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How I manage the toxicities of myeloma drugs

Michel Delforge and Heinz Ludwig

Abstract

The treatment of multiple myeloma is considered a continuously evolving paradigm as a result of the growing availability of new and highly effective drugs, including first-and second-generation proteasome inhibitors, immunomodulatory agents and monoclonal antibodies. Clinical trials advocate long-term rather than short-term treatment schedules with combinations of these new anti-myeloma drug classes. Although the overall toxicity profile of the recommended regimens can be considered favorable, their increasing complexity and prolonged use warrants a heightened vigilance for early and late side-effects, a priori because real-life patients can be more frail or present with one or more comorbidities. The treatment decision process -at diagnosis and at relapse- therefore requires myeloma physicians to carefully balance efficacy and toxicity profiles for each individual patient. Early and/or unneccesary tapering or treatment discontinuation for drug-related adverse events may not only reduce patients their quality of life, but can also negatively impact their outcome. Accurate knowledge in recognizing and managing the potential side-effects of present-day treatment regimens is therefore a cornerstone in myeloma care. Using 5 case vignettes, we discuss how to prevent and manage the most common non-hematological adverse events of anti-myeloma treatment regimens containing proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies.

  • Submitted January 6, 2017.
  • Accepted March 6, 2017.