title: How I manage the toxicities of myeloma drugs.
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 warrant a heightened vigilance for early and late side effects, a priori because real-life patients can be more frail or present with 1 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 unnecessary tapering or treatment discontinuation for drug-related adverse events may not only reduce patients' quality of life, but 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 nonhematological adverse events of anti-myeloma treatment regimens containing proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies.
authors.affiliation: Department of Hematology, University Hospital Leuven, Leuven, Belgium; and.
authors.forename: Michel
authors.identifier: 0000-0002-0147-2291
authors.initials: M
authors.lastname: Delforge
authors.affiliation: Wilhelminen Cancer Research Institute, First Department of Medicine, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna, Austria.
authors.forename: Heinz
authors.identifier: 0000-0002-3302-8726
authors.initials: H
authors.lastname: Ludwig
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D019468:Disease Management; D057915:Drug Substitution / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D057285:Precision Medicine / Q000379:methods*; D061988:Proteasome Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012074:Remission Induction
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D061988:Proteasome Inhibitors