Side Effects of Treatment in Multiple Myeloma

The treatment of multiple myeloma has evolved impressively over the last two decades. Conventional chemotherapy has nowadays been largely replaced by several combinations of newer agents including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. Rather than fixed duration therapy, the majority of patients are nowadays exposed to combinations of anti-myeloma agents for prolonged periods of time that can exceed several years. Most importantly, this change in treatment paradigm has significantly improved the outcome of myeloma patients. Prevention and appropriate management of drug-related adverse events are a prerequisite for treatment success and for preservation of the quality of life of patients. Toxicities of anti-myeloma drugs include hematological and non-hematological adverse events that can involve several organ systems. In the following chapter we describe the most common class- and drug-related adverse events of the agents that are currently used for the management of multiple myeloma. Topics that are discussed include the clinical presentation, pathophysiology, and frequency of drug-related adverse events plus mitigation and management strategies. In addition to the commonly used agents, we also focus on side effects of T-cell redirecting therapies that will become more widely available for the management of multiple myeloma in the near future.