Multipl Myelom Hastalarında Güncel Tedavi Önerileri ve Semptom Yönetimi

Öz

Hematolojik malignensiler arasında yer alan Multipl Myelom, uygulanan tedaviler sonucunda sağkalımı, yaşam kalitesini, fiziksel, sosyal ve psikolojik durumu olumsuz yönde etkileyen önemli bir sağlık sorunudur. Multipl Myelom hastalarının tedavisinde kemoterapi, immünomodülatör ajanlar ve kök hücre nakli gibi tedavi seçenekleri kombinasyonlar halinde bulunmaktadır. Kök hücre nakli için uygun bulunan hastalarda ilk tedavi seçeneği olarak Lenalidomid, nâkile uygun bulunmayan hastalarda immünomodülatör ajan ve steroid tedavisi kullanılması önerilmektedir. Multipl Myelomda hiperkalsemi, böbrek yetmezliği, anemi ve kemik lezyonları en sık görülen semptomlar arasında yer almaktadır. Hastanın semptom yönetiminde; kan kalsiyum düzeyi izlemi, hiperkalsemi tedavisi, böbrek fonksiyonlarının izlemi, yeterli hidrasyonun sağlanması, ilaçların böbrek dozuna göre uygulanması, anemi izlemi ve tedavisi, beslenmenin desteklenmesi ve hastaların travma oluşturabilecek fiziksel aktivitelerden kaçınması önerilmektedir. Sağlık profesyonellerinin Multiple Myelomda hastalık ve tedavi ilişkili kanıta dayalı güncel tedavi önerilerini takip etmesi, semptomların önlenmesi, hastaların tedavi uyumlarının, yaşam kalitelerinin ve sağkalımlarının artırılması açısından çok önemlidir. Bu derleme Multipl Myeloma hastalarında güncel tedavi önerileri, semptom yönetimi ve hemşirelik girişimlerinin değerlendirilmesi amacıyla yapılmıştır.

Anahtar Kelimeler

• Multipl Myelom
• güncel tedaviler
• semptom yönetimi
• hemşirelik

Current Treatment Recommendations and Symptom Management in Patients with Multiple Myeloma

Öz

Kaynakça

1. 1. Acquah, M.E., Hsing, A.W., McGuire, V., et al. (2019). Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases. Ghana Medical Journal, 53, 52-58.
2. 2. American Cancer Society. (2016). Cancer facts & figures. American Cancer Society.
3. 3. Bertolotti, P., Pierre, A., Rome, S., et al.(2017). Evidence-Based Guidelines for Preventing and Managing Side Effects of Multiple Myeloma. Seminars in Oncology Nursing, 33, 332-347.
4. 4. Bird, S.A., Boyd, K. (2019). Multiple myeloma: an overview of management. Palliatiave Care Society Practice, 13, 1178224219868235.
5. 5. Brigle, K., Pierre, A., Finley-Oliver, E., et al. (2017). Myelosuppression, Bone Disease, and Acute Renal Failure: Evidence-Based Recommendations for Oncologic Emergencies. Clinical Journal Oncology Nursing, 21, 60-76.
6. 6. Brigle,, K., Rogers, B. (2017). Pathobiology and Diagnosis of Multiple Myeloma. Seminars in Oncology Nursing, 33, 225-236.
7. 7. Buege, M.J., Do, B., Lee, H.C., et al. (2019). Corrected calcium versus ionized calcium measurements for identifying hypercalcemia in patients with multiple myeloma. Cancer Treatment and Research Communications, 21, 100159.
8. 8. Chavda, D.S., Yong, P.K. (2017). Multiple myeloma. British Journal of Hospital Medicine, 78, C21-C27.

9. 9. Colson, K. (2015). Treatment-related symptom management in patients with multiple myeloma: a review. Support Care Cancer, 23, 1431-45.
10. 10. Dimopoulos, M., Siegel, D., White, D.J., et al. (2019). Carfilzomib vs bortezomib in patients with multiple myeloma and renal failure: a subgroup analysis of ENDEAVOR. Blood, 133,147-155.14.
11. 11. Gascón, P., Arranz, R., Bargay, J., et al. (2018). Fatigue- and health-related quality-of-life in anemic patients with lymphoma or multiple myeloma. Support Care Cancer, 26, 1253-1264.
12. 12. Gleason, C. (2013). Nursing Considerations for Combination Therapy in Multiple Myeloma. www.TheOncologyNurse.com, 6(7).
13. 13. GLOBACAN. (2018). Cancer Today. Volume 2020, Erişim adresi: https://gco.iarc.fr/today/online-analysis-table?v=2018&mode=cancer&mode_population=continents&population=900&populations=900&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=1&include_nmsc_other=1 Erişim tarihi: 01.09.2020.
14. 14. Heher, E.C., Rennke, H.G., Laubach, J.P., et al. (2013). Kidney disease and multiple myeloma. Clinical journal of the American Society of Nephrology : CJASN, 8, 2007-2017.
15. 15. Ho, P.J., Moore, E.M., McQuilten, Z.K., et al. (2019). Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry. Clinical Lymphoma Myeloma Leukemia, 19, e415-e424.
16. 16. Kanellias, N., Gavriatopoulou, M., Terpos, E., et al. (2018). Management of multiple myeloma bone disease: impact of treatment on renal function. Expert Review Hematology, 11, 881-888.
17. 17. Karataş, T., Kutlutürkan, S. (2017). Nursing in care of patients with multiple myeloma- Literature Search. Journal of Contemporary Medicine, 7, 91-91.
18. 18. Kehrer, M., Koob, S., Strauss, A., et al. (2017). [Multiple Myeloma - Current Status in Diagnostic Testing and Therapy]. Z Orthop Unfall, 155, 575-586.
19. 19. Keilani, M., Kainberger, F., Pataraia, A., et al. (2019). Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma. Wien Klin Wochenschr, 131, 567-575.
20. 20. Kidney, D., Improving, GOKC-M., Work, G. (2017). KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney international supplements, 7:1.
21. 21. Landgren, O., Rajkumar, S.V. (2016). New Developments in Diagnosis, Prognosis, and Assessment of Response in Multiple Myeloma. Clinical Cancer Research, 22, 5428-5433.
22. 22. Liu, L., Hao, M., Deng, S., et al. (2019). The bone marrow microenvironment of multiple myeloma promotes myeloma related anemia by suppressing the differentiation of hematopoietic stem cells. Clinical Lymphoma Myeloma and Leukemia, 19, e92-e93.
23. 23. Liu, Y., Perez-Riera, A.R., Barbosa-Barros, R., et al. (2018). Severe hypercalcemia from multiple myeloma as an acquired cause of short QT. Journal Electrocardiology, 51, 939-940.
24. 24. Marsala, A. (2014). Nursing Strategies for Improved Outcomes in Multiple Myeloma. Personalized Medicine in Oncology, 3(1), 27-28.
25. 25. Miceli, T.S., Colson, K., Faiman, B.M., et al. (2011).nMaintaining bone health in patients with multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clinical Journal Oncology Nursing, 15 Suppl, 9-23.
26. 26. Mhaskar, R., Djulbegovic, B. (2016). Iron Supplementation for Chemotherapy-Induced Anemia in Patients Receiving Erythropoiesis-Stimulating Agents. JAMA Oncology, 2, 1499-1500.
27. 27. Mikhael, J., Ismaila, N., Cheung, M.C., et al. (2019). Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline. Journal of Clinical Oncology, 37, 1228-1263.
28. 28. Minisola, S., Pepe, J., Piemonte, S., et al. (2015). The diagnosis and management of hypercalcaemia. British Medical Journal, 350.
29. 29. Moreau, P., San Miguel, J., Sonneveld, P., et al. (2017). Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 28, iv52-iv61.
30. 30. NCCN. (2017). Cancer and Chemotherapy Induced Anemia. Volume 2020.
31. 31. Nnonyelum, O.N., Anazoeze, M.J., Eunice, N.O., et al. (2015). Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study. The Pan African Medical Journal, 22, 292.
32. 32. Okay, E., Özkan, K. (2020). Multiple Miyelomda Kemik Tutulumunun Tanı ve Tedavisi. 33. Pacca, R.L., Silva, J., Souza, K.C.E., et al. (2017). Autoimmune hemolytic anemia and hyperglobulinemia leading to the diagnosis of multiple myeloma. Revista Brasileria Hematology Hemoterapia, 39, 357-359.
33. 34. Rajkumar, S.V. (2020). Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. American Journal Hematology, 95, 548-567.
34. 35. Rajkumar, S.V., Kumar, S. (2016). Multiple Myeloma: Diagnosis and Treatment. Mayo Clinic Proceedings, 91, 101-19.
35. 36. Rome, S., Noonani K., Bertolotti, P., et al. (2017). Bone Health, Pain, and Mobility: Evidence-Based Recommendations for Patients With Multiple Myeloma. Clinical Journal Oncology Nursing, 21, 47-59.
36. 37. Safadi, S., Dispenzieri, A., Amer, H., et al. (2015). Multiple myeloma after kidney transplantation. Clinical Transplantion, 29, 76-84.
37. 38. Siegel, R.L., Miller, K.D., Jemal, A. (2020). Cancer statistics, CA Cancer Journal Clinicians, 70, 7-30.
38. 39. Sonneveld, P. (2017). Management of multiple myeloma in the relapsed/refractory patient. Hematology American Society Hematology Education Program, 508-517.
39. 40. Terpos, E., Kleber, M., Engelhardt, M., et al. (2015). European Myeloma Network guidelines for the management of multiple myeloma-related complications. Haematologica, 100, 1254-66.
40. 41. Türkiye Cumhuriyeti Sağlık Bakanlığı. (2017). Türkiye böbrek hastalıkları önleme ve kontrol programı 2014-2017. Erişim tarihi 01.09.2020.
41. 42. Türk Hematoloji Derneği.(2020). Multipl Myelom Tanı ve Tedavi Kılavuzu, Sürüm 1.03 - Mart 2020.