Treatment and disease‐related complications in multiple myeloma: Implications for survivorship

Abstract

New treatments have transformed multiple myeloma into a chronic disease. Hence, optimal management of treatment and disease‐related complications remains a critical component of survivorship care. Survivorship care model in cancers requiring a fixed‐duration therapy may not be applicable to myeloma, since patients are exposed to multiple lines of continuous therapy along the disease trajectory. The two most common therapy‐related causes of death, which require special consideration, are infection and second cancers. Identifying patients at a high risk of toxicities will facilitate individualized treatment selection and designing clinical trials for protective strategies targeting those patients. For example, prophylactic antibiotic or immunoglobulin replacement can be tested for primary prevention of infections in high‐risk patients. Long‐term follow up of ongoing trials and epidemiologic data will help identify the nature and trajectory of rare toxicities with a long latency, such as secondary cancers. Patients who are frail, have persistent renal insufficiency, and refractory to multiple lines of therapy need special attention regarding treatment toxicity and quality of life. In this review, we discuss the incidence, risk‐factors, and management of treatment and disease‐related complications in myeloma, discuss knowledge gaps and research priorities in this area, and propose a survivorship care model to improve health‐care delivery to a growing pool of myeloma survivors.

Cardiovascular Toxicity of Carfilzomib: The Real-World Evidence Based on the Adverse Event Reporting System Database of the FDA, the United States

“…Subsequently, Waxman et al performed the first meta-analysis investigating the potential association of carfilzomib with cardiovascular AEs, concluding that carfilzomib was associated with an augmented risk of high-grade and all-grade cardiovascular events compared with noncarfilzomib-receiving controls ( 8 ). Currently, the precise pathogenesis of cardiovascular events in carfilzomib receivers has not been completely understood, though several underlying mechanisms included endothelial effects, proteasome inhibition, and cardiorenal syndrome were proposed ( 28 , 29 ). More mechanistic studies are needed in the future to unravel the mechanism of the carfilzomib-associated cardiovascular toxicity.…”

Epidemiology, Staging, and Management of Multiple Myeloma

“…With the advancement in the treatment options, myeloma is more like a chronic disease and the goal of the therapy is to prevent end-organ damage and to attain disease-free survival [ 50 ]. The complications could be secondary to the disease itself or drug induced.…”

Recommendations on the management of multiple myeloma in 2020

“…Apart from personal risk factors (age, obesity, inherited thrombophilia, familial history of thrombosis, surgery, immobilization, presence of catheter), MM patients presented an increased risk of thrombosis that is significantly enhanced by the use of high-dose dexamethasone, anthracyclines, growth factors (EPO), IMiDs and carfilzomib [109].…”