Abstract
Purpose
Recent therapeutic advancements have significantly improved overall survival of patients with multiple myeloma (MM). As a result, the impact of disease- and treatment-related symptoms must be managed effectively to improve patient quality of life, given prolonged survival after diagnosis. This review discusses current MM treatment options, effective symptom management approaches, and practical strategies for supportive care.
Methods
A literature search was performed using MEDLINE/PubMed and scientific congress databases, focusing on clinical trials, review articles, clinical practice guidelines, and other guidance documents on treatment paradigms and supportive care strategies in MM. Additionally, clinical practice worksheets were developed from published sources, and nursing “pearls of wisdom” were gathered from practical experience in the clinic.
Results
Current therapeutic regimens for relapsed/refractory MM include proteasome inhibitors (i.e., bortezomib, carfilzomib) and immunomodulatory agents (i.e., thalidomide, lenalidomide, pomalidomide), alone or in combination with chemotherapy or corticosteroids. Toxicities associated with agents and combination regimens used in the treatment of MM include myelosuppression, venous thromboembolism, peripheral neuropathy, infections, fatigue, gastrointestinal disorders, and/or cardiac events. Treatment-specific tools and clinical assessments can be useful for optimizing dosing and schedule adjustments to increase therapy duration, and implementing supportive care strategies (e.g., growth factors, transfusional support, intravenous hydration, bisphosphonates, antiviral therapies) to manage treatment-related symptoms.
Conclusions
Improved survival after MM diagnosis has led to increased patient susceptibility to other diseases and comorbidities due to advanced age. In addition to appropriate drug dosing and administration, effective supportive care and health maintenance are crucial for maximizing quality of life and disease control.
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References
Collins CD (2005) Problems monitoring response in multiple myeloma. Cancer Imaging 5 Spec No A:S119-26
Katzel JA, Hari P, Vesole DH (2007) Multiple myeloma: charging toward a bright future. CA Cancer J Clin 57:301–318
Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G, Gertz M, Giralt S, Jagannath S, Vesole D (1998) Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 102:1115–1123
Kyle RA, Rajkumar SV (2009) Treatment of multiple myeloma: a comprehensive review. Clin Lymphoma Myeloma 9:278–288
Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (2013) SEER cancer statistics review, 1975–2010. National Cancer Institute
Waxman AJ, Mink PJ, Devesa SS, Anderson WF, Weiss BM, Kristinsson SY, McGlynn KA, Landgren O (2010) Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood 116:5501–5506
San-Miguel JF, Paiva B, Gutierrez NC (2013) New tools for diagnosis and monitoring of multiple myeloma. Am Soc Clin Oncol Educ Book 313–318
Jakubowiak A (2012) Management strategies for relapsed/refractory multiple myeloma: current clinical perspectives. Semin Hematol 49(Suppl 1):S16–S32
Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Zeldenrust SR, Dingli D, Russell SJ, Lust JA, Greipp PR, Kyle RA, Gertz MA (2008) Improved survival in multiple myeloma and the impact of novel therapies. Blood 111:2516–2520
Snowden JA, Ahmedzai SH, Ashcroft J, D’Sa S, Littlewood T, Low E, Lucraft H, Maclean R, Feyler S, Pratt G, Bird JM, Haemato-oncology Task Force of British Committee for Standards in Haematology and UK Myeloma Forum (2011) Guidelines for supportive care in multiple myeloma 2011. Br J Haematol 154:76–103
Bird JM, Owen RG, D’Sa S, Snowden JA, Pratt G, Ashcroft J, Yong K, Cook G, Feyler S, Davies F, Morgan G, Cavenagh J, Low E, Behrens J, Haemato-oncology Task Force of British Committee for Standards in Haematology (BCSH) and UK Myeloma Forum (2011) Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol 154:32–75
National Comprehensive Cancer Network (2014) NCCN clinical practice guidelines in oncology, multiple myeloma V2.2014
Cavo M, Rajkumar SV, Palumbo A, Moreau P, Orlowski R, Blade J, Sezer O, Ludwig H, Dimopoulos MA, Attal M, Sonneveld P, Boccadoro M, Anderson KC, Richardson PG, Bensinger W, Johnsen HE, Kroeger N, Gahrton G, Bergsagel PL, Vesole DH, Einsele H, Jagannath S, Niesvizky R, Durie BG, San Miguel J, Lonial S, International Myeloma Working Group (2011) International myeloma working group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood 117:6063–6073
Palumbo A, Sezer O, Kyle R, Miguel JS, Orlowski RZ, Moreau P, Niesvizky R, Morgan G, Comenzo R, Sonneveld P, Kumar S, Hajek R, Giralt S, Bringhen S, Anderson KC, Richardson PG, Cavo M, Davies F, Blade J, Einsele H, Dimopoulos MA, Spencer A, Dispenzieri A, Reiman T, Shimizu K, Lee JH, Attal M, Boccadoro M, Mateos M, Chen W, Ludwig H, Joshua D, Chim J, Hungria V, Turesson I, Durie BG, Lonial S, IMWG (2009) International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation. Leukemia 23:1716–1730
International Myeloma Foundation (2012) Multiple myeloma: the patient journey through survivorship. Oncology Nursing Society’s (ONS) 37th Annual Congress
American Cancer Society (2013) Multiple myeloma. http://www.cancer.org/cancer/multiplemyeloma/detailedguide/index. Accessed 22 May 2014
Hideshima T, Richardson PG, Anderson KC (2011) Mechanism of action of proteasome inhibitors and deacetylase inhibitors and the biological basis of synergy in multiple myeloma. Mol Cancer Ther 10:2034–2042
Millenium Pharmaceuticals (2012) VELCADE prescribing information
Argyriou AA, Iconomou G, Kalofonos HP (2008) Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature. Blood 112:1593–1599
Moreau P, Pylypenko H, Grosicki S, Karamanesht I, Leleu X, Grishunina M, Rekhtman G, Masliak Z, Robak T, Shubina A, Arnulf B, Kropff M, Cavet J, Esseltine DL, Feng H, Girgis S, van de Velde H, Deraedt W, Harousseau JL (2011) Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study. Lancet Oncol 12:431–440
Moreau P, Coiteux V, Hulin C, Leleu X, van de Velde H, Acharya M, Harousseau JL (2008) Prospective comparison of subcutaneous versus intravenous administration of bortezomib in patients with multiple myeloma. Haematologica 93:1908–1911
Hrusovsky I, Emmerich B, von Rohr A, Voegeli J, Taverna C, Olie RA, Pliskat H, Frohn C, Hess G (2010) Bortezomib retreatment in relapsed multiple myeloma - results from a retrospective multicentre survey in Germany and Switzerland. Oncology 79:247–254
Petrucci MT, Giraldo P, Corradini P, Teixeira A, Dimopoulos MA, Blau IW, Drach J, Angermund R, Allietta N, Broer E, Mitchell V, Blade J (2013) A prospective, international phase 2 study of bortezomib retreatment in patients with relapsed multiple myeloma. Br J Haematol 160:649–659
Moreau P, Richardson PG, Cavo M, Orlowski RZ, San Miguel JF, Palumbo A, Harousseau JL (2012) Proteasome inhibitors in multiple myeloma: 10 years later. Blood 120:947–959
Gay F, Palumbo A (2010) Management of disease- and treatment-related complications in patients with multiple myeloma. Med Oncol 27(Suppl 1):S43–S52
Delforge M, Blade J, Dimopoulos MA, Facon T, Kropff M, Ludwig H, Palumbo A, Van Damme P, San-Miguel JF, Sonneveld P (2010) Treatment-related peripheral neuropathy in multiple myeloma: the challenge continues. Lancet Oncol 11:1086–1095
Onyx Pharmaceuticals (2012) KRYPOLIS prescribing information
Dytfeld D, Jasielec J, Griffith KA, Lebovic D, Vesole DH, Jagannath S, Al-Zoubi A, Anderson T, Detweiler-Short K, Stockerl-Goldstein K, Ahmed A, Jobkar T, Durecki DE, McDonnell K, Mietzel M, Couriel D, Kaminski M, Vij R, Jakubowiak AJ (2014) Carfilzomib, lenalidomide, and low-dose dexamethasone in elderly patients with newly diagnosed multiple myeloma. Haematologica 99:e162–164
Fostier K, De Becker A, Schots R (2012) Carfilzomib: a novel treatment in relapsed and refractory multiple myeloma. Onco Targets Ther 5:237–244
Singhal S, Siegel DS, Martin T, Vij R, Wang L, Jakubowiak AJ, Lonial S, Kuketi V, Zonder JA, Wong AF, McCulloch L, Bardos AZ, Niesvizky R, Orlowski RZ, Stewart AK, Kotlovker D, Jagannath S (2011) Integrated safety from phase 2 studies of monotherapy carfilzomib in patients with relapsed and refractory multiple myeloma (MM): an updated analysis. Blood 118:abstr 1876
Siegel DS, Martin T, Wang M, Vij R, Jakubowiak AJ, Lonial S, Trudel S, Kukreti V, Bahlis N, Alsina M, Chanan-Khan A, Buadi F, Reu FJ, Somlo G, Zonder J, Song K, Stewart AK, Stadtmauer E, Kunkel L, Wear S, Wong AF, Orlowski RZ, Jagannath S (2012) A phase 2 study of single-agent carfilzomib (PX-171-003-A1) in patients with relapsed and refractory multiple myeloma. Blood 120:2817–2825
Latif T, Chauhan N, Khan R, Moran A, Usmani SZ (2012) Thalidomide and its analogues in the treatment of multiple myeloma. Exp Hematol Oncol 1:27-3619-1-27
Celgene (2013) THALDOMID prescribing information
Palumbo A, Facon T, Sonneveld P, Blade J, Offidani M, Gay F, Moreau P, Waage A, Spencer A, Ludwig H, Boccadoro M, Harousseau JL (2008) Thalidomide for treatment of multiple myeloma: 10 years later 111:3968–3977
Lonial S, Mitsiades CS, Richardson PG (2011) Treatment options for relapsed and refractory multiple myeloma. Clin Cancer Res 17:1264–1277
Celgene (2013) REVLIMID prescribing information
Yang B, Yu RL, Chi XH, Lu XC (2013) Lenalidomide treatment for multiple myeloma: systematic review and meta-analysis of randomized controlled trials. PLoS One 8:e64354
Bringhen S, Gay F, Pautasso C, Cerrato C, Boccadoro M, Palumbo A (2012) Evaluation of the pharmacokinetics, preclinical, and clinical efficacy of lenalidomide for the treatment of multiple myeloma. Expert Opin Drug Metab Toxicol 8:1209–1222
Faiman B (2013) Nursing considerations for patients with multiple myeloma. Clin Care Opt Oncol
Celgene (2014) POMALYST precribing information
Chanan-Khan AA, Swaika A, Paulus A, Kumar SK, Mikhael JR, Rajkumar SV, Dispenzieri A, Lacy MQ (2013) Pomalidomide: the new immunomodulatory agent for the treatment of multiple myeloma. Blood Cancer J 3:e143
Ocio EM, Mateos MV, San-Miguel JF (2012) Novel agents derived from the currently approved treatments for MM: novel proteasome inhibitors and novel IMIDs. Expert Opin Investig Drugs 21:1075–1087
United States National Library of Medicine (2014) LiverTox clinical clinical and research information on drug-induced liver injury: drug record, alkylating agents
International Myeloma Foundation (2007) Understanding dexamethasone and other steroids
Reeder CB, Reece DE, Kukreti V, Mikhael JR, Chen C, Trudel S, Laumann K, Vohra H, Fonseca R, Bergsagel PL, Leis JF, Tiedemann R, Stewart AK (2014) Long-term survival with cyclophosphamide, bortezomib and dexamethasone induction therapy in patients with newly diagnosed multiple myeloma. Br J Haematol 167:563–565
Stanbury RM, Graham EM (1998) Systemic corticosteroid therapy–side effects and their management. Br J Ophthalmol 82:704–708
Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME, Abonour R, Siegel DS, Katz M, Greipp PR, Eastern Cooperative Oncology Group (2010) Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol 11:29–37
Roxane Laboratories (2012) PredniSONE package insert
Richardson PG, Hungria VTM, Yoon S, Beksac M, Dimopoulos MA, Elghandour A, Jedrzejczak WW, Guenther A, Nakorn TN, Siritanaratkul N, Schlossman RL, Hou J, Moreau P, Lonial S, Lee JH, Einsele H, Sopala M, Bengoudifa B, Corrado C, San-Miguel JF (2014) Panorama 1: a randomized, double-blind, phase 3 study of panobinostat or placebo plus bortezomib and dexamethasone in relapsed or relapsed and refractory multiple myeloma. ASCO Ann Meet:Abstr 8510
Prince HM, Bishton MJ, Harrison SJ (2009) Clinical studies of histone deacetylase inhibitors. Clin Cancer Res 15:3958–3969
Richardson PG, Schlossman RL, Alsina M, Weber DM, Coutre SE, Gasparetto C, Mukhopadhyay S, Ondovik MS, Khan M, Paley CS, Lonial S (2013) PANORAMA 2: panobinostat in combination with bortezomib and dexamethasone in patients with relapsed and bortezomib-refractory myeloma. Blood 122:2331–2337
Siegel D, Dimopoulos M, Yoon S, Laubach JP, Kaufman JL, Goldschmidt H, Reece D, Leleu X, Durrant S, Offner F, Cavo M, Nagler A, Jagannath S, Houp J, Sun L, Howe J, Wear S, Anderson KC (2012) Vantage 095: final results from a global, single-arm, phase 2B trial of vorinostat in combination with bortezomib in salvage multiple myeloma patients. Eur Hematol Assoc Meet:Abstr 0294
Dimopoulos M, Siegel DS, Lonial S, Qi J, Hajek R, Facon T, Rosinol L, Williams C, Blacklock H, Goldschmidt H, Hungria V, Spencer A, Palumbo A, Graef T, Eid JE, Houp J, Sun L, Vuocolo S, Anderson KC (2013) Vorinostat or placebo in combination with bortezomib in patients with multiple myeloma (VANTAGE 088): a multicentre, randomised, double-blind study. Lancet Oncol 14:1129–1140
Dimopoulos M, Jagannath S, Yoon SS, Siegel DS, Lonial S, Hajek R, Facon T, Rosinol L, Blacklock H, Goldschmidt H, Hungaria V, Spencer A, Palumbo A, Reece D, Graef T, Houp J, Sun L, Eid JE, Anderson KC (2011) VANTAGE 088: an international, multicenter, randomized, double-blind study of vorinostat (MK-0683) or placebo in combination with Bortezomib in patients with multiple myeloma. Blood 118:368–369
Raje N, Hari PN, Vogl DT, Jagannath S, Orlowski RZ, Supko JG, Stephenson P, Jones SS, Wheeler C, Lonial S (2012) Rocilinostat (ACY-1215), a selective HDAC6 inhibitor, alone and in combination with Bortezomib in multiple myeloma: preliminary results from the first-in-humans phase I/II study. ASH Ann Meet:Abstr 4061
Raje N, Vogl DT, Hari PN, Jagannath S, Jones SS, Supko JG, Leone G, Wheeler C, Orlowski RZ, Richardson PG, Lonial S (2013) ACY-1215, a selective histone deacetylase (HDAC) 6 inhibitor: interim results of combination therapy with Bortezomib in patients with multiple myeloma (MM). ASH Ann Meet:Abstr 759
Yee A, Vorhees P, Bensinger WI, Berdeja J, Supko JG, Richardson PG, Jones SS, Patrick G, Wheeler C, Raje N (2013) ACY-1215, a selective histone deacetylase (HDAC) 6 inhibitor, in combination with lenalidomide and Dexamethasone (dex), is well tolerated without dose limiting toxicity (DLT) in patients (Pts) with multiple myeloma (MM) at doses demonstrating biologic activity: interim results of a phase 1b trial. ASH Ann Meet:Abstr 3190
Lonial S, Jagannath S, Moreau P, Jakubowiak AJ, Raab MS, Facon T, Vij R, Bleickardt E, Reece DE, Benboubker L, Zonder JA, Deng W, Singhal AK, Richardson PGG (2013) Phase (Ph) I/II study of elotuzumab (Elo) plus lenalidomide/dexamethasone (Len/dex) in relapsed/refractory multiple myeloma (RR MM): updated Ph II results and Ph I/II long-term safety. J Clin Oncol 31:8542, abstract
Lonial S, Vij R, Harousseau JL, Facon T, Moreau P, Mazumder A, Kaufman JL, Leleu X, Tsao LC, Westland C, Singhal AK, Jagannath S (2012) Elotuzumab in combination with lenalidomide and low-dose dexamethasone in relapsed or refractory multiple myeloma. J Clin Oncol 30:1953–1959
Plesner T, Lokhorst H, Gimsing P, Nahi H, Lisby S, Richardson PG (2012) Daratumumab, a CD38 monoclonal antibody in patients with multiple myeloma - data from a dose-escalation phase I/II study. ASH Ann Meet Abstr 120:73
Plesner T, Arkenau T, Lokhorst H, Gimsing P, Krejcik J, Lemech C, Minnema MC, Lassen U, Cakana A, Brun NC, Basse L, Palumbo A, Richardson P (2013) Preliminary safety and efficacy data of daratumumab in combination with lenalidomide and Dexamethasone in relapsed or refractory multiple myeloma. Blood 122(21):1986, abstract
van der Veer MS, de Weers M, van Kessel B, Bakker JM, Wittebol S, Parren PW, Lokhorst HM, Mutis T (2011) Towards effective immunotherapy of myeloma: enhanced elimination of myeloma cells by combination of lenalidomide with the human CD38 monoclonal antibody daratumumab. Haematologica 96:284–290
Martin TG, Strickland SA, Glenn M, Zheng W, Daskalakis N, Mikhael JR (2013) SAR650984, A CD38 monoclonal antibody in patients with selected CD38+ hematological malignancies – data from a dose-escalation phase I study. Blood 122(21):284
Richardson PG, Delforge M, Beksac M, Wen P, Jongen JL, Sezer O, Terpos E, Munshi N, Palumbo A, Rajkumar SV, Harousseau JL, Moreau P, Avet-Loiseau H, Lee JH, Cavo M, Merlini G, Voorhees P, Chng WJ, Mazumder A, Usmani S, Einsele H, Comenzo R, Orlowski R, Vesole D, Lahuerta JJ, Niesvizky R, Siegel D, Mateos MV, Dimopoulos M, Lonial S, Jagannath S, Blade J, Miguel JS, Morgan G, Anderson KC, Durie BG, Sonneveld P (2012) Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia 26:595–608
Richardson PG, Xie W, Mitsiades C, Chanan-Khan AA, Lonial S, Hassoun H, Avigan DE, Oaklander AL, Kuter DJ, Wen PY, Kesari S, Briemberg HR, Schlossman RL, Munshi NC, Heffner LT, Doss D, Esseltine DL, Weller E, Anderson KC, Amato AA (2009) Single-agent bortezomib in previously untreated multiple myeloma: efficacy, characterization of peripheral neuropathy, and molecular correlations with response and neuropathy. J Clin Oncol 27:3518–3525
Palumbo A, Rajkumar SV, Dimopoulos MA, Richardson PG, San Miguel J, Barlogie B, Harousseau J, Zonder JA, Cavo M, Zangari M, Attal M, Belch A, Knop S, Joshua D, Sezer O, Ludwig H, Vesole D, Blade J, Kyle R, Westin J, Weber D, Bringhen S, Niesvizky R, Waage A, von Lilienfeld-Toal M, Lonial S, Morgan GJ, Orlowski RZ, Shimizu K, Anderson KC, Boccadoro M, Durie BG, Sonneveld P, Hussein MA, International Myeloma Working Group (2008) Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 22:414–423
Zonder JA, Barlogie B, Durie BG, McCoy J, Crowley J, Hussein MA (2006) Thrombotic complications in patients with newly diagnosed multiple myeloma treated with lenalidomide and dexamethasone: benefit of aspirin prophylaxis. Blood 108:403, author reply 404
Rajkumar SV, Blood E, Vesole D, Fonseca R, Greipp PR, Eastern Cooperative Oncology Group (2006) Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 24:431–436
Cavo M, Zamagni E, Tosi P, Cellini C, Cangini D, Tacchetti P, Testoni N, Tonelli M, de Vivo A, Palareti G, Tura S, Baccarani M (2004) First-line therapy with thalidomide and dexamethasone in preparation for autologous stem cell transplantation for multiple myeloma. Haematologica 89:826–831
Rome S, Doss D, Miller K, Westphal J, Nurse Leadership Board IMF (2008) Thromboembolic events associated with novel therapies in patients with multiple myeloma: consensus statement of the IMF Nurse Leadership Board. Clin J Oncol Nurs 12:21–28
Vij R (2011) Treatment-related adverse events in patients with relapsed/refractory multiple myeloma. Oncology 25(Suppl 2):45–55
Nucci M, Anaissie E (2009) Infections in patients with multiple myeloma. Semin Hematol 46:277–288
Mols F, Oerlemans S, Vos AH, Koster A, Verelst S, Sonneveld P, van de Poll-Franse LV (2012) Health-related quality of life and disease-specific complaints among multiple myeloma patients up to 10 yr after diagnosis: results from a population-based study using the PROFILES registry. Eur J Haematol 89:311–319
Coleman EA, Goodwin JA, Coon SK, Richards K, Enderlin C, Kennedy R, Stewart CB, McNatt P, Lockhart K, Anaissie EJ, Barlogie B (2011) Fatigue, sleep, pain, mood, and performance status in patients with multiple myeloma. Cancer Nurs 34:219–227
Hanna LR, Avila PF, Meteer JD, Nicholas DR, Kaminsky LA (2008) The effects of a comprehensive exercise program on physical function, fatigue, and mood in patients with various types of cancer. Oncol Nurs Forum 35:461–469
National Comprehensive Cancer Network (2014) Cancer-related fatigue version I. 2014
Smith LC, Bertolotti P, Curran K, Jenkins B, Nurse Leadership Board IMF (2008) Gastrointestinal side effects associated with novel therapies in patients with multiple myeloma: consensus statement of the IMF Nurse Leadership Board. Clin J Oncol Nurs 12:37–52
Wang M, Cheng J (2013) Overview and management of cardiac and pulmonary adverse events in patients with relapsed and/or refractory multiple myeloma treated with single-agent carfilzomib. Oncology
Chen N, Ye Y, Liu L, Reyes J, Assaf MS, Kasserra C, Zhou S, Palmisano M (2013) Lenalidomide at therapeutic and supratherapeutic doses does not prolong QTc intervals in the thorough QTc study conducted in healthy men. Basic Clin Pharmacol Toxicol 113:179–186
Colson K (2010) Nursing considerations in the treatment of multiple myeloma. Clin Care Opt
Richardson PG, Laubach JP, Schlossman RL, Mitsiades C, Anderson K (2010) Complications of multiple myeloma therapy, part 1: risk reduction and management of peripheral neuropathy and asthenia. J Natl Compr Cancer Netw 8(Suppl 1):S4–S12
Niesvizky R, Badros AZ (2010) Complications of multiple myeloma therapy, part 2: risk reduction and management of venous thromboembolism, osteonecrosis of the jaw, renal complications, and anemia. J Natl Compr Cancer Netw 8(Suppl 1):S13–S20
Kurtin S (2013) Clinical expert commentaries: subcutaneous administration of Bortezomib. Response Assess
Gado K, Domjan G (2013) Quality of life issues of patients with multiple myeloma. InTech open multiple myeloma - a quick reflection on the fast progress:275–288
Bilotti E, Faiman BM, Richards TA, Tariman JD, Miceli TS, Rome SI, International Myeloma Foundation Nurse Leadership Board (2011) Survivorship care guidelines for patients living with multiple myeloma: consensus statements of the international myeloma foundation nurse leadership board. Clin J Oncol Nurs 15(Suppl):5–8
Palumbo A, Bringhen S, Ludwig H, Dimopoulos MA, Blade J, Mateos MV, Rosinol L, Boccadoro M, Cavo M, Lokhorst H, Zweegman S, Terpos E, Davies F, Driessen C, Gimsing P, Gramatzki M, Hajek R, Johnsen HE, Leal Da Costa F, Sezer O, Spencer A, Beksac M, Morgan G, Einsele H, San Miguel JF, Sonneveld P (2011) Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN). Blood 118:4519–4529
Sharma A, Lokeshwar N (2005) Febrile neutropenia in haematological malignancies. J Postgrad Med 51(Suppl 1):S42–S48
Fritz E, Ludwig H, Scheithauer W, Sinzinger H (1986) Shortened platelet half-life in multiple myeloma. Blood 68:514–520
Barkhan P (1974) Blood and neoplastic diseases. Thrombocytopenia. Br Med J 2:324–325
Enrico O, Gabriele B, Nadia C, Sara G, Daniele V, Giulia C, Antonio S, Mario P (2007) Unexpected cardiotoxicity in haematological bortezomib treated patients. Br J Haematol 138:396–397
Baxer (2013) Cytoxan package insert
GlaxoSmithKline (2011) ALKERAN package insert
Boehringer-Ingelheim (2007) Dexamethasone package insert
San-Miguel JF, Richardson PG, Gunther A, Sezer O, Siegel D, Blade J, LeBlanc R, Sutherland H, Sopala M, Mishra KK, Mu S, Bourquelot PM, Victoria Mateos M, Anderson KC (2013) Phase Ib study of panobinostat and bortezomib in relapsed or relapsed and refractory multiple myeloma. J Clin Oncol 31:3696–3703
Merck (2013) ZOLINZA package insert
Siegel DS, Richardson P, Dimopoulos M, Moreau P, Mitsiades C, Weber D, Houp J, Gause C, Vuocolo S, Eid J, Graef T, Anderson KC (2014) Vorinostat in combination with lenalidomide and dexamethasone in patients with relapsed or refractory multiple myeloma. Blood Cancer J 4:e202
Lokhorst H, Plesner T, Gimsing P, Nahi H, Minnema MC, Lassen U, Krejcik J, Laubach J, Lisby S, Basse L, Richardson P (2013) Phase I/II dose-escalation study of daratumumab in patients with relapsed or refractory multiple myeloma. J Clin Oncol (suppl;abstr 8512)
Acknowledgments
William H. Fazzone, PhD, Amanda L. Kauffman, PhD, and Peter J. Simon, PhD, provided medical editorial assistance with this manuscript that was financially supported by Novartis Pharmaceuticals Corporation.
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Kathleen Colson consults and serves in an advisory role for Celgene, Millenium, Novartis, and Onyx.
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Colson, K. Treatment-related symptom management in patients with multiple myeloma: a review. Support Care Cancer 23, 1431–1445 (2015). https://doi.org/10.1007/s00520-014-2552-1
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DOI: https://doi.org/10.1007/s00520-014-2552-1