / or less fit) would not normally be candidates. This is primarily because the possible benefits are almost certainly outweighed by the potential risks to older and / or less fit patients.
What is an autologous stem cell transplant?
An autologous stem cell transplant, using a patient’s own stem cells, is the most common type of transplant used for people with myeloma. This is carried out after the initial (induction) treatment has reduced the level of myeloma as much as possible.
Autologous stem cell transplantation is a standard treatment for myeloma and has been used for many years. It has been subjected to clinical studies and has been shown to improve the duration, depth and overall survival in the majority of cases. The length of remission or response varies greatly between patients. Some patients can remain stable for many years after this type of transplant, whilst others may unfortunately relapse much sooner.
This treatment option is limited to younger and / or fitter patients. There are no rigid age cut-offs, but patients over the age of 65 – 70 years old (i.e. older and / or less fit) would not normally be candidates. This is primarily because the possible benefits are almost certainly outweighed by the potential risks to older and / or less fit patients.
How does it work?
The initial high-dose chemotherapy given kills many more myeloma cells than lower doses of chemotherapy. After the myeloma has been reduced by high-dose chemotherapy, the patient is given back their own previously collected stem cells. This effectively ‘rescues’ the patient’s bone marrow, allowing blood cell production to continue.
What is involved?
The procedure itself involves receiving high-dose chemotherapy through a central or Hickman line™, which has been previously placed in a large vein. The end of the line or catheter exits just below the collar bone and can be used not just for giving the chemotherapy but also for giving other medications such as antibiotics or for the regular blood investigations required.
The high-dose chemotherapy given will hopefully destroy any residual myeloma cells but it also destroys the healthy cells within the bone marrow. Previously collected stem cells are then replaced to allow the bone marrow to recover. This is called engraftment.
What are the potential side-effects of an autologous stem cell transplant?
As with most treatment, there are potential side-effects that can occur. Side-effects such as mild flu-like symptoms and cramps can occur as part of the stem cell collection process. However, side-effects are more likely to occur after the high-dose chemotherapy and when the previously collected stem cells have been returned.
The high-dose chemotherapy may cause the following side-effects:
The stem cell transplant process may cause your white blood cell numbers to fall to very low levels. If this happens you will be at increased risk of picking up an infection. You may be given treatment in order to try to prevent infection from occurring.
What is an allogeneic stem cell transplant?
Allogeneic stem cell transplantation involves high-dose therapy and the use of stem cells from a donor. This is generally an option only for younger patients because the risks involved with allogeneic stem cell transplantation increase with age.
There are two types of allogeneic stem cell transplant (SCT) – a standard (or myeloablative) allogeneic SCT and a non-myeloablative (also known as a mini or reduced intensity) allogeneic SCT.
Standard allogeneic stem cell transplant
The standard allogeneic SCT involves ‘conditioning’ with high-dose chemotherapy and high-dose radiotherapy to reduce the number of myeloma cells and suppress the immune system. This is followed by the donor SCT. As the conditioning is so intense, the upper age limit for this type of transplant is about 50 years of age.
Mini-allogeneic stem cell transplant
A mini-SCT uses less intense chemotherapy conditioning (often with less intense radiotherapy) to reduce the number of myeloma cells, followed by the donor SCT. The mini-SCT is intended to kill some of the myeloma cells and to suppress the immune system just enough to allow the SCT to take place, so that the donor cells can produce a new immune system.
Mini-SCTs have the advantage that high-dose chemotherapy is not used. This reduces the toxicity compared to a standard allogeneic SCT. This makes the mini-SCT more suitable for older patients including some in their 60s.
Although mini-SCTs are uncommon, they are now performed more often than standard allogeneic SCTs. To increase their effectiveness, they are generally preceded by an autologous SCT.
How does it work?
The initial high-dose chemotherapy given kills many more myeloma cells than lower doses of chemotherapy. After the myeloma has been reduced by the autologous SCT and high-dose chemotherapy, the patient is given stem cells that have been collected from a donor, usually a brother or sister.
Donated stem cells are used because those stem cells recognise myeloma cells as foreign and destroy them; this may result in a long period of remission. When the myeloma patient is given donated stem cells after high-dose chemotherapy, this effectively ‘rescues’ the patient’s bone marrow, allowing blood cell production to continue.
What is involved?
The procedure itself normally involved undergoing an autologous SCT. After the autologous SCT you will receive reduced intensity high-dose chemotherapy through a central or Hickman line™ which has been previously placed in a large vein. The end of the line or catheter exits just below the collar bone and can be used not just for giving the chemotherapy but also for giving other medications such as antibiotics or for the regular blood investigations required.
The high-dose chemotherapy given will hopefully destroy any residual myeloma cells but it also destroys the healthy cells within the bone marrow. Donor stem cells are then given to allow the bone marrow to recover. This is called engraftment.
What are the potential side-effects of an allogeneic stem cell transplant?
As with any treatment there are risks involved and there are additional risks associated with allogeneic stem cell transplant that are not associated with autologous stem cell transplant. This is the main reason why the upper age limit on patient suitability for this procedure is generally lower than that for an autologous stem cell transplant.
The high-dose chemotherapy may cause the following side-effects:
When donor stem cells are used there is also the additional risk of a complication called graft versus host disease. This complication is described in more detail below.
Graft versus host disease
Graft versus host disease (GvHD) is a complication that can occur after an allogeneic stem cell transplant. When the donor’s stem cells are given to the host (patient), the donated stem cells may recognise healthy cells of the patient as ‘foreign’ and fight against them. GvHD can range from mild to severe and it can be life-threatening. GvHD occurring early after transplant is known as acute GvHD. GvHD occurring later (generally more than 100 days after transplant) is known as chronic GvHD. Drugs are given to all patients early after transplant to try and reduce the risk of GvHD.
Severe GvHD requires intense suppression of the immune system with drugs such as steroids and cyclosporine, resulting in a high rate of infection.
What is radiotherapy?
Radiotherapy is the use of high-energy radiation (usually X-rays) to kill cancer cells. It works by targeting cells that are dividing rapidly (such as myeloma cells) and damaging them so they cannot survive or divide.
Myeloma cells cannot repair themselves as well as normal cells so more are destroyed. Radiotherapy is very useful in treating myeloma, but, because it also damages the normal bone marrow cells, it is usually only used to treat small areas that are causing particular problems.
How does it work?
Radiotherapy may be used to destroy myeloma cells and to relieve pain in particular areas where there is damage caused by myeloma bone disease. Radiotherapy can often relieve pain more quickly than chemotherapy and may sometimes be the initial treatment given.
Radiotherapy can be used in the following ways:
How is it given?
Radiotherapy is a treatment that requires specialist staff and equipment and is carried out in the radiotherapy department of larger hospitals. This means that it is sometimes necessary to travel to another hospital for treatment. Radiotherapy is usually given as an out-patient, unless already in hospital for other treatment.
Radiotherapy treatment needs to be carefully planned to make sure the targeted area receives the correct dose of radiation while normal body tissues are as unaffected as possible.
Normal X-rays, CT scanning or MRI imaging can be used to define the area to be treated. This area is then marked using a special pen to guide the treatment.
Treatment is given using a large machine positioned exactly over the area of the body to be treated. Receiving radiotherapy is very similar to having an X-ray. The radiation beam is invisible but the machine may move and make a noise.
Radiotherapy treatment is painless, and lasts for only a few minutes, sometimes seconds. It is important to remain still and breathe normally. Often only one or two treatments of radiotherapy (called fractions) are needed to relieve symptoms. Pain normally improves within 2 – 3 weeks.
What are the potential side-effects of radiotherapy?
Side-effects vary from patient to patient and may depend on the area being treated, but are almost always temporary and disappear after treatment is finished. Most people have no problems at all.
Some of the more common potential side-effects may include:
If side-effects develop during or after radiotherapy, it is important to tell your doctor or nurse as most of these problems can be controlled with medication. The radiation does not stay in the body after treatment so a patient does not become radioactive, and it is safe to mix with other people.
What is Percutaneous vertebroplasty?
Percutaneous vertebroplasty is a minimally invasive surgical procedure which may be an option for some myeloma patients who have chronic pain and disability due to collapsed vertebrae.
Percutaneous vertebroplasty may be considered in myeloma patients for whom conventional treatments such as painkillers and / or radiotherapy have failed. It involves the injection of special bone cement into the site of the collapsed vertebrae, giving stability and relieving pain.
How does it work?
Percutaneous vertebroplasty can be used to stabilise fractured vertebra and reduce pain by injecting bone cement into the site of the fractured vertebra.
What is involved?
Percutaneous vertebroplasty is a relatively minor surgical procedure that uses cement to strengthen and stabilise the fracture.
Percutaneous vertebroplasty is performed with the patient lying face down and involves injection of a small amount of acrylic material (bone cement) through a hollow tube (cannula) into the vertebra, in order to restore its strength. The cannula needs only a small keyhole incision in the skin and is inserted into the bone very precisely by X-rays.
Percutaneous vertebroplasty can be performed using a general or local anaesthetic. As it is a minimally invasive surgical procedure it can be carried out as a day bed procedure or involve only one night in hospital. It is possible for percutaneous vertebroplasty to be performed on more than one vertebra at a time.
It is very important that Percutaneous vertebroplasty is performed by specialist spinal doctors, who are fully trained in the procedure and work in a hospital with all the necessary support, in case of any complications during the procedure.
The procedure is generally performed as a day case under local anaesthetic, depending on how many vertebrae are to be treated. It is possible to have more than one vertebroplasty treatment. Up to four vertebrae may be treated at one time.
What are the potential side-effects of Percutaneous vertebroplasty? As with all medical treatments, there are some risks involved with Percutaneous vertebroplasty. There are risks associated with the surgery in general such as the risk of reaction to the anaesthesia or post-operative infection.
The potential risks and side-effects are:
What is Balloon kyphoplasty?
Balloon kyphoplasty is a minimally invasive surgical procedure used to treat patients with vertebral compression fractures and the spinal deformity they can cause.
Collapse of the bones of the spine can lead to a progressive spinal deformity, called kyphosis, where the spine curves forward. Patients with kyphosis have an increased risk of developing more vertebral compression fractures, making their spinal deformity and pain progressively worse.
In some cases, kyphosis can lead to chronic pain, height loss, mobility and breathing problems and a reduced appetite due to bloating and / or bowel obstruction.
Balloon kyphoplasty aims to reduce pain, and improve any complications a patient may have as a result of kyphosis. Some patients may regain some lost height after Balloon kyphoplasty.
How does it work?
Quick-setting bone cement is injected directly into the collapsed vertebrae via an inflated balloon. The purpose of the inflated balloon is to restore the shape of the vertebrae. The cement is injected into the space made by the balloon and hardens. This restores the height and stability to the collapsed vertebra.
What is involved?
Balloon kyphoplasty is a relatively minor surgical procedure that uses cement to expand the vertebra and stabilise the fracture.
A small balloon (known as an inflatable bone tamp) is inserted into the vertebrae and inflated to create a space between the compressed vertebrae. Inflation of the balloon aims to restore or improve the shape and height of the vertebrae and correct the kyphosis.
The balloon is then deflated, removed and a precise amount of quick-setting cement is injected in the space produced by the inflated balloon. The cement hardens and restores the shape and strength of the vertebrae.
Balloon kyphoplasty can be performed using a general or local anaesthetic. As it is a minimally invasive surgical procedure it can be carried out as a day bed procedure or involve only one night in hospital. It is possible for Balloon kyphoplasty to be performed on more than one vertebra at a time.
It is very important that Balloon kyphoplasty is performed by specialist spinal doctors, who are fully trained in the procedure and work in a hospital with all the necessary support, in case of any complications during the procedure.
What are the potential side-effects of Balloon kyphoplasty?
There are a number of risks associated with any medical or surgical treatment. However, side-effects in patients who have had Balloon kyphoplasty are uncommon.
The potential risks and side-effects are:
Safety information about new medical treatments is obtained as part of large clinical studies. As Balloon kyphoplasty is relatively new and few studies have been completed, no-one can be sure about the possible medium to long-term risks.
If you didn't find the answer to your question, use our Ask the Nurse email form to get in touch with one of our Myeloma Information Specialists. We aim to respond within three working days, or call our Myeloma Infoline on 0800 980 3332.
© 2010 Myeloma UK
Charity No: SC 026116
Myeloma UK,
Broughton House,
31 Dunedin Street,
Edinburgh EH7 4JG