The Role of High-Dose Chemotherapy Supported by Hematopoietic Stem Cell Transplantation in Patients With Multiple Myeloma: Implications for Nursing

Abstract

Multiple myeloma (MM), a neoplastic proliferation of plasma cells originating from the B-cell line, is associated with deleterious complications and poor outcomes. The failure of conventional combination chemotherapies to improve the overall survival of patients with MM has led to the use of high-dose chemotherapy supported by stem cell transplantation (SCT). Although several novel therapies have emerged since the late 1990s, their survival benefits are undetermined. Highdose chemotherapy with SCT provides better response rates compared to conventional chemotherapy and yields a trend toward greater survival benefits, especially with the use of a tandem (two successive) transplantation strategy. This article discusses standard SCT in patients with MM and some of the new transplantation strategies, including tandem autologous SCTs and reduced-intensity nonmyeloablative allogeneic SCT, and their implications for nursing.The role of high-dose chemotherapy supported by stem cell transplantation (SCT) as a safe and effective therapy for patients with multiple myeloma (MM) is well established (Singhal, 2002). Since the 1990s, myeloma treatment advances have been made in the transplantation arena, but major challenges still lie ahead to improve overall survival (Barlogie et al., 2004). Several transplantation-related strategies have emerged, including tandem (i.e., two successive) autologous SCTs (ASCTs), autologous followed by allogeneic SCT, nonmyeloablative allogeneic transplantation, and sequential ASCTs followed by Author Contact: Anna Liza Rodriguez, RN, BSN, OCN ® , can be reached at anrodrig@nmh.org, with copy to editor at CJONEditor@ons.org. No financial relationships to disclose. NIH Public Access Author ManuscriptClin J Oncol Nurs. Author manuscript; available in PMC 2014 October 17. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript nonmyeloablative allogeneic transplantation, all in an effort to improve overall survival (Hari, Pasquini, & Vesole, 2006). Although several novel agents such as thalidomide, bortezomib, and lenalidomide have been effective in the treatment of MM, their impact on overall survival and quality of life in patients with MM is unclear . This article discusses standard SCT in patients with MM, some of the newer transplantation strategies (e.g., tandem ASCT, reduced-intensity nonmyeloablative allogeneic SCT) and their implications for nursing. Multiple Myeloma OverviewMM is the abnormal clonal proliferation of plasma cells originating from the B-cell line. An estimated 19,900 new myeloma cases and 10,790 deaths caused by the disease are anticipated in (Jemal et al., 2007. Many patients diagnosed with myeloma tend to be older (median age at diagnosis is 66), but some cases in patients younger than 40 have been reported (Kyle et al., 2003).MM is a neoplastic growth from the single clone of a plasma cell that became aberrant and proliferated in an uncontrolled pattern with eventual accumulation in the bone marrow. Myeloma cells produce abnormal and dysfuncti...

Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care

“…At this stage of the conditioning regimen, nurses must inform patients and their caregivers about adverse effects, including pancytopenia with the frequent changes of the mucosa and about pain control. 18 They must also assess the fatigue, anxiety, insomnia, poor appetite, mucositis, nausea and vomiting of the patients. These are among the most common symptoms reported during HSCT.…”

“… 19 Nurses are essential in the continuous assessment of symptoms and are also responsible for evidence-based nursing interventions. 18 Symptoms can affect the quality of life of patients 20 , 21 and, therefore, in the context of early hospital discharge the nurse should pay attention to patient complaints, trying to minimize the possibility of events outside the hospital, counseling them on how to identify possible changes and the necessity to seek professional assistance when changes do occur. The detection and rating of toxicities should be accurate, leading to early intervention in cases of worsening even possibly the need of hospitalization.…”

Evidence-based guidelines for physiotherapy management of patients with multiple myeloma: study protocol

“…High-dose chemotherapy is a systemic therapy that uses high doses of cytotoxic drugs to destroy myeloma cells. In addition to destroying myeloma cells, the cytotoxic drugs also destroy hematopoietic stem cells leading to neutropenia and thrombocytopenia [ 6 ]. This puts patients at the risk of developing infections and hemorrhage.…”

“…This puts patients at the risk of developing infections and hemorrhage. Typically, patients receiving high-dose chemotherapy always undergo stem cell re-infusion to restore marrow function [ 6 ]. In addition, patients receiving high-dose chemotherapy may experience numerous side effects including, but not limited to, nausea, vomiting, diarrhea, stomach pain, heart burn, mouth sores, hair loss, and skin rash [ 6 ].…”

Infusion of Hematopoietic Stem Cells: Types, Characteristics, Adverse and Transfusion Reactions and the Implications for Nursing

“…Thus, during infusion, nurses must monitor vital signs, oxygen saturation, symptoms of fluid overload, acute hemolytic reaction, reaction to the DMSO, allergic or anaphylactic reaction. If a reaction is perceived, the nurse must reduce or cease infusion, immediately report to the physician, and administer medication and oxygen if necessary (13) .…”