Management of Adverse Events and Supportive Therapy in Relapsed/Refractory Multiple Myeloma

Abstract

Relapsed/refractory (RR) multiple myeloma (MM) patients are a fragile population because of prolonged drug exposure and advanced age. Preserving a good quality of life is of high priority for these patients and the treatment of disease- and treatment-related complications plays a key role in their management. By preventing and limiting MM-induced complications, supportive care improves patients’ outcome. Erythropoietin-stimulating agents and bisphosphonates are well-established supportive strategies, yet novel agents are under investigation, such as anabolic bone agents and activin receptor-like kinase (ALK) inhibitors. The recent dramatic changes in the treatment landscape of MM pose an additional challenge for the routine care of RRMM patients. Multidrug combinations in first and later lines increase the risk for long-lasting toxicities, including adverse cardiovascular and neurological events. Moreover, recently approved first-in-class drugs have unique side-effect profiles, such as ocular toxicity of belantamab mafodotin or gastrointestinal toxicity of selinexor. This review discusses current standards in supportive treatment of RRMM patients, including recommendations in light of the recent SARS-CoV-19 pandemic, and critically looks at the incidence and management of side effects of standard as well as next generation anti-MM agents.

Multiple Myeloma: A Review of the Literature and a Case Report Highlighting the Immunocompromised State of Myeloma Patients

“…Although treatment strategies have improved, they do not come without side effects. Some of the major adverse effects secondary to treatment regimens include increased risk of venous thromboembolism, immunosuppression, cytopenias, secondary malignancies, renal insufficiency, peripheral neuropathy, cardiac toxicity, gastrointestinal toxicity, and ocular toxicity [ 33 , 34 ].…”

Pain Management in Multiple Myeloma Patients: A Literature Review

“…Pozzi et al discuss that prolonged exposure to opioids, including morphine and methadone, in MM patients may contribute to increased tolerance. Regular dose adjustments and periodic reassessments are vital to maintaining efficacy [ 35 ].…”

Multiple Myeloma: Possible Cure from the Sea

“…As previously discussed, the incidence of MM is increasing, and things are much more complicated if we consider not only new patients, and refractory and relapsed ones for whom available therapies failed, but also the several adverse events caused by therapies that impact the life quality of patients. Adverse effects can vary depending on treatments and the patient’s age [ 23 , 24 , 47 ]. The scenario can be even worse considering that frontline therapies are a combination of different drugs with peculiar side effects.…”

“…Two strategies are taken to overcome these with uncomfortable side effects. One is the post-therapy management of fragile patients, especially relapsed and refractory ones (RR) [ 47 ]; the other is to increase the efforts across the scientific community in the discovery of new compounds with specific features, such as the ones with immunomodulatory activity or compounds able to target cancer cells. For this reason, research on MNPs is attracting interest.…”