First-line treatment for multiple myeloma generally includes a combination of:

  1. Proteasome inhibitors such as bortezomib (Velcade). These block digestion of proteins produced by MM cells.
    Potential side effects:
    • Peripheral neuropathy
    • Thrombocytopenia (low blood platelet count)
    • Neutropenia (low blood neutrophil count)
    • Anemia (low red blood cell and/or hemoglobin count)
    • Fatigue
    • Diarrhea

  2. Immunomodulatory drugs (IMiDs) such as lenalidomide (Revlimid) and thalidomide (Thalomid). These help the immune system fight multiple myeloma cells. These are also used for maintenance therapy, which can help prolong remission after successful first-line treatment.
    Potential side effects:
    • Drowsiness
    • Fatigue
    • Constipation
    • Leukopenia (low white blood cell count)
    • Neutropenia (low blood neutrophil count)
    • Neuropathy
    • There is also an increased risk of serious blood clots that start in the leg and can travel to the lungs. These are more common on thalidomide than on other multiple myeloma drugs.

  3. Chemotherapy with agents like cyclophosphamide (Cytoxan). These stop or slow the growth of multiple myeloma cells.
    Potential side effects:
    • Leukopenia (low white blood cell count)
    • Anemia (low red blood cell and/or hemoglobin count)
    • Thrombocytopenia (low blood platelet count)
    • Hair loss
    • Nausea and vomiting
    • Loss of appetite
    • Loss of fertility
    • Discoloration of the skin or nails

    Less common side effects:
    • Diarrhea
    • Mouth sores
    • Bladder problems, including irritation and bleeding

  4. Steroids such as dexamethasone. These kill multiple myeloma cells and reduce inflammation.
    Potential side effects:
    • Increased infection risk
    • Water retention
    • Increased blood pressure
    • Slow wound healing
    • Rashes or acne
    • Increased blood glucose
    • Nausea, vomiting, hiccups, bloating, decreased appetite

Second-Line or Later Therapy:

These treatments are used if multiple myeloma returns or doesn’t respond to first-line therapy. They may include any of the first-line treatments that weren’t used initially, or:

Monoclonal antibodies (MoAbs) such as daratumumab (Darzalex), elotuzumab (Empliciti), isatuximab-irfc (Sarclisa), and belantamab mafodotin-blmf (Belamaf). These are synthetic proteins that act like naturally occurring antibodies in the immune system.

Side effects of these include:
  • Increased risk of bleeding
  • Increased risk of infection
  • Fatigue related to anemia
  • Visual changes or ocular toxicity

Multiple Myeloma Treatment Side Effects

Side effects can often be prevented or managed.

Here are some tips on what you can do for:

  1. Immune system effects such as increased risk of infection, low blood counts, and fever.
    What you can do:
    • Wash your hands often, especially before eating and after using the restroom.
    • Avoid contact with people who are sick.
    • Check your temperature regularly and let your care team know if it goes over 101 degrees.
    • Let your care team know of any new cough or other signs of infection such as flu-like symptoms or a sore that is not healing.

  2. Cardiac effects, such as changes in blood pressure, fluid retention, new or worsening heart failure, fatigue due to anemia, and risk of bleeding or bruising due to low platelet count.
    What you can do:
    • Stay active. Even short but frequent activities such as a walk in your neighborhood can help.
    • Follow your care team’s advice for monitoring your blood pressure or having lab work done. Be sure to notify your  team of any signs of bleeding such as nosebleeds, gum bleeding, blood in urine or stool, new bruises, or rashes. Also let your team know if you have:
      • Extreme fatigue, dizziness, or heart palpitations. 
      • New swelling, pain, or redness in your hands or feet.

  3. Neurological effects such as numbness, tingling, stabbing, or burning pain in your hands or feet, or tremors.
    What you can do:
    • Report any new or worsening symptoms to your healthcare team. They may prescribe medications such as gabapentin to help manage the discomfort.

  4. Respiratory effects, such as shortness of breath and respiratory infections.
    What you can do:
    • Report any new cough or shortness of breath to your team. 

  5. Endocrine effects, such as increased blood sugar.
    What you can do:
    • Follow your team’s advice for monitoring your blood sugar. This might include using a glucometer machine at home. Your healthcare team may prescribe medications such as oral hypoglycemics or insulin to help manage your blood sugar.

  6. Skin problems, such as slow wound healing or rash.
    What you can do:
    • These can usually be managed by careful cleaning of open wounds, but you should report any new rash to your healthcare team

  7. GI effects: Oral mucositis, nausea, vomiting, bloating, appetite changes, heartburn, diarrhea, changes in liver function, constipation.
    What you can do:
    • Try eating small, frequent meals instead of large meals at breakfast, lunch, and dinner.
    • Avoid spicy, fatty, or fried foods. 
    • Take anti-nausea medications before eating.
    • Drink plenty of fluids. 
    • Take anti-diarrheal medications as prescribed and avoid dairy if you are having diarrhea.
    • If you develop constipation, talk with your healthcare team about foods or medications to help, drink fluids, and stay active.

You may also experience other effects during treatment, such as:

  • Headaches.
  • Sleep problems.
  • Musculoskeletal effects like pain, muscle weakness, or osteoporosis.
  • Eye problems such as optic nerve damage, eye infections, cataracts, or blurred vision.
  • Mental health issuesincluding mood swings, irritability, and personality changes. 

Unique reactions can also occur, including interference with certain types of medical tests or infusion reactions and allergic-type reactions. Talk to your healthcare team about any concerns you have or symptoms you experience.