Management of acute spinal cord compression in multiple myeloma

Chen, Bin; Cai, Lin; Zhou, Fuling

doi:10.1016/j.critrevonc.2020.103205

Cited by 16 publications

(21 citation statements)

References 81 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The upper extremities can be involved in thoracic or cervical spine lesions. Magnetic resonance imaging of the entire spine should be performed immediately if spinal cord compression is suspected, computed tomography is an alternative if magnetic resonance imaging is not available [4]. If spinal cord compression is confirmed, treatment needs to begin as soon possible to prevent permanent neurologic sequelae.…”

Section: Are There Emergencies That the Ed Physicians Should Be On Th...mentioning

confidence: 99%

“…Multiple myeloma patients seen in community/rural ED with features concerning for spinal cord compression should be transferred for necessary imaging and emergent treatment. Urgent management of spinal cord compression in multiple myeloma includes high dose intravenous steroids [4] (i.e., dexamethasone 10 mg intravenous every 6 h); however, consultation with radiation oncology and/or neurosurgery is required for further management.…”

Section: Are There Emergencies That the Ed Physicians Should Be On Th...mentioning

confidence: 99%

See 1 more Smart Citation

Just the facts: how to diagnose and manage patients with multiple myeloma in the emergency department?

2022

View full text Add to dashboard Cite

show abstract

Section: Are There Emergencies That the Ed Physicians Should Be On Th...mentioning

confidence: 99%

Section: Are There Emergencies That the Ed Physicians Should Be On Th...mentioning

confidence: 99%

Just the facts: how to diagnose and manage patients with multiple myeloma in the emergency department?

2022

View full text Add to dashboard Cite

show abstract

“…18,19 Kemik iliğinde gelişen anormal monoklonal protein hücreleri, çoklu organ yetersizliğine neden olmakta ve hastaların yaşam kalitesini olumsuz etkilemektedir. 20,21 Hastalarda gelişen acil durumlar; mekanik, metabolik ve hematolojik olarak ortaya çıkmaktadır. 13,[21][22][23][24][25] Multipl miyelom nedeniyle ortaya çıkan acil durumların yıkıcı etkilerinin bilinmesi, erken tanımlanabilmesi ve etkin yönetiminin sağlanması, hastaların yaşam kali-tesinin iyileşmesi ve sağkalım süresinin artması açısından büyük önem taşımaktadır.…”

Section: Multi̇pl Mi̇yelom Hastalarinda Onkoloji̇k Aci̇llerunclassified

“…Multipl miyelomlu hastalarda, vertebral kırıklar ve spinal kord basısı en sık görülen mekanik acil durumlar olup, bu mekanik acil durumların yönetimine ilişkin bilgiler aşağıda verilmiştir. 21,26,27…”

Section: Multi̇pl Mi̇yelomlu Hastalarda Mekani̇k Aci̇llerunclassified

“…Spinal kord basısı, multipl miyelomlu hastaların %7,8'inde görülmekte olup, tıbbi açıdan acil bir durum olarak değerlendirilmelidir. 21,22 Miyelomda, anormal plazma hücrelerinin artışına bağlı olarak oluşan plazmasitoma vertebral foramen ve yumuşak dokunun artması ile omuriliğin ön kısmının sıkışmasına ve sonrasında spinal kord basısına neden olmaktadır. 6 Spinal kord basısı, multipl miyelomlu hastalarda diğer kanser hastalarına göre daha sık ve daha erken ortaya çıkmaktadır.…”

Section: Spi̇nal Kord Basisiunclassified

See 1 more Smart Citation

Evidence-Based Medical Recommendations and Nursing Management for Oncological Emergencies in Patients with Multiple Myelom: Traditional Review

Metin¹,

Uğur²

2022

Turkiye Klinikleri J Nurs Sci

View full text Add to dashboard Cite

ÖZET Kanser, dünya çapında ölüm nedenleri arasında 2. sırada yer alan ve insidansı her geçen gün artan önemli bir sağlık sorunudur. Hematolojik kanserler arasında yer alan ve yaklaşık olarak tüm malignitelerin %10'unu oluşturan multipl miyelom, anormal monoklonal protein sentezi, immunoglobulin ve hafif serbest zincir artışı ile karakterize progresif neoplastik plazma hücrelerinin bir hastalığıdır. Kemik iliğinde gelişen anormal monoklonal protein hücreleri, çoklu organ yetersizliğime neden olmakta ve hastaların yaşam kalitesini olumsuz etkilemektedir. Miyelom tanısı alan ve tedavi gören kişiler metabolik, kardiyojenik, nörolojik olaylar ve enfeksiyon gibi yaşamlarını tehdit eden bazı komplikasyonların gelişmesi yönünden risk altındadır. Onkolojik aciller olarak adlandırılan bu durum, bilinen bir malignitenin ilerlemesinden kaynaklanan veya önceden teşhis edilmemiş bir malignitenin ilk belirtisi olarak ortaya çıkan geniş bir hastalık yelpazesini temsil etmektedir. Multipl miyelom nedeniyle hastalarda gelişen acil durumlar; mekanik, metabolik ve hematolojik olarak ortaya çıkmaktadır. En sık görülen mekanik aciller arasında, %7,8 oranında spinal kord basısı ve %39,2'sinde vertebral kırık yer almaktadır. Metabolik aciller arasında en sık %54 oranında hafif serbest zincir artışına bağlı akut renal yetersizlik, %30 oranında hiperkalsemi ve %18,1'inde tümör lizis sendromu görülmektedir. Hematolojik aciller arasında ise %72 oranında anemi, %39-%50 oranında nötropeni ve %18'inde trombositopeni yer almaktadır. Multipl miyelom nedeniyle ortaya çıkan acil durumların yıkıcı etkilerinin bilinmesi, erken tanımlanabilmesi ve etkin yönetiminin sağlanması hastaların yaşam kalitesinin iyileşmesi ve sağkalım süresinin artması açısından büyük önem taşımaktadır. Bu nedenle bu derlemede, multipl miyelom hastalarında onkolojik acil durumlara ilişkin kanıt temelli tıbbi önerilerin sunulması ve multipl miyelom hastalarında onkolojik acil durumlarda hemşirelik yönetiminin ele alınması amaçlanmaktadır.Anah tar Ke li me ler: Multipl miyelom; onkoloji hemşireliği; aciller; kanıta dayalı hemşirelik ABS TRACT Cancer is an important health problem that ranks second among the causes of death worldwide and its incidence is increasing day by day. Multiple myeloma, which is among the hematological cancers and constitutes approximately 10% of all malignancies, is a disease of progressive neoplastic plasma cells characterized by abnormal monoclonal protein synthesis, immunoglobulin and light free chain increase. Abnormal monoclonal protein cells developing in the bone marrow cause multi-organ failure and adversely affect the quality of life of patients. People diagnosed and treated for myeloma are at risk of developing some life-threatening complications such as metabolic, cardiogenic, neurological events and infection. These socalled oncological emergencies represent a wide spectrum of diseases arising from the progression of a known malignancy or presenting as the first manifestation of a previously undiagnosed malignancy. Emergencies developing in...

show abstract

Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma

Kaufmann,

Täubl,

Nikolaidou

et al. 2024

Strahlenther Onkol

View full text Add to dashboard Cite

Purpose Multiple myeloma is associated with osteolytic bone lesions, often requiring surgery of the spine and postoperative radiotherapy (RT). Although common, data for clinical and informed decision-making are sparse. In this monocentric retrospective study, we aim to report the outcome of patients who underwent spinal surgery and postoperative RT due to multiple myeloma. Methods A total of 54 patients with multiple myeloma who underwent prior spinal surgery and postoperative RT at our institution between 2009 and 2020 were analyzed. Spinal instability neoplastic score (SINS) and Bilsky score, posttherapeutic adverse events, clinical data, and outcomes were collected and analyzed. The primary endpoint of this study was overall survival (OS), secondary endpoints were progression-free survival (PFS), pain response, local control, and skeletal-related events (SRE). Results The 3‑ and 5‑year overall survival (OS) was 74.9% (95% confidence interval [CI]: 63.5–88.4%) and 58% (95% CI: 44.5–75.6%), respectively. Median survival was not reached and 75% survival was 34.3 months (95% CI: 28.7–95.4 months). Median follow-up was 63 months (95% CI: 49–94 months). The number of patients with good to adequate performance status (Karnofsky performance score [KPS] ≥ 70) significantly increased after surgery (p < 0.01). We observed no grade 3/4 toxicity and only 13 (24%) grade 1/2 adverse events. Two patients (4%) experienced SRE. Overall, 92% of patients reported reduced pain after radiotherapy, with 66% reporting complete pain response. There was no difference in pain response between patients with different Bilsky scores. Bisphosphonate therapy and lower Bilsky score at the start of RT were associated with improved OS in univariate analysis (all p < 0.05). Multivariate Cox regression confirmed a Bilsky score of 2 or 3 as an independent negative prognostic factor (HR 3.89; 95 CI 1.4–10.7; p < 0.01). We observed no in-field recurrences. Conclusion In this study, we were able to show that the current standard of RT after spinal surgery of osteolytic lesions is safe. In addition, we observed a very low rate of SRE (4%) and no in-field recurrences, demonstrating the local efficacy of RT in multiple myeloma patients. Higher Bilsky scores were associated with worse OS in multivariate analysis, but had no effect on pain response.

show abstract

Management of acute spinal cord compression in multiple myeloma

Cited by 16 publications

References 81 publications

Just the facts: how to diagnose and manage patients with multiple myeloma in the emergency department?

Just the facts: how to diagnose and manage patients with multiple myeloma in the emergency department?

Evidence-Based Medical Recommendations and Nursing Management for Oncological Emergencies in Patients with Multiple Myelom: Traditional Review

Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma

Contact Info

Product

Resources

About