CEPHEUS Trial: Adverse Events

EP: 1.Introduction/Treatment Overview of Transplant-Ineligible Newly Diagnosed Multiple Myeloma

EP: 2.CEPHEUS Trial: Design/Baseline Characteristics

EP: 3.CEPHEUS Trial: MRD Negativity

EP: 4.CEPHEUS Trial: Efficacy in Transplant-Ineligible Patients

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EP: 5.CEPHEUS Trial: Adverse Events

EP: 6.Treatment Overview of Transplant-Eligible Newly Diagnosed Multiple Myeloma

Safety is a crucial consideration when using a 4-drug regimen, especially in transplant-eligible patients. The data from the study comparing the quadruplet to the 3-drug regimen showed no unexpected adverse events. There was a slight increase in neutropenia and thrombocytopenia, as well as a modest rise in infections, including upper respiratory infections and COVID-19 cases. These increases align with what is generally known about the CD38 antibody’s effect on infection risk. Overall, however, the safety profile remains manageable, and patients often report feeling better thanks to the deeper and faster responses achieved with the 4-drug combination.

In practical terms, one of the key ways to reduce adverse effects is to modify dosing schedules, particularly with bortezomib and dexamethasone. Weekly, rather than twice weekly, dosing of bortezomib helps to lower the risk of peripheral neuropathy, a common and debilitating adverse effect. Likewise, dexamethasone dosing can be quickly reduced after initial disease control to minimize its well-known toxicities such as insomnia, metabolic changes, and mood disturbances. These adjustments help to tailor the treatment to individual patients’ tolerances and needs, improving overall quality of life during therapy.

Another important aspect is monitoring for infections, as patients on the 4-drug regimen may be at increased risk due to immunosuppression, sometimes related to hypogammaglobulinemia. Clinicians should remain vigilant, using supportive measures such as immunoglobulin replacement or prophylactic antibiotics when necessary. Ultimately, the combination of careful dose management and close clinical monitoring allows this potent regimen to be delivered safely and effectively, ensuring patients gain the maximum benefit with minimal impact on their well-being.