Haematology: Multiple Myeloma
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* Jonathan Cullis

Editor – I wish to point out a significant and potentially harmful error in the CME Medical Masterclass article on multiple myeloma published in the January 2019 issue of Clinical Medicine.1

In the section on supportive care the authors state that ‘Pain is common in myeloma and often requires opiate analgesia plus NSAIDs’. This is at odds with the current UK guidelines on supportive care in myeloma published on behalf of the British Committee for Standards in Haematology and the UK Myeloma Forum,2 which state that NSAIDs should*be avoided apart from very short term use (eg 3–5 days) with acute severe pain, eg bone fracture. They should not be used in the presence of renal impairment, and used with extreme caution in myeloma patients in view of the risk of precipitating renal compromise.*

The Medicines and Healthcare products Regulatory Agency also issued a warning in 2009 highlighting the need for great caution when using NSAIDs in patients at risk of renal impairment, including those with myeloma.3

This practice of avoiding NSAID use is well-established in the haematology community because of the risk of precipitating acute kidney injury, but the risks may be less well-known amongst those in general medicine, to whom this CME series is directed. It is important that inappropriate use of NSAIDs in patients with myeloma is avoided to prevent renal damage in these susceptible patients.

*   © Royal College of Physicians 2019. All rights reserved.

## References

1.  1.  Firth J
    
    Medical Masterclass contributors; Firth J (ed). Haematology: multiple myeloma. Clin Med 2019;19:58–60.
    
    [FREE Full Text](http://www.rcpjournals.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTI6ImNsaW5tZWRpY2luZSI7czo1OiJyZXNpZCI7czo3OiIxOS8xLzU4IjtzOjQ6ImF0b20iO3M6Mjk6Ii9jbGlubWVkaWNpbmUvMTkvMi8xODguMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  1.  Ahmedzai JA
    
    
    
    
    1.  Ashcroft J, 
    2.  et al
    
    Snowden JA, Ahmedzai JA, Ashcroft J, et al. Guidelines on supportive care in multiple myeloma 2011. Brit J Haem 2011;154:76–103.
    
    [CrossRef](http://www.rcpjournals.org/lookup/external-ref?access_num=10.1111/j.1365-2141.2011.08574.x&link_type=DOI) 
    
    [PubMed](http://www.rcpjournals.org/lookup/external-ref?access_num=21517805&link_type=MED&atom=%2Fclinmedicine%2F19%2F2%2F188.2.atom) 

3.  MRHA. Non-steroidal anti-inflammatory drugs: reminder on renal failure and impairment. Drug safety update 2009;2:4. [https://webarchive.nationalarchives.gov.uk/20141206163736/http://www.mhra.gov.uk/home/groups/pl-p/documents/publication/con046452.pdf](https://webarchive.nationalarchives.gov.uk/20141206163736/http://www.mhra.gov.uk/home/groups/pl-p/documents/publication/con046452.pdf).