| Drug class | Considerations |
| Immunomodulatory drugs |
- Lenalidomide
- Pomalidomide
- Thalidomide
| - Antithrombotic prophylaxis
- Dose adjustments for renal dysfunction
- May impair stem cell mobilization
- Increased risk of second primary malignancies
|
| Proteasome inhibitors |
- Bortezomib
- Carfilzomib
- Ixazomib
| - Increased risk of herpes zoster and infections related to neutropenia
- Risk of peripheral neuropathy varies with agent
- Dose adjustments for hepatic dysfunction
- Rare cases of reversible posterior leukoencephalopathy syndrome
- Heart failure and hypertension
- Acute renal failure with carfilzomib
|
| Monoclonal antibodies* |
- Daratumumab
- Isatuximab
- Elotuzumab
| - Acute and delayed infusion reactions
- Daratumumab, isatuximab, and elotuzumab associated with increased risk of herpes zoster and opportunistic infections
- Daratumumab, isatuximab, and elotuzumab may be detected on SPEP and immunofixation assays as IgG-kappa
- Daratumumab and isatuximab can interfere with cross-matching and red blood cell antibody screening
- Elotuzumab-induced hepatotoxicity
|
| Alkylating agents |
- Melphalan
- Cyclophosphamide
| - GI toxicity and immune suppression with all doses
- Mucositis and alopecia with intermediate- or high-dose therapy
|
| Other drugs |
| | - Infusion reactions, irritant with vesicant-like properties, GI toxicity, bone marrow suppression, increased serum bilirubin
|
| | - Cardiomyopathy, vesicant, secondary malignancy, myelosuppression, alopecia
|
| | - Cardiomyopathy, infusion reactions, hand-foot syndrome, GI toxicity, secondary malignancy, myelosuppression
|
- Corticosteroids (eg, dexamethasone, prednisone)
| - GI toxicity, hyperglycemia, immune suppression, insomnia, altered mood, fluid retention
|
| | - Limited off-label use in t(11;14) myeloma
|
| | - Hyponatremia, GI toxicity, neurologic toxicity
|
| CAR-T cell therapy |
- Idecabtagene vicleucel
- Ciltacabtagene autoleucel
| - REMS program; cytokine release syndrome, neurologic toxicity, hypersensitivity reactions, serious infections, prolonged cytopenias, prolonged hypogammaglobulinemia, hemophagocytic lymphohistiocytosis/macrophage activation syndrome, effects on ability to drive and use machines, and second malignancies
|
| Bispecific antibodies |
- Teclistamab (targets BCMA and CD3)
- Elranatamab (targets BCMA and CD3)
- Talquetamab (targets GPRC5D and CD3)
| - REMS program; cytokine release syndrome, neurologic toxicity, hypersensitivity reactions, serious infections, hepatotoxicity
- Additional toxicities with talquetamab include oral toxicity, weight loss, skin toxicity, and nail toxicity
|
