PMID- 21497966
OWN - NLM
STAT- MEDLINE
DCOM- 20110920
LR  - 20181201
IS  - 1532-1681 (Electronic)
IS  - 0268-960X (Linking)
VI  - 25
IP  - 4
DP  - 2011 Jul
TI  - Practical management of adverse events in multiple myeloma: can therapy be 
      attenuated in older patients?
PG  - 181-91
LID - 10.1016/j.blre.2011.03.005 [doi]
AB  - The current standard of care for elderly patients with newly diagnosed multiple 
      myeloma is melphalan and prednisone (MP) in combination with either bortezomib 
      (VMP) or thalidomide (MPT), with lenalidomide plus dexamethasone increasingly 
      being employed. The addition of bortezomib or thalidomide to the established MP 
      regimen significantly improves outcomes and prolongs survival in elderly and 
      transplant-ineligible patients. However, these benefits are accompanied by 
      increases in treatment-related adverse events (AEs), which may be particularly 
      pronounced in older individuals. Patients receiving bortezomib as part of a VMP 
      regimen commonly experience transient and cyclical thrombocytopenia and 
      neutropenia, along with gastrointestinal AEs. Fortunately, these AEs can be 
      managed with appropriate supportive care and, when necessary, adjustments in 
      dose. Peripheral neuropathy (PN) is the most important side effect of bortezomib, 
      and although it is reversible in a high proportion of patients, it affects their 
      quality of life. Furthermore, PN can require temporary or permanent withholding 
      of bortezomib, which will reduce treatment efficacy. PN is also a common adverse 
      effect of thalidomide; thromboembolic events are also a key concern, requiring 
      thromboprophylaxis in patients receiving thalidomide in combination. For 
      lenalidomide in combination with dexamethasone, the most clinically important 
      adverse effects are hematologic toxicity (particularly neutropenia) and 
      thromboembolic events. Recent phase III studies in newly diagnosed elderly 
      patients are providing further insight into the most appropriate treatment 
      regimens to maximize outcomes and minimize toxicity in individual patients. Of 
      note, once-weekly bortezomib dosing (in combination with MP+/-T) was shown to 
      reduce the incidence of peripheral neuropathy and gastrointestinal events 
      compared with twice-weekly dosing, while maintaining efficacy. Elderly patients 
      may be less able to withstand the AEs associated with newer treatment regimens 
      and combinations of multiple drugs, and may experience greater declines in 
      quality of life and, subsequently, reduced treatment adherence. It is therefore 
      critical that these patients are closely monitored and any emergent AEs promptly 
      and appropriately managed. For very elderly, frail patients, tailored therapy, 
      reduced intensity regimens, and adverse event management are necessary to 
      encourage treatment adherence and reduce discontinuation. This article will 
      provide practical guidance on the management of bortezomib-, thalidomide-, and 
      lenalidomide-associated AEs, to maximize treatment feasibility and active drug 
      delivered, and thus help minimize toxicity and maximize outcomes.
CI  - Copyright (c) 2011 Elsevier Ltd. All rights reserved.
FAU - Palumbo, Antonio
AU  - Palumbo A
AD  - Myeloma Unit, University of Torino, Azienda Ospedaliero-Universitaria (A.O.U.) S. 
      Giovanni Battista, Italy. appalumbo@yahoo.com
FAU - Mateos, Maria-Victoria
AU  - Mateos MV
FAU - Bringhen, Sara
AU  - Bringhen S
FAU - San Miguel, Jesus F
AU  - San Miguel JF
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20110416
PL  - England
TA  - Blood Rev
JT  - Blood reviews
JID - 8708558
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Boronic Acids)
RN  - 0 (Pyrazines)
RN  - 4Z8R6ORS6L (Thalidomide)
RN  - 69G8BD63PP (Bortezomib)
RN  - F0P408N6V4 (Lenalidomide)
SB  - IM
MH  - Aged
MH  - Antineoplastic Agents/*adverse effects/*therapeutic use
MH  - Boronic Acids/adverse effects/therapeutic use
MH  - Bortezomib
MH  - Clinical Trials, Phase III as Topic
MH  - Humans
MH  - Lenalidomide
MH  - Multiple Myeloma/*therapy
MH  - Pyrazines/adverse effects/therapeutic use
MH  - Thalidomide/adverse effects/analogs & derivatives/therapeutic use
EDAT- 2011/04/19 06:00
MHDA- 2011/09/21 06:00
CRDT- 2011/04/19 06:00
PHST- 2011/04/19 06:00 [entrez]
PHST- 2011/04/19 06:00 [pubmed]
PHST- 2011/09/21 06:00 [medline]
AID - S0268-960X(11)00032-4 [pii]
AID - 10.1016/j.blre.2011.03.005 [doi]
PST - ppublish
SO  - Blood Rev. 2011 Jul;25(4):181-91. doi: 10.1016/j.blre.2011.03.005. Epub 2011 Apr 
      16.