多发性骨髓瘤

患者应接受肺炎和流感疫苗接种。应维持良好的补液，以避免肾脏并发症。应尽量减少使用非甾体抗炎药，在放射学检查时避免使用造影剂，并及时治疗感染。双膦酸盐可用于预防包括病理性骨折在内的骨相关并发症。[155]Anderson K, Ismaila N, Flynn PJ, et al. Role of bone-modifying agents in multiple myeloma: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018 Mar 10;36(8):812-8.http://ascopubs.org/doi/full/10.1200/JCO.2017.76.6402http://www.ncbi.nlm.nih.gov/pubmed/29341831?tool=bestpractice.com [ ]How do bisphosphonates compare with placebo/no treatment and each other in people with multiple myeloma?https://cochranelibrary.com/cca/doi/10.1002/cca.2026/full显示答案地诺单抗（denosumab，一种单克隆抗体，以核因子 κB 配体受体激活物 [RANKL] 为靶向）可代替双磷酸盐用于某些患者，例如存在肾损伤的患者。[155]Anderson K, Ismaila N, Flynn PJ, et al. Role of bone-modifying agents in multiple myeloma: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018 Mar 10;36(8):812-8.http://ascopubs.org/doi/full/10.1200/JCO.2017.76.6402http://www.ncbi.nlm.nih.gov/pubmed/29341831?tool=bestpractice.com[156]Raje N, Terpos E, Willenbacher W, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study. Lancet Oncol. 2018 Mar;19(3):370-81.http://www.ncbi.nlm.nih.gov/pubmed/29429912?tool=bestpractice.com 2018 年 6 月，英国药物和医疗产品监管署在对晚期恶性肿瘤累及骨骼的患者使用地诺单抗 (denosumab) 的四项3期研究进行汇总分析后发布了安全警告。[157]Medicines and Healthcare products Regulatory Agency. Denosumab (Xgeva) for advanced malignancies involving bone: study data show new primary malignancies reported more frequently compared to zoledronate. Jun 2018 [internet publication].https://www.gov.uk/drug-safety-update/denosumab-xgeva-for-advanced-malignancies-involving-bone-study-data-show-new-primary-malignancies-reported-more-frequently-compared-to-zoledronate 据报道，接受地诺单抗治疗的患者新患原发恶性肿瘤的频率高于接受唑来膦酸治疗的患者（使用地诺单抗，新患原发恶性肿瘤的累积发病率在第 1 年为 1.1%，使用唑来膦酸则为 0.6%）。还未发现与治疗相关的某种癌症或某组癌症的特定发病模式。