Management of Adverse Events in Multiple Myeloma

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When deciding which treatment regimen is appropriate for a patient with multiple myeloma, clinicians take into account patient-specific factors and patient tolerance of adverse events due to treatment. Noopur Raje, MD, Sagar Lonial, MD, and Ann McNeill, RN, MSN, APN, discuss adverse event profiles for various multiple myeloma treatment options and explain how clinicians can minimize the risk of adverse events and manage adverse events should they occur.

Raje notes that patients with multiple myeloma often have immune paresis and thus are prone to infections. For this reason, Raje recommends vaccinations (eg, the flu vaccine) and prophylactic antibiotics.

Lonial remarks that when treating patients with immunomodulatory drugs, specifically lenalidomide and pomalidomide, myelosuppression is a common adverse event; myelosuppression may be more severe in patients with renal insufficiency, and dose adjustments may be necessary. Although there are no dosing guidelines for the use of pomalidomide in patients with renal impairment, McNeill has safely administered pomalidomide to patients with varying degrees of renal impairment, including patients undergoing hemodialysis. She suggests monitoring elderly patients and those with renal impairment or comorbidities more closely.

Proteasome inhibitors are associated with a different range of adverse events, including peripheral neuropathy, decreased platelet counts, and gastrointestinal adverse events (eg, nausea, diarrhea, and constipation), states Raje.

Should patients experience grade 3 or 4 toxicities, Raje notes that discontinuation may be necessary; however, discontinuation due to adverse events occurs infrequently. Through the use of preventive measures, supportive care, and dose reductions, clinicians can help prevent and manage adverse events.