Myelosuppression

Myelosuppression is a common complication of myeloma. It is defined as “reduced bone marrow activity that results in the decreased production of red blood cells, white blood cells, and platelets”.

In myeloma, myelosuppression is primarily caused by the inhibition of stem cell proliferation by cytokines secreted by the myeloma cells. It is also a common and expected side effect of many anti-myeloma treatments including thalidomide, bortezomib, lenalidomide, cyclophosphamide and melphalan and novel therapies such as bispecific antibodies.

The clinical consequences of myelosuppression are:

• Leukopenia – a reduction in total white blood cells, particularly neutrophils (neutropenia), increasing the risk of bacterial, viral and fungal infection
• Anaemia – a reduction in red blood cells with symptoms including fatigue, shortness of breath and malaise
• Thrombocytopenia – a reduction in platelets increasing the risk of bruising and bleeding

Of these, neutropenia is potentially the most serious and even life-threatening but anaemia and /or thrombocytopenia can also pose problems and significantly diminish quality of life. It is also not uncommon for myeloma patients to have all three simultaneously. Early intervention and appropriate management of myelosuppression and its consequences are therefore vital in improving patient outcomes, overall outlook and survival.

If myelosuppression occurs, subsequent treatments may require dose reduction or a temporary break in treatment to enable the bone marrow to recover and restore blood cell production. Any break in treatment is difficult as by allowing blood cells to recover, it is also allowing the myeloma cells to recover and flourish.

Nurses have a key role to play in assessing and monitoring their patients for myelosuppression, in implementing the necessary supportive care, and in educating patients and their families on preventative measures to reduce the risks associated with this potentially serious and sometimes life-threatening complications. Read more in our Myelosuppression Nurse Guide and Infection Nurse Guide.

Watch the following animation describing the effect of myeloma on bone marrow function: