This review discusses current multiple myeloma treatment options, effective symptom management approaches, and practical strategies for supportive care. Summary points Recent therapeutic advances have significantly improved overall survival in patients with multiple myeloma (MM), with a concomitant increase in susceptibility to disease- and treatment-related symptoms. Current therapeutic regimens for relapsed/refractory MM include proteasome inhibitors (eg, bortezomib, carfilzomib) and immunomodulatory agents (eg, thalidomide, lenalidomide, pomalidomide), alone or in combination with chemotherapy or corticosteroids. Toxicities associated with agents and combination regimens used in the treatment of MM include myelosuppression, venous thromboembolism, peripheral neuropathy, infections, fatigue, gastrointestinal disorders, and/or cardiac events. Treatment-specific tools and clinical assessments can be useful for optimizing dosing and schedule adjustments to increase therapy duration, and implementing supportive care strategies (such as growth factors, transfusional support, intravenous hydration, bisphosphonates, and antiviral therapies) to manage treatment-related symptoms. Effective management of the patient with MM requires knowledge of the disease and of treatment-associated adverse events in addition to preventative measures, supportive care strategies, and management of comorbidities. Patient education and individualized survivorship plans can play a role in achieving maximal patient responses to treatment. Improved survival after MM diagnosis has led to increased patient susceptibility to other diseases and comorbidities due to advanced age, thus optimal symptom management will be important to maximize quality of life for patients in addition to disease control and survival. Colson K. Support Care Cancer 2015; 23: 1431–1445. doi:10.1007/s00520-014-2552-1

This articles reviews the clinical efficacy of immunomodulatory drugs, their structure-function relationship, molecular mechanisms of action, and associated second primary malignancies and thrombosis. Holstein SA & McCarthy PL. Drugs 2017; 77: 505–520. doi:10.1007/s40265-017-0689-1

Currently, trials are incorporating the use of pomalidomide, carfilzomib and the monoclonal antibodies into ongoing maintenance therapy (clinicaltrials.gov) while attempting to identify patient and disease-specific predictors of response. 46  Results of these trials will expand our experience and knowledge base while provoking new questions, concerns and recommendations.

Pomalidomide is another potent derivative of thalidomide.

An expert review of current treatment options for relapsed/refractory multiple myeloma, the mechanism of action of panobinostat, and how panobinostat fits into the current therapeutic landscape. San-Miguel JF, Einsele H, & Moreau P. Adv Ther 2016; 33: 1896–1920. doi:10.1007/s12325-016-0413-7

The authors review the plethora of novel agents currently in development or recently approved for the treatment of patients with multiple myeloma. Naymagon L & Abdul-Hay M. J Hematol Oncol 2016; 9: 52. doi:10.1186/s13045-016-0282-1

Next-generation novel agents The data with second-generation novel agents, carfilzomib and pomalidomide, are primarily in the relapsed/refractory MM.