Myeloma multiple and high calcium levels: Association, causes, and further insights
Hypercalcemia, a condition characterized by abnormally high levels of calcium in the blood, is a common complication in people with multiple myeloma (MM). This condition is primarily caused by increased bone resorption due to malignant plasma cells disrupting normal bone metabolism.
Causes
The malignant plasma cells in MM produce factors that stimulate osteoclasts, leading to increased breakdown of bone and the release of calcium into the bloodstream, causing hypercalcemia. Additionally, hypercalcemia can worsen kidney function, and kidney damage can reduce calcium clearance, exacerbating hypercalcemia.
Symptoms
Symptoms of hypercalcemia in MM patients include bone pain, kidney issues, gastrointestinal symptoms such as nausea, vomiting, and constipation, neurological symptoms like confusion, disorientation, and lethargy, and fatigue and general malaise.
Treatments
Treatment for hypercalcemia in MM patients focuses on aggressive hydration and medications to reduce calcium levels, as well as therapies targeting the underlying myeloma.
Treating Hypercalcemia Directly
Aggressive intravenous hydration with normal saline is used to improve renal calcium clearance and prevent dehydration. Medications such as bisphosphonates that inhibit osteoclast-mediated bone resorption can also be used. However, bisphosphonates can be toxic to the kidneys.
Treating the Underlying Multiple Myeloma
Treatments for the underlying MM include chemotherapy to reduce malignant plasma cell burden, proteasome inhibitors, immunomodulators, immunotherapy options, radiotherapy for bone lesions, and bone marrow or stem cell transplantation to restore healthy plasma cells.
Managing hypercalcemia effectively often requires controlling the myeloma itself to reduce ongoing bone destruction.
Additional Considerations
Bisphosphonates, such as pamidronate, zoledronic acid, and ibandronate, can help reduce bone reabsorption and pull excess calcium in the bloodstream into the bones. However, they can be toxic to the kidneys.
Medications that can worsen hypercalcemia include calcium, vitamin D, diuretics, lithium, and antacids. Corticosteroids can help boost the effects of calcitonin, inhibit bone destruction, kill tumor cells, and decrease the activity and production of immune cells.
In some cases, when people with heart or kidney failure cannot tolerate high-volume fluid therapy, hemodialysis may be used. In these cases, doctors may recommend hemodialysis with low levels or no amounts of calcium in the dialysate.
By taking a comprehensive approach to managing hypercalcemia in MM patients, symptoms can be mitigated, kidney damage prevented, and overall prognosis improved.
- Science has identified hypercalcemia, a condition with high levels of calcium in the blood, as a common complication in people with multiple myeloma (MM), a type of medical condition.
- This condition is primarily caused by the malignant plasma cells in MM, which produce factors stimulating increased bone resorption, leading to hypercalcemia.
- Symptoms of hypercalcemia in MM patients include bone pain, kidney issues, gastrointestinal symptoms, neurological symptoms, fatigue, and general malaise.
- Treatment for hypercalcemia in MM patients focuses on aggressive hydration, reducing calcium levels, and targeting the underlying myeloma.
- Aggressive intravenous hydration and medications such as bisphosphonates, which inhibit osteoclast-mediated bone resorption, can help manage hypercalcemia.
- However, bisphosphonates can be toxic to the kidneys, and other medications like calcium, vitamin D, diuretics, lithium, antacids, and substances that boost calcium levels should be avoided.
- Treatments for the underlying MM include chemotherapy, proteasome inhibitors, immunomodulators, immunotherapy options, radiotherapy, and bone marrow or stem cell transplantation.
- Effectively managing hypercalcemia often requires controlling the myeloma itself to reduce ongoing bone destruction.
- In some cases, hemodialysis may be used for people with heart or kidney failure who cannot tolerate high-volume fluid therapy, with low levels or no amounts of calcium in the dialysate.
- By taking a comprehensive approach to managing hypercalcemia in MM patients, symptoms can be mitigated, kidney damage prevented, and overall prognosis improved.
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