Understanding Adverse Events in Multiple Myeloma

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Nina Shah, MD: Understanding the adverse events from these particular studies and what has happened is important to understand what you’re going to choose for your patients. This is one of the other parts of myeloma decision making. It’s not just how well they’re going to do, but how poorly they won’t do. Meaning if you know your patient has a poor cardiovascular status, you’re not going to give them something that could potentially drop their blood pressure. For example, that person should not get a CAR T-cell therapy because there’s a very high chance that the person would has cytokine release syndrome [CRS] could also have low blood pressure. There are also patients who have renal insufficiency, and they cannot get conditioning chemotherapy with fludarabine and also cannot get CAR T-cell therapy. On the whole, giving yourself information, being educated, and giving the patients a lot of information—which is actually available very nicely from all the presentations—at least sets expectations. If the patients know that there’s a chance they’re going to have a fever with these novel regimens, they may have low blood pressure, they may have low blood counts, which is something that we expect for a lot of different agents in multiple myeloma, but at least these expectations are set and then these can be managed and mitigated sometimes by things like close monitoring. Grade 1 CRS can be addressed with things like tocilizumab [Actemra]. Ultimately, what you know is the adverse event pattern should be one of the major pathways that helps you guide how to choose which medication for each particular patient.