1
|
Ludwig H, Delforge M, Facon T, Einsele H, Gay F, Moreau P, Avet-Loiseau H, Boccadoro M, Hajek R, Mohty M, Cavo M, Dimopoulos MA, San-Miguel JF, Terpos E, Zweegman S, Garderet L, Mateos MV, Cook G, Leleu X, Goldschmidt H, Jackson G, Kaiser M, Weisel K, van de Donk NWCJ, Waage A, Beksac M, Mellqvist UH, Engelhardt M, Caers J, Driessen C, Bladé J, Sonneveld P. Prevention and management of adverse events of novel agents in multiple myeloma: a consensus of the European Myeloma Network. Leukemia 2018; 32:1542-1560. [PMID: 29720735 PMCID: PMC6035147 DOI: 10.1038/s41375-018-0040-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 01/03/2023]
Abstract
During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved the treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drug classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.
Collapse
Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria.
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Catholic University Leuven, Leuven, Belgium
| | - Thierry Facon
- Department of Hematology, Lille University Hospital, Lille, France
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Philippe Moreau
- Department of Hematology, University Hospital, University of Nantes, Nantes, France
| | - Hervé Avet-Loiseau
- Centre de Recherches en Cancerologie de Toulouse CRCT, Institut National de la Sante et de la Recherche Medicale, Université Toulouse, Toulouse, France
| | - Mario Boccadoro
- Division of Hematology, Citta della Salute e della Scienza, University of Torino, Torino, Italy
| | - Roman Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - Michele Cavo
- A 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jesús F San-Miguel
- Department of Hematology, Clinica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Laurent Garderet
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - María-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - Gordon Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, PRC, and Inserm CIC1402, Hospital de la Miléterie, Poitiers, France
| | - Hartmut Goldschmidt
- National Center for Tumor Diseases, Heidelberg Medical University, Heidelberg, Germany
| | - Graham Jackson
- Department of Hematology, Newcastle University, Newcastle, UK
| | - Martin Kaiser
- Myeloma Group, The Institute of Cancer Research ICR, London, UK
| | - Katja Weisel
- Department of Hematology and Oncology, University of Tuebingen, Tuebingen, Germany
| | | | - Anders Waage
- Department of Hematology, St. Olavs Hospital, and IKOM, NTNU, Trondheim, Norway
| | - Meral Beksac
- Department of Medicine, Ankara University, Ankara, Turkey
| | - Ulf H Mellqvist
- Department of Hematology, Sahlgrenska Hospital, Gothenburg, Sweden
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - Jo Caers
- Department of Hematology, University Hospital of Liège, Liège, Belgium
| | - Christoph Driessen
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Joan Bladé
- Department of Hematology, Amyloidosis and Myeloma Unit, Hospital Clínic de Barcelona, Spain
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Abstract
This review gives an overview of autonomic dysfunction encountered in Guillain-Barré syndrome (GBS) and multiple sclerosis (MS). In GBS, cardiovascular dysregulation is common and may lead to serious bradyarrhythmias that need to be recognised for the early initiation of appropriate therapy. Although standardised autonomic tests were useful for the diagnosis of autonomic failure, they were not able to indicate vagal over-reactivity. In this regard, eyeball pressure testing may correctly identify patients at risk for impending and potentially life-threatening bradyarrhythmias which may easily be administered at the bedside. In MS, cardiovascular autonomic dysfunction is usually of minor clinical importance. However, orthostatic intolerance may be present in approximately 50% of patients and could easily be detected by routine measurements of heart rate and blood pressure during rest and during standing. More subtle alterations may require more sophisticated methods such as autonomic reflex testing or baroreflex stimulation. Several in vitro, animal and clinical studies provide evidence that there are many interactions between the sympathetic nervous system and the immune system giving rise to the hypothesis that autonomic dysfunction in MS may not only be a consequence of the disease, but may in itself affect the course of MS.
Collapse
Affiliation(s)
- Peter Flachenecker
- Neurological Rehabilitation Center "Quellenhof", Kuranlagenallee 2, 75323, Bad Wildbad, Germany.
| |
Collapse
|
5
|
Dodt C, Gunnarsson T, Elam M, Karlsson T, Wallin BG. Central blood volume influences sympathetic sudomotor nerve traffic in warm humans. ACTA PHYSIOLOGICA SCANDINAVICA 1995; 155:41-51. [PMID: 8553876 DOI: 10.1111/j.1748-1716.1995.tb09946.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objective of this study was to test whether changes in central blood volume can induce reflex effects on sweating. Multi-unit skin sympathetic nerve activity (SSA) was recorded from the posterior cutaneous nerve of the forearm or radial nerve branches in 11 healthy volunteers. Skin electrical resistance and skin blood flow were recorded in the area innervated by the impaled nerve fascicle. Sudomotor nerve traffic and sweating was induced by whole body heating. Lower body negative pressure (LBNP) and tilting (30 degrees head up) was used for blood volume displacement from the chest to the lower body. Low levels of LBNP (5 and 10 mmHg) had no effect on blood pressure, heart rate or skin blood flow but induced a prompt inhibition of SSA and a reduced number of transient skin resistance changes (n = 9), both rapidly returning to control levels after cessation of LBNP. Quantitatively, the effect was similar at both levels of LBNP. Head up tilting also reduced SSA (n = 3, 19 tilt manoeuvres). A capacity for mental stress-induced SSA increase remained during LBNP. Spontaneous fluctuations in blood pressure did not affect SSA, arguing against arterial (high-pressure) baroreceptors modulating SSA. Consequently, the present results indicate that unloading of cardiopulmonary (low-pressure) volume receptors reduces sympathetic sudomotor nerve traffic and sweating in warm subjects. It is suggested that the reflex contributes to counteracting hypovolaemia.
Collapse
Affiliation(s)
- C Dodt
- Department of Clinical Neuroscience, Sahlgren Hospital, University of Göteborg, Sweden
| | | | | | | | | |
Collapse
|