Management UKMF Guidelines Br J Haematol 115 522540

Initial considerations and general aspects

• Pain control: titrate simple analgesia and opiates (MST + prn Oramorph) ± NSAIDs (monitor renal function) ± local radiotherapy (8-20Gy) ± spinal support corset for severe back pain.

• Correction of renal impairment: rehydration with high fluid input (3-4L/day) and rapid treatment of hypercalcaemia, infection and hyper-uricaemia may improve renal function; caution with nephrotoxic drugs including NSAIDs; ?role of plasmapheresis in established renal failure; peritoneal or haemodialysis if required (<5%); VAD-type regimen treatment of choice after response to rehydration or established CRF; follow with PBSC harvest (mobilised by G-CSF alone) and HDM (140mg/m2) and SCT in younger patients; after response EFS and OS same as other patients.

• Hypercalcaemia: rehydration (3-6L/day IV); loop diuretics; IV bisphos-phonate; (pamidronate 30-90mg IV or zoledronate 4mg IV; 5 dose in renal impairment); chemotherapy.

• Bone disease: local radiotherapy for localised pain (8-20Gy); fixation of fractures/potential fractures; long term bisphosphonate prophylaxis.

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