Complications of Myeloma Therapy Angela Dispenzieri, MD Division of Hematology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA A ppreciating the complications of myeloma therapy is paramount in the twenty-first century. Before the era of novel agents, such as thalido- mide, bortezomib, and lenalidomide, median survival for myeloma patients was 3 to 4 years and options were few. Patients received alkylators and corticosteroids fully knowing the risks of these drugs. For the former, one watched predominantly for myelosuppression and in a minority of cases secondary myelodysplasia or leukemia. For the latter, one thought about infec- tion, hyperglycemia, mood swings, insomnia, gastrointestinal bleeding, myop- athy, and cataracts. The situation has become far more complicated with the advent of novel agents. Not only are there more complications to consider but patients are also living longer and the risk for delayed complications is becoming more relevant. Patients and physicians must deal with long-term complications. The perfect example of this problem is the issue of bisphospho- nate-induced osteonecrosis of the jaw, which is described later. Our successes for the treatment of multiple myeloma (MM) provide us with additional challenges. Our mission is not only for our patients who have my- eloma to live as long as possible but also for them to have the best possible quality of life (ie, as few treatment-related complications as possible). Herein, treatment-related complications are split into two major categories: supportive care therapies and chemotherapy. SUPPORTIVE CARE Supportive care is an important adjunct to cancer therapy. Recommendations for conservative measures, such as adequate hydration, a balanced diet, and moderate amounts of low-impact exercise, are universal and noncontroversial. Pharmacologic supportive care measures have also become a mainstay of multiple therapy, but the current use of some of these agents—specifically the bisphosphonates and erythropoietin-stimulating agents—has recently been brought into question because of safety concerns. Angela Dispenzieri is supported in part by grants CA125614, CA062242, CA107476, CA15083, and CA11345 from the National Cancer Institute. Support for clinical trials was received from Celgene, Cytogen, and Neurochem. E-mail address: dispenzieri.angela@mayo.edu 0889-8588/07/$ – see front matter ª 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.hoc.2007.08.002 hemonc.theclinics.com Hematol Oncol Clin N Am 21 (2007) 1247–1273 HEMATOLOGY/ONCOLOGY CLINICS OF NORTH AMERICA