How to maintain patients on long-term therapy: understanding the profile and kinetics of adverse events

Thalidomide, lenalidomide, and bortezomib have considerably improved the survival of patients with multiple myeloma. These agents have specific adverse event (AE) profiles, and it is especially important to consider severe AEs that may lead to premature discontinuation, negatively affecting outcomes. AEs of particular concern are peripheral neuropathy (associated with thalidomide and bortezomib), venous thromboembolism (associated with thalidomide and lenalidomide), and myelosuppression (associated with lenalidomide and bortezomib). AEs are usually predictable and easily managed with monitoring, appropriate dose adjustments, and supportive care. AEs are generally transient, occurring early in the course of treatment, providing evidence for the feasibility of continuous therapy.