Managing Treatment Side Effects
- The main treatments for relapsed multiple myeloma are drugs that act on the immune system or target cancer cells in specific ways.
- These medications can keep your cancer at bay, but they also may cause side effects ranging from nerve damage and blood clots to an increased risk for infections.
- Let your doctor know if you have side effects, so they can lower the dose of the drug or add a treatment like a blood thinner to manage them.
“Fortunately, the treatments that we have for multiple myeloma are overall very well tolerated,” Dr. Sumit Madan, multiple myeloma specialist at Banner MD Anderson Cancer Center in Arizona, tells SurvivorNet. “But all of our drugs have certain specific side effects.”
Read MoreImmunomodulator Side Effects
Drugs like thalidomide (brand name: Thalidomid), lenalidomide (brand name: Revlimid), and pomalidomide (brand name: Pomalyst) work on your immune system to treat your cancer.Some of the main side effects from these drugs are:
- Low blood cell counts
- Blood clots
- Fatigue
- Diarrhea
- Nerve damage
Proteasome Inhibitor Side Effects
Ixazomib (brand name: Ninlaro), carfilzomib (brand name: Kyprolis), and bortezomib (brand name: Velcade) are part of a class of medications called proteasome inhibitors. They block an enzyme that breaks down the proteins in your cells that control cell division. This prevents cancer cells from multiplying quickly, but it can sometimes affect healthy cells too, leading to side effects like:
- Nausea and vomiting
- Diarrhea
- Constipation
- Tiredness
- Fever
- Appetite loss
- Low blood cell counts
- Numbness and tingling from nerve damage in the hands and feet
- Increased risk of infections such as shingles
Kyprolis can also cause serious heart, kidney, or liver problems. Dr. Madan says doctors often avoid this drug in people who have existing heart conditions because of its tendency to boost blood pressure.
Monoclonal Antibody Side Effects
Monoclonal antibodies are man-made versions of natural proteins, which have been redesigned to attack proteins on the surface of cancer cells. The ones doctors use to treat multiple myeloma are:
- Daratumumab (Darzalex)
- Elotuzumab (Empliciti)
- Isatuximab-ifrc (Sarclisa)
Along with causing skin reactions at the injection site, these drugs can have side effects like:
- Tiredness
- Nausea
- Low blood cell counts
- Back pain
- Fever
- Bleeding and bruising
Managing Multiple Myeloma Treatment Side Effects
Before you start taking one of these medications, it’s a good idea to go over all the possible side effects with your doctor and learn how you can manage them. Sometimes you can reduce or avoid some of these problems by changing the way you get the medication. For example, giving a proteasome inhibitor under the skin can reduce your risk for nerve damage.
Medications are also available to prevent some side effects, such as anti-nausea drugs and drugs that boost white blood cell counts. Your doctor might put you on an antiviral medicine while you take Velcade to prevent you from getting shingles.
RELATED: How Are Multiple Myeloma Patients Monitored for Recurrence?
Blood clots are a big concern with immunomodulators. The worry with a clot is that it could break free and travel to your heart or brain, cutting off blood flow to these essential organs. “We need to make sure that all patients on an immunomodulator are on some kind of anticoagulation [blood thinner],” Dr. Madan says. Your doctor might prescribe aspirin, or a newer blood thinner such as apixaban (brand name: Eliquis).
Because many multiple myeloma drugs lower white blood cell counts, they can leave your body more vulnerable to infection. You may need to be extra careful to avoid getting sick; for example by avoiding anyone who is sick, getting up to date on your vaccinations, and washing your hands several times a day.
If you do develop serious side effects like nerve damage while on one of these medications, your doctor will lower the dose, Dr. Madan says.
Talk to Your Doctor
Remember that everyone responds differently to these medications. Some people don’t have any side effects, while others experience a lot of problems from their cancer drugs. If you aren’t tolerating your medications very well, let your doctor know about it. Once your doctor knows what’s going on, they can offer advice and treatments to help you feel better.
Learn more about SurvivorNet's rigorous medical review process.
