Common side effects of new treatments in multiple myeloma

This paper reviewed the adverse (negative) events associated with new treatments in multiple myeloma. Patients should be closely monitored for adverse events.

Multiple myeloma is a cancer of the plasma cells (type of white blood cell). Treatment includes the use of various types of medications. Adverse events (undesired outcomes of treatment) can occur. As overall survival improves, management of side effects due to treatment is important.

One major adverse event is low levels of white blood cells and platelets (cells involved in blood clotting). This increases the risk of infection. Patients should thus be closely monitored for low levels of blood cells.

A rash can be caused by various drugs, but especially lenalidomide (Revlimid). In a mild rash, lenalidomide can still be continued. However, for more serious rashes, treatment should be stopped.  

Peripheral neuropathy, damage to the nerves of usually the hands and feet, can occur. Nerve damage mostly affects sensation. Drugs causing this include bortezomib (Velcade), carfilzomib (Kyprolis), ixazomib (Ninlaro), pomalidomide (Imnovid) and lenalidomide.  If nerve damage occurs, the medication should be stopped, or the dosage reduced. Treatment for peripheral neuropathy is not well studied. This generally includes drugs like gabapentin (Neurontin), amnitriptyline (Elavil), duloxetine (Cymbalta), and drugs used to treat epilepsy.  

Clots in the vein can also occur while patients are on treatment. Measures should be taken to prevent clots in patients who are at high risk.

Diarrhea can occur as well. Patients should be encouraged to maintain water intake, eat smaller portions, and limit caffeine, alcohol, and milk products.  

Heart-related adverse events can also occur. With carfilzomib, high blood pressure, abnormal heart rate and heart failure can occur. Patients should be closely observed. If necessary, the drug should be stopped to manage the heart-related adverse events.

When a treatment is administered directly into the blood vessel, infusion-related reactions can occur. This includes breathlessness, cough, throat irritation and nausea. The use of steroids after the infusion can be used to prevent some infusion reactions.

The authors concluded that patients should be closely monitored while they are on long term treatment. This is so that actions can be taken to reduce the impact of these adverse events.