Treating Multiple Myeloma: Common Side Effects to Watch Out For
Being aware of side effects can help pick the treatment that’s right for you.
Before starting treatment for multiple myeloma—a cancer of the plasma cell, which is a type of white blood cell made in the bone marrow—it’s important to be aware of the side effects you may experience. Knowing how certain therapies will affect your life can help you find the treatment plan that’s right for you.
Here are the main treatments for multiple myeloma and the side effects that may occur:
Chemotherapy kills cancer cells but can also damage normal, healthy cells. “It’s the high-dose chemotherapy that treats the myeloma, and then we use stem cells to help you recover quickly,” says Adriana Rossi, MD, associate clinical director of the Myeloma Center at Weill Cornell Medicine and NewYork-Presbyterian.
Common side effects of chemo may include:
Hair loss
Mouth sores
Loss of appetite
Nausea and vomiting
And low blood counts.
Stem cell (bone marrow) transplantation. “We use stem cells that come from the bone marrow, and we now collect them through an IV in your arm to help you recover from high-dose chemotherapy,” says Dr. Rossi. “With a stem cell transplant, we’re really rebooting the immune system.”
A stem cell transplant can be done using the patient’s own stem cells (autologous transplantation) or from a donor (allogeneic transplantation). In multiple myeloma, most transplants are performed using the patient’s own stem cells.
Some side effects of stem cell transplants may include:
Fatigue
Mouth and throat pain
Nausea and vomiting
Infections
Bleeding
And lung problems, such as pneumonia.
Corticosteroids (steroids) are an important part of the treatment of multiple myeloma. “They really enhance the response to every other drug that we use,” says Dr. Rossi.
Common side effects of these drugs may include:
High blood sugar
Increased appetite and weight gain
Problems sleeping
Changes in mood (some people become irritable or “hyper”)
Weakening of the bones
And a suppressed immune system.
Most of these side effects go away over time after the patient stops taking the medicine.
Proteasome inhibitors work by stopping enzyme complexes (proteasomes) in cells from breaking down proteins that are important for cell division. “Proteasome inhibitors are very commonly used and generally well tolerated,” says Dr. Rossi.
However, this treatment may cause:
Nerve damage (peripheral neuropathy)
Constipation
And low platelet counts.
Monoclonal antibodies are a type of immunotherapy. “Monoclonal antibodies are the newest class of drugs that we have in myeloma and they’re incredibly well tolerated,” says Dr. Rossi. Monoclonal antibodies treat multiple myeloma by attacking specific substances (antigens) on the surface of the cancer cells.
“Other than an allergic reaction, usually to the first dose, there are very few side effects,” says Dr. Rossi.
If you begin to experience side effects, your cancer care team can help. “It’s very important to maintain close communication with your physician, especially during that first cycle of new therapy, as your body gets used to not only the treatments, but [also] the other medicines that we use to prevent side effects,” says Dr. Rossi. “[If] a treatment either stops working or has side effects that the patient finds intolerable, that’s a reason for us to find a new line of therapy.”
Adriana Rossi, MD, is the Associate Clinical Director of the Myeloma Center at Weill Cornell Medicine and NewYork-Presbyterian.
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The best way to alleviate symptoms due to
myeloma is to treat the disease itself.
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Should a treatment either stop working or
have side effects that the patient finds
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intolerable, that's a reason for
us to find a new line of therapy.
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It's very important to maintain close
communication with your physician,
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especially during that first cycle
of a new therapy as your body gets
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used to not only the treatments, but
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the other medicines that we
use to prevent side effects.
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It's the high-dose chemotherapy
that treats the myeloma, and
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then we use the stem cells
to help you recover quickly.
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The most common side effects are hair
loss, fatigue, and diarrhea.
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Stem cell transplants are what we
used to call bone marrow transplants.
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We use stem cells that come from the bone
marrow, and we now collect them through
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an IV in your arm, to help you
recover from high-dose chemotherapy.
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With the stem cell transplant, we're
really rebooting the immune system, which
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leads to fatigue and low white blood cells
that can increase your risk for infection.
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Steroids are a part of almost
all therapies for myeloma.
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They really enhance the response
to every other drug that we use.
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We dose it usually weekly.
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They tend to cause insomnia,
increased appetite, increased energy.
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Patients will have one day of being very
high and then one day of being very low,
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and then start to feel better
in time to do it again.
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Proteasome inhibitors
are very commonly used and
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generally very well tolerated, but
it can cause peripheral neuropathy.
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It's very important that we pick up on
any worsening peripheral neuropathy and
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adjust the therapy quickly.
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It can also cause constipation and
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low platelet counts, so the doctor will
be checking the blood counts regularly.
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Monoclonal antibodies are the newest class
of drugs that we have in myeloma, and
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they're incredibly well tolerated.
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Other than an allergic reaction,
usually to the first dose,
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there are very few side effects.
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It's very important that you tell
your doctor about any symptoms that
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you're having.
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Many times there are different options for
treatment or
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ways to mitigate the toxicity.
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Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment–Patient Version. National Cancer Institute. (Accessed on June 25, 2019 at https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq)
Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics). UpToDate. (Accessed on June 25, 2019 at https://www.uptodate.com/contents/multiple-myeloma-symptoms-diagnosis-and-staging-beyond-the-basics)
Multiple myeloma treatment (Beyond the Basics). UpToDate. (Accessed on June 25, 2019 at https://www.uptodate.com/contents/multiple-myeloma-treatment-beyond-the-basics)
Stem Cell Transplant Side Effects. American Cancer Society. (Accessed on June 26, 2019 at https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant/transplant-side-effects.html)