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How to Manage the Side Effects of Multiple Myeloma Treatment

Medically Reviewed by Neha Pathak, MD on March 29, 2021

Your multiple myeloma treatments fight your cancer and can save your life. They can also give you side effects that are tough to take, like feeling very tired or throwing up.

You might not get these problems or other ones. But if you do, talk to your doctor. They can help you find ways to feel better while you stay on your treatment plan.

Why Do Side Effects Happen?

Medications, radiation, and other cancer treatments destroy cancer cells, but they can also damage healthy ones in the process. Others make your immune system weak, which makes it harder for your body to fight off infections.

Most people who get multiple myeloma treatment will have some common side effects. Even if you can’t prevent them, you can try a few things to get some relief. Often, side effects go away when your treatment is over.

Anemia

When chemotherapy (or chemo) drugs for myeloma kill off cancer cells, they may also harm red blood cells in your bone marrow. When you don’t have enough of these red blood cells you have a condition called anemia. You may feel tired, weak, dizzy, or have swollen ankles. After a stem cell transplant, your body may also make fewer red blood cells for a while.

What you can do: A blood transfusion may replace some of the cells you’ve lost, especially after a stem cell transplant. Erythropoiesis-stimulating agents, also called ESA drugs, like epoetin alfa (Procrit), help your body make new red blood cells. Iron supplements also can help with anemia.

Appetite Changes

Many of the treatments for multiple myeloma can change your eating habits. Chemotherapy and drugs called proteasome inhibitors, histone deacetylase inhibitors, and monoclonal antibodies may make you less hungry. Steroids can also affect your appetite.

What you can do: If you don’t have much of an appetite, try nutritional supplement drinks. Aim for five or six small meals a day, and snack whenever you’re hungry. Choose foods high in calories and protein such as yogurt, cheeses, eggs, milkshakes, and protein bars. Drink fluids between meals, especially higher-calorie ones like sports drinks. Steroid side effects like hunger should go away after you stop taking the drug.

Bleeding

A stem cell transplant and some chemo drugs lower your numbers of platelets, the parts of your blood that help it clot when blood vessels are injured. If your platelet count gets too low, you might bruise and bleed more easily.

What you can do: The problem should go away soon after you stop these treatments, but you may need blood transfusions if you lose too much blood. You may also need platelet transfusions. Be careful when you move around to avoid getting cuts and bruises.

Blood Clots

When you take IMiD drugs -- lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid) -- with a steroid called dexamethasone, you may raise your chances of getting blood clots. When they build up in certain veins, you can get deep vein thrombosis (DVT).

What you can do:Aspirin or blood thinners like heparin may lower your risk of getting blood clots. Also, stay as active as you can, keep your weight under control, and don’t smoke.

Bone Weakness and Dental Problems

Many people with myeloma take bisphosphonate drugs to strengthen their bones. But in rare cases, these drugs can make your jawbone weak.

What you can do: Tell your dentist what medications you take before you have any dental work. Get regular dental checkups to look for signs of jaw damage. Basic oral hygiene helps too -- brush your teeth and floss regularly.

Fatigue

Chemotherapy drugs, monoclonal antibodies, and interferon can make you feel weak or tired.

What you can do: Your doctor may be able to change your medication dosage to keep you from feeling so run down. A healthy diet and drinking enough water can help, too.

Graft vs. Host Disease

This can be a serious side effect of stem cell transplants from another person, called allogeneic transplants. It happens when the donor’s stem cells attack yours, causing dangerous inflammation.

What you can do: Your doctor can give you medication to prevent graft vs. host disease or to manage it, if you get it.

Hair Loss

Depending on the drug, chemo can make some, or all, of your hair fall out.

What you can do: Your hair will usually grow back after treatment. Talk to your doctor about “cold caps” to wear during chemo. Some studies have found that they may help prevent hair loss.

Infections

A stem cell transplant may make your immune system weak for a few weeks, which makes it hard to fight off serious infections like pneumonia. Chemotherapy drugs can lower your numbers of disease-fighting white blood cells. Some people get infections after they have surgery to fix damaged bones, too.

What you can do: If you have an infection, your doctor may give you antibiotics. You should avoid people who are sick. Anyone who comes to see you in the hospital after a stem-cell transplant will have to wear masks and gloves. At home, wash your hands often and avoid touching your or your pet’s poop. You’ll even need to keep flowers out of your home. They may have fungi that cause infections.

Mood or Emotion Changes

Multiple myeloma and its treatment can be hard on you and your loved ones. It’s common to have some mood swings or emotional changes. Drugs like thalidomide and steroids might also cause mood swings.

What you can do: Talk to your doctor about palliative, or supportive, care to help you manage your emotions. This can be just as important as treatment for the cancer itself. If you have a hard time sharing what you’re going through, it might help to talk to a social worker or a counselor. Research has also found that low- to moderate-intensity exercise may boost your mood. Your doctor can help you make an exercise plan.

Mouth Sores

After you have chemotherapy and radiation, you can get painful sores inside your mouth.

What you can do: They usually go away soon after treatment. Your doctor can give you a medicine to numb the pain for a while so you can eat and drink more comfortably.

Neuropathy

Myeloma drugs like bortezomib (Velcade) and IMiD drugs can make your hands or feet hurt, tingle, burn, or feel numb.

What you can do: Your doctor could lower your medicine dosage or even stop using that drug if your pain gets too bad. They can also give you a separate medication to ease these symptoms.

Pain

Surgery to fix bones damaged by myeloma can also cause temporary pain.

What you can do: Pain-relieving drugs can make you feel better for the few days after surgery.

Sleep Problems

Trouble sleeping is a common side effect of steroids like dexamethasone.

What you can do: Avoid alcohol and caffeine, and limit your screen time in the hours before bed. If you find that you have problems sleeping soon after you take a steroid, try to take it in the morning. But if the effects take a while, take your dose just before bed.

Stomach Problems

Meds like bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro) can cause constipation, diarrhea, nausea, or vomiting. Other chemotherapy drugs, bisphosphonates, and radiation treatments can make you queasy or throw up. Steroids may also make your stomach upset.

What you can do: Stool softeners or laxatives can ease constipation. You can also drink more fluids, eat high-fiber foods, and stay active to get your digestion moving. Anti-diarrheal drugs can help with diarrhea, as can drinking fluids and a low-fiber diet. You can also take meds to ease nausea, and it’s helpful to eat smaller meals more often throughout the day if you feel sick to your stomach.

WebMD Medical Reference

Sources

SOURCES:

American Cancer Society.

National Comprehensive Cancer Network: “Guide for Patients: Multiple Myeloma.”

Multiple Myeloma Research Foundation.

National Blood Clot Alliance: “Blood Clot Risk and What You Can Do.”

American College of Rheumatology: “Osteonecrosis of the Jaw.”

Macmillan Cancer Support UK.

Johns Hopkins Medicine: “Vertebroplasty.”

North American Spine Society: “Spinal Infections.”

National Cancer Institute.

American Cancer Society: “Drug Therapy for Multiple Myeloma,” “Cooling Caps (Scalp Hypothermia) to Reduce Hair Loss.”

American Society of Clinical Oncology: “Appetite Loss,” “Side Effects of a Bone Marrow Transplant (Stem Cell Transplant),” “Multiple Myeloma: Types of Treatment,” “Multiple Myeloma: Coping with Treatment.”

University of Rochester Medical Center: “Multiple Myeloma: Chemotherapy and Targeted Therapy.”

Cancer Nursing: “Fatigue, Sleep, Pain, Mood and Performance Status in Patients with Multiple Myeloma.”

International Myeloma Foundation: “Dexamethasone (Steroid) Side Effects.”

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