A Focus on Newly Diagnosed Multiple Myeloma.

Multiple myeloma (MM) is an incurable plasma cell disorder that affects nearly 35,000 people annually. Over 149,000 individuals are estimated to live in the United States with MM. Research has generated a greater understanding of the pathology of this disease, now combined with mature clinical trial data that support the use of combination therapy in treatment. This article focuses on updated diagnosis, prognosis, and treatment of newly diagnosed patients. While the diagnosis of MM remains based on the 2014 International Myeloma Working Group (IMWG) guidelines, we review these and updated recommendations for the diagnosis and treatment of myeloma as well as relevant supportive care. The prognosis of patients with newly diagnosed MM relies heavily on the cytogenetic profile of the disease, along with other patient-specific risk factors. There are multiple first-line treatment options that combine three or four novel agents with the goal of reducing plasma cell burden and achieving minimal residual disease (MRD) negative status early in the treatment trajectory. Supportive care interventions aimed at minimizing the risk of infection and thromboembolic events, and protecting bone health are critical for maintaining quality of life and are as important as therapeutic treatment interventions.

Myelosuppression, Bone Disease, and Acute Renal Failure: Evidence-Based Recommendations for Oncologic Emergencies

BACKGROUND: Oncologic emergencies associated with multiple myeloma include myelosuppression (anemia, neutropenia, and thrombocytopenia), bone-related emergencies, and acute renal failure. 
. OBJECTIVES: This article reviews the pathophysiology of these multiple myeloma-associated oncology emergencies and provides a framework for assessment and effective intervention.
. METHODS: A comprehensive review of the levels of evidence, focusing on assessment, diagnosis, comorbidities, treatment, ongoing monitoring, and patient education, are presented to support the plan of care for at-risk patients.
. FINDINGS: Attention to signs and symptoms is the foundation for preventing these emergencies or managing additional escalation of symptoms.

Pathobiology and Diagnosis of Multiple Myeloma.

OBJECTIVE: To understand the role of the genetic changes and bone marrow microenvironment on the development, progression, and staging of multiple myeloma (MM). DATA SOURCES: Peer-reviewed articles and clinical guidelines. CONCLUSION: The acquisition of genetic changes and the bone marrow microenvironment in which myeloma cells develop both influence the pathogenic potential of these malignant cells and is reflected in staging of the disease, risk of progression, and predicted response to treatment. IMPLICATIONS FOR NURSING PRACTICE: Treatment of multiple myeloma is largely dependent on risk factors in which specific genetic alterations play a large role. Clinicians should be aware of these genetic changes and how they may influence the individual treatment plan for each patient.

Effects of stress management on PNI-based outcomes in persons with HIV disease.

A pretest-posttest, repeated-measures design was used to evaluate the effects of two stress management interventions on a battery of outcomes derived from a psychoneuroimmunological (PNI) framework. The effects of cognitive-behavioral relaxation training groups (CBSM) and social support groups (SSG) were compared with a WAIT-listed control group on the outcomes of psychosocial functioning, quality of life, neuroendocrine mediation, and somatic health. Participants were 148 individuals (119 men, 29 women), diagnosed with HIV disease; 112 (76%) completing the study groups. Using analysis of covariance, the CBSM group was found to have significantly higher postintervention emotional well-being and total quality-of-life scores than did either the SSG or WAIT groups. SSG participants had significantly lower social/family well-being scores immediately postintervention and lower social support scores after 6 months. The findings point to a pressing need for further, well-controlled research with these common intervention modalities.