Toxicity Management in Multiple Myeloma

Tanika Pittman, APRN, discusses practical strategies for maintaining patients with multiple myeloma on effective long-term therapy through proactive toxicity management, supportive care, and ongoing communication with the multidisciplinary team. She emphasizes intervening before adverse effects become severe enough to result in treatment discontinuation and describes the value of proactively asking patients about symptoms that may not be captured through routine laboratory monitoring, including neuropathy, sleep disturbances, fatigue, and challenges with medication use. Tanika also highlights the importance of identifying logistical barriers, such as difficulty obtaining oral therapy, that may affect adherence. The discussion reinforces that dose modification should not necessarily be viewed as compromising treatment; thoughtful adjustments may help patients remain on therapy when toxicity would otherwise lead to discontinuation. Tanika notes that treatment selection and dosing should account for factors such as organ dysfunction and cardiovascular or thrombotic risk, particularly in patients with comorbidities. She describes the APP role as creating an ongoing feedback loop between patients and the prescribing team. The faculty also recognize financial and logistical burden as important contributors to treatment adherence in multiple myeloma, alongside clinical toxicities such as nausea or neuropathy.