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Expert Rev Hematol. 2018 Dec;11(12):957-973. doi: 10.1080/17474086.2018.1538777. Epub 2018 Dec 4.

Triplet therapies - the new standard of care for multiple myeloma: how to manage common toxicities.

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a Division of Hematology, Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA.
b Division of Cardiology, Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA.
c Division of Medical Oncology, Department of Medicine , University of Washington , Seattle , WA , USA.


Introduction: Multiple three drug combination regimens have been approved for the treatment of multiple myeloma in the last few years. Triplets have become the new standard of care for transplant eligible and ineligible patients with newly diagnosed as well as relapsed multiple myeloma. Novel agents have a unique profile of side effects. The management of toxicities is important to maintain quality of life and maximize treatment duration and benefit. Areas covered: This article reviews efficacy data, incidence of key adverse events and provide recommendations and expert opinion regarding how to manage common toxicities in triplet therapies. Relevant publications and abstracts were searched in PubMed, ASH, ASCO and EHA meetings. Guidelines from IMWG, NCCN, ESMO and ASCO, published trial protocols and prescribing information were used to formulate recommendations for the management of toxicities. Expert commentary: Side effects are a critical factor guiding the selection of optimal chemotherapy regimens for multiple myeloma. The majority of toxicities encountered with triplet therapies are reversible and can be readily managed with supportive care and dose modifications.


Myeloma; adverse; management; three-drug; toxicity; triplets

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