Treatment Advances Make Supportive Care More Important in Multiple Myeloma

As patients with multiple myeloma (MM) live longer thanks to advancements in treatments, more attention is being paid to treatment-related toxicities that are becoming more relevant.

Two studies presented at the 60th American Society of Hematology Annual Meeting & Exposition delved into the symptoms of treatment and the potential impact supportive care can have for patients. Patients with MM report high rates of bone pain, skeletal events, and infections.

One study¹ reviewed a total of 36 articles on supportive care for patients with MM published after 2004 and found management of complications arising from treatment is necessary to improve quality of life for patients.

For instance, patients on bortezomib or carfilzomib plus herpes zoster prophylaxis had a reduced risk of herpes zoster reactivation versus a group that didn’t receive the prophylaxis (2.4% vs 5.8%). Another study found that plasmapheresis reduced dialysis dependency in patients with renal impairment. Patients treated with plasmapheresis and chemotherapy had a lower 6-month dialysis dependency ratio compared with patients on chemotherapy alone (15.6% vs 37.2%).

In addition, bortezomib caused peripheral neuropathy in 37% of patients, but dose modifications caused peripheral neuropathy to improve in 68% of patients. When patients were treated with duloxetine, a selective serotonin and norepinephrine reuptake inhibitor that treats nerve pain, there was a significant improvement in peripheral neuropathy compared with placebo.

The second study² reviewed the extent to which supportive care measures are used. The authors analyzed 1569 patients age 65 or older who had been diagnosed with MM between 2008 and 2013. They found that 66% of the patients on active MM therapy received bisphosphonates, which prevent loss of bone density, within 12 months of diagnosis; 53% of patients received the influenza vaccine during the first flu season following their diagnosis; and 44% received antiviral prophylaxis during therapy.

Factors that predicted a lack of use of bisphosphonates included older age (85-plus years), non-Hispanic black and Hispanic ethnicity, and a higher comorbidity index. Non-Hispanic black ethnicity was also a predictor of not receiving a flu shot.

“We found significant under-utilization of supportive care measures focused at bone health and infection prevention among elderly adults with MM in the US,” the authors wrote. “Similar to prior work evaluating utilization of novel MM therapies and transplantation, we found significant racial disparities in receipt of MM supportive care.”

1. Qureshi A, Tariq MJ, Shah Z, et al. Evidence based recommendations for supportive care in multiple myeloma. Presented at the 60th American Society of Hematology Annual Meeting & Exposition; December 1, 2019. San Diego, CA. Abstract 1952.

2. Giri S, Zhu W, Wang R, et al. Racial disparities in the utilization of recommended supportive care among patients with multiple myeloma in the United States. Presented at the 60th American Society of Hematology Annual Meeting & Exposition; December 3, 2019. San Diego, CA. Abstract 978.

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