Treatment and disease‐related complications in multiple myeloma: Implications for survivorship

Abstract

New treatments have transformed multiple myeloma into a chronic disease. Hence, optimal management of treatment and disease‐related complications remains a critical component of survivorship care. Survivorship care models in cancers requiring a fixed‐duration therapy may not be applicable to myeloma as patients are exposed to multiple lines of continuous therapy along the disease trajectory. Infections and secondary cancers, which are the most common therapy‐related causes of death in myeloma, need special consideration. Identifying patients at a high risk of toxicities will facilitate individualized treatment selection and designing clinical trials for protective strategies targeting those patients, for example, prophylactic antibiotic or immunoglobulin replacement for primary prevention of infections in high‐risk patients. Long‐term follow up of ongoing trials and epidemiologic data will be help identify the nature and trajectory of rare toxicities with a long latency like secondary cancers. Patients who are frail, have persistent renal insufficiency, and refractory to multiple lines of therapy need special attention. In this review, we discuss the incidence, risk‐factors, and management of treatment and disease‐related complications in myeloma, discuss knowledge gaps and research priorities in this area, and propose a survivorship care model to improve health‐care delivery to a growing pool of myeloma survivors.