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Pain in Hematologic Malignancies

  • Kanu SharanEmail author
Chapter

Abstract

Hematologic malignancies (HTM) or blood-related cancers (BRC) include leukemia (acute or chronic), lymphomas, and plasma cell disorders. HTM are generally less common than solid tumors, but can be associated with substantial symptom burden, including several pain syndromes, some of which are unique to these conditions. During the course of HTM, pain can be induced by the disease itself, by the diagnostic procedures, or by the different treatment modalities. Pain can also occur from disease-associated complications, secondary to iatrogenic causes, or even at times may be due to unrelated clinical conditions.

In patients with BRC, pain may be the presenting symptom at disease onset, and this kind of pain generally responds with initiation of treatment. Patients under active treatment can report iatrogenic pains of short or long duration. Survivors on the other hand can experience chronic pain due to treatment-related complication or residual post treatment of the disease itself. In patients with advanced, incurable/refractory disease distressing pain symptoms should be managed in context of comprehensive end of life care.

Keywords

Blood-related cancers Hematologic malignancies Bone pain Cancer pain 

References

  1. 1.
    Niscola P, et al. Pain syndromes in hematologic malignancies: an overview. Hematol J. 2004;5:293–303.CrossRefGoogle Scholar
  2. 2.
    Niscola P, et al. Pain in blood cancers. Indian J Palliat Care. 2011;17(3):175–83.CrossRefGoogle Scholar
  3. 3.
    Roodman, GD. Mechanisms of bone lesions in myeloma and lymphoma. Cancer. 1997;80(8):1557–63.CrossRefGoogle Scholar
  4. 4.
    Pathogenesis and Management of Myeloma Bone Disease. Christoulas, et al. Expert Rev Hematol. 2009;2(4):385–98.CrossRefGoogle Scholar
  5. 5.
    Khan OA, et al. Vertebral augmentation in patients with multiple myeloma: a pooled analysis of published case series. Am J Neuroradiol. 2014;35:207–10.CrossRefGoogle Scholar
  6. 6.
    Kubista E, Glaspy J, Holmes FA, Green MD, Hackett J, Neumann T, Pegfilgrastim Study Group. Bone pain associated with once-per-cycle pegfilgrastim is similar to daily filgrastim in patients with breast cancer. Clin Breast Cancer. 2003;3(6):391–8.CrossRefGoogle Scholar
  7. 7.
    Pawloski PA, Larsen M, Thoresen A, Giordana MD. Pegfilgrastim use and bone pain: a cohort study of community-based cancer patients. J Oncol Pharm Pract. 2015 May 7. pii: 1078155215585188. [Epub ahead of print].Google Scholar
  8. 8.
    Xu H, Gong Q, Vogl FD, Reiner M, Page JH. Risk factors for bone pain among patients with cancer receiving myelosuppressive chemotherapy and pegfilgrastim. Support Care Cancer. 2016;24(2):723–30.  https://doi.org/10.1007/s00520-015-2834-2. Epub 2015 Jul 11.CrossRefPubMedGoogle Scholar
  9. 9.
    Kirshner JJ, Heckler CE, Janelsins MC, Dakhil SR, Hopkins JO, Coles C, Morrow GR. Prevention of pegfilgrastim-induced bone pain: a phase iii double-blind placebo-controlled randomized clinical trial of the university of rochester cancer center clinical commun oncol program research base. J Clin Oncol. 2012;30(16):1974–9.  https://doi.org/10.1200/JCO.2011.37.8364. Epub 2012 Apr 16.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Moukharskaya J, Abrams DM, Ashikaga T, Khan F, Schwartz J, Wilson K, Verschraegen C, Openshaw T, Valentine J, Eneman J, Unger P, Ades S. Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim. Support Care Cancer. 2016 Feb 19. [Epub ahead of print].Google Scholar
  11. 11.
    Visani G, Bontempo G, Manfroi S, Pazzaglia A, D’Alessandro R, Tura S. All-trans-retinoic acid and pseudotumor cerebri in a young adult with acute promyelocytic leukemia: a possible disease association. Haematologica. 1996;81(2):152–4. Review.PubMedGoogle Scholar
  12. 12.
    Visani G, Bontempo G, Manfroi S, Pazzaglia A, D’Alessandro R, Tura S. All-trans-retinoic acid and pseudotumor cerebri in a young adult with acute promyelocytic leukemia: a possible disease association. Haematologica. 1996;81(2):152–4.PubMedGoogle Scholar
  13. 13.
    Guirgis MF, Lueder GT. Intracranial hypertension secondary to all-trans retinoic acid treatment for leukemia: diagnosis and management. J AAPOS. 2003;7(6):432–4.CrossRefGoogle Scholar
  14. 14.
    Decaudin D, Adams D, Naccache P, Castagna L, Munck JN. Maintained all-trans retinoic acid therapy in a patient with pseudotumour cerebri despite aggravated symptoms. Leuk Lymphoma. 1997;27(3–4):373–4.CrossRefGoogle Scholar
  15. 15.
    Jabbour E, O’Brien S, Kantarjian H, Garcia-Manero G, Ferrajoli A, Ravandi F, Cabanillas M, Thomas DA. Neurologic complications associated with intrathecal liposomal cytarabine given prophylactically in combination with high-dose methotrexate and cytarabine to patients with acute lymphocytic leukemia. Blood. 2007;109(8):3214–8. Epub 2007 Jan 5.CrossRefGoogle Scholar
  16. 16.
    Kantarjian HM, O’Brien S, Smith TL, et al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000;18:547–61.CrossRefGoogle Scholar
  17. 17.
    Kantarjian H, Thomas D, O’Brien S, et al. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. 2004;101:2788–801.CrossRefGoogle Scholar
  18. 18.
    Thomas DA, O’Brien S, Cortes J, et al. Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma. Blood. 2004;104:1624–30.CrossRefGoogle Scholar
  19. 19.
    Thomas DA, Faderl S, O’Brien S, et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006;106:1569–80.CrossRefGoogle Scholar
  20. 20.
    Scott BJ, van Vugt VA, Rush T, Brown T, Chen CC, Carter BS, Schwab R, Fanta P, Helsten T, Bazhenova L, Parker B, Pingle S, Saria MG, Brown BD, Piccioni DE, Kesari S. Concurrent intrathecal methotrexate and liposomal cytarabine for leptomeningeal metastasis from solid tumors: a retrospective cohort study. J Neuro Oncol. 2014 Jun 19. [Epub ahead of print].Google Scholar
  21. 21.
    Chamberlain MC. Neurotoxicity of intra-CSF liposomal cytarabine (DepoCyt) administered for the treatment of leptomeningeal metastases: a retrospective case series. J Neuro-Oncol. 2012;109(1):143–8.  https://doi.org/10.1007/s11060-012-0880-x. Epub 2012 Apr 27.CrossRefGoogle Scholar
  22. 22.
    JLM J, et al. Chemotherapy induced peripheral neuropathies in hematological malignancies. J Neuro-Oncol. 2015;121(2):229–37.CrossRefGoogle Scholar
  23. 23.
    Sonneveld P, et al. Dealing with neuropathy in plasma-cell dyscrasias. ASH Education Book. 2010;2010(1):423–30.Google Scholar
  24. 24.
    Rison RA, et al. Paraproteinemic neuropathy: a practical review. BMC Neurol. 2016;16:13.CrossRefGoogle Scholar
  25. 25.
    Tran TN, et al. Complications of herpes zoster in cancer patients. Scand J Infect Dis. 2014;46(7):528–32.CrossRefGoogle Scholar
  26. 26.
    Wade J. Viral infections in patients with hematological malignancies. ASH Education Book. 2006;2006(1):368–74.Google Scholar
  27. 27.
    Niscola P, et al. Mucositis in patients with hematologic malignancies: an overview. Haematologica. 2007;92(2):222–31.CrossRefGoogle Scholar
  28. 28.
    Spielberger R, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med. 2004;351(25):2590–8.CrossRefGoogle Scholar
  29. 29.
    Niscola P, et al. Pain syndromes in the setting of haematopoietic stem cell transplantation for haematological malignancies. Bone Marrow Transplant. 2008;41:757–64.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.MD Anderson Cancer Center at Cooper, Department of Hematology/OncologyCamdenUSA

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