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Peripheral neuropathy (PN) and asthenia (fatigue) occur as both diseaseand treatment-related complications in patients with multiple myeloma (MM). Risk factors for treatment-related PN, which has an estimated incidence of 37% to 83% among patients with MM, include therapy duration, dose intensity, cumulative dose, and the presence of preexisting neuropathy. Asthenia is the most common adverse effect of treatment, occurring in approximately 76% to 96% of patients receiving therapy. The severity of PN and asthenia can range from mild to potentially debilitating. These conditions can be dose limiting; they may interfere with optimizing duration of therapy and may also substantially affect patient qualPeripheral neuropathy (PN) and asthenia (fatigue) are among the most commonly seen complications in patients undergoing multiple myeloma (MM) therapy. These potentially debilitating adverse effects are frequently dose limiting, and they may interfere with optimal therapy and substantially affect patient quality of life as well as outcome. Effective strategies for preventing and managing these complications of MM therapy are thus critical. Peripheral Neuropathy Overview PN occurs in MM both as a disease-related complication in newly diagnosed patients and as a side effect of MM therapy. The reported incidence is 1% to 20% in untreated patients with MM and 37% to 83% in previously treated individuals; neurophysiologic evidence of neuropathy may be detected in 11% to 52% and 39% to 46% of these populations, respectively.1–6 Risk factors for PN include treatment-specific characteristics, such as therapy duration, dose intensity, and cumulative dose, and patient-specific factors, such as age, comorbidities (e.g., diabetes mellitus, alcoholism), and the presence of preexisting neuropathy.4,6–11 From Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts. Dr. Richardson reports having participated in funded research for Celgene Corporation and Millennium and having participated as an advisory board member or consultant for Celgene Corporation; Millennium Pharmaceuticals, Inc.; and Johnson & Johnson. Dr. Laubach reports no potential conflicts of interest. Dr. Schlossman reports having served as a speakers’ bureau member for Celgene Corporation and Millennium Pharmaceuticals, Inc. Dr. Mitsiades reports having participated in funded research for OSI Pharmaceuticals, Inc.; Amgen, Inc.; AVEO Pharmaceuticals, Inc.; EMD Serono, Inc.; and Sunesis Pharmaceuticals, Inc., and having participated as an advisory board member for Millennium Pharmaceuticals, Inc.; Novartis International AG; Merck & Co.; and Pharmion Corporation. Dr. Anderson reports having received preclinical and clinical research support from Millennium Pharmaceuticals, Inc., Celgene Corporation, and Novartis, and having served as an advisory board member for Millennium Pharmaceuticals, Inc., Celgene Corporation, Novartis, and Merck & Co. Supported by an educational grant from Millennium Pharmaceuticals, Inc. Correspondence: Paul G. Richardson, MD, Harvard Medical School, Dana-Farber Cancer Institute, 44 Binney Street, Dana 1B02, Boston, MA 02115. E-mail: paul_richardson@dfci.harvard.edu Complications of Multiple Myeloma Therapy, Part 1: Risk Reduction and Management of Peripheral Neuropathy and Asthenia Paul G. Richardson, MD; Jacob P. Laubach, MD; Robert L. Schlossman, MD; Constantine Mitsiades, MD, PhD; and Kenneth Anderson, MD; Boston, Massachusetts ity of life. Regular screening and monitoring, combined with patient education and effective management strategies, can reduce the risk of these treatment-related complications, as well as their consequences. (JNCCN 2010;8[Suppl 1]:S4–S12)

Introduction: Addressing Challenges in Multiple Myeloma Management in an Era of New Therapeutics