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Side Effects of Myeloma Treatment: What is Too Much?

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Published on August 28, 2020

How Do Doctors Determine If a Side Effect of Myeloma Treatment is Minor or Severe?

How do doctors determine if the side effects caused by myeloma medications are minor or severe? If I'm having a bad side effect that is impacting my quality of life, would a clinical trial for that drug be stopped? Dr. Cesar Rodriguez of Wake Forest Baptist Health answers these questions brought up by myeloma patient advocate, Yolanda Brunson. Watch to hear the full discussion.


Transcript | Side Effects of Myeloma Treatment: What is Too Much?

Weighing the Side Effects of Myeloma Treatment

Yolanda Brunson-Sarrabo: 

How do you guys class minor side effects versus like the big ones?  

Dr. Rodriguez: 

Your question is a very valid question about side effects and toxicities, whenever we're doing clinical trials part of the... one of the main objectives of the clinical trials is, is the drug effective? But at the same time the other very important question that we're trying to answer is, is this drug safe? So, as the studies are ongoing any side effect or any symptom that a patient has while they're on treatment or while they're on study we document, whether it be a headache, whether it be nausea whether it be you seeing purple elephants or whether you got run over by a truck. Any of those things get documented as a side effect or as a potential side effect of the drug. Even it has nothing to do with the drug itself like being run over by a truck. 

Now, at the end of the study we clump all the symptoms to try to determine what percentage of the patients treated had a specific symptom like a headache, or low platelets or keratopathy or the osteonecrosis of the jaw. We also grade the side effects based on the severity and we use a grading system of 1, 2, 3, and 4. Three and four being the more serious and sometimes even life threatening side effects and grades one and two being some mild symptoms that can be easily managed with medications or some recommendations by the doctor. But the percentage that is given whenever somebody... let's say if you're going to start chemotherapy, we consent you for the chemotherapy and we'll go over all the side effects of the drug that you're going to be getting. Within those side effects we tend to focus on the most common side effects, and we also tend to emphasize the most serious side effects. But that doesn't mean that you're going to get those most common side effects or those most serious side effects, because in the end you are an individual you're not a statistic and the odds of you getting a side effect are 50-50, you either have it or you don't.  

So for example you mentioned osteonecrosis of the jaw. It is a very small number of patients that take bisphosphonates that develop osteonecrosis of the jaw compared to the whole population of patients that get it, but if you get it you get it and that's the reason why you have to be monitoring... being monitored by a doctor and making sure that you are talking to your doctor about any side effect that you might be having. 


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