8 LATE SEQUELAE IN MULTIPLE MYELOMA
Since multiple myeloma is up to now an incurable disease, with a median survival of only 30-36 months, the issue of treatment late effects is rarely addressed.
Moreover, the disease itself induces a number of complications, which have a great impact on the quality of life. The high incidence of bone complications (bone pains, and pathological fractures) should be underlined. The late effects of intensive therapies with stem cell transplantation have not yet been evaluated.
The only well-studied complication of the therapy of multiple myeloma is the association with acute myeloid leukemia and myelodysplasia. Although there are reports of acute leukemia in patients with myeloma prior to any treatment, this association is considered as a complication of the use of alkylating agents or of radiotherapy (8.I, 8.II). The risk of acute leukemia has been correlated to the duration of melphalan treatment.
As with other secondary acute myeloid leukemias, treatment is difficult and prognosis is very poor.
References
8.I
Cuzick J, Erskine S, Edelman D et al. A comparison of the incidence of the myelodysplastic syndrome and acute myeloid leukemia following melphalan and cyclophosphamide treatment for myelomatosis. Br J Cancer 1987;55:523-9.
8.II
Kyle RA, Robert MD, Pierre RV et al. Multiple myeloma and acute myelomonocytic leukemia. N Engl J Med 1970;283:1121-5.
© European School of Oncology, 1996
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