Multiple myeloma: management of adverse events

The combination of conventional chemotherapy or dexamethasone with new drugs, such as immunomodulatory agents and proteasome inhibitors, has substantially changed the treatment paradigm of myeloma patients. New drugs have been incorporated in pre-transplant induction regimens and post-transplant consolidation and maintenance strategies for young patients; in elderly patients, standard melphalan and prednisone (MP) plus thalidomide or plus bortezomib are now considered standards of care, and ongoing trials are assessing if lenalidomide plus standard MP or plus low-dose dexamethasone may be other options. The efficacy of these drugs needs to be balanced against their toxicity. Different drugs have a different toxicity profile. The choice for the best treatment strategy for every single patient should be based on results of scientific randomized studies but tailored to account for patient's biological age, comorbidities, and the expected toxicity profile of different regimens. Prompt dose reduction and accurate management of treatment-related toxicity can greatly reduce early discontinuation rate and significantly improve treatment efficacy. This chapter will focus on frequency and management of main adverse events in newly diagnosed and relapsed myeloma patients and will provide guidelines for dose reductions and supportive therapy.