Quiz: Toxicities in Multiple Myeloma

July 19, 2019

How much do you know about toxicities associated with multiple myeloma? Here's your chance to find out.

In our July multiple myeloma quiz, you’ll get a chance to test your knowledge on toxicities associated with this blood cancer. Here’s your first question:

1.  In the modern era of novel agent treatment options, infections are no longer a major complication of multiple myeloma treatment.

A.True

B.False

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B. False. According to a retrospective single-institution analysis of 479 myeloma patients in Germany, potentially lethal infections remain a common complication of treatment. Bacterial infections are associated with disease burden, relapse, and high-dose chemotherapy. However, varicella zoster virus reactivation does appear to have become a less common complication since 2009.

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2.  Selinexor was recently approved by the FDA for use in combination with dexamethasone for treating patients with relapsed/refractory multiple myeloma (RRMM). Which of the following side effects are associated with selinexor?

A.Leukopenia

B.Neutropenia

C.Anemia

D.All of the above

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D. All of the above.On July 3, 2019, the FDA approved selinexor tablets in combination with dexamethasone corticosteroid therapy for treating adults with RRMM following at least four prior therapies and whose RRMM is refractory to an anti-CD38 monoclonal antibody, at least two proteasome inhibitors, and at least two immunomodulatory agents. The approval went ahead despite an advisory panel’s recommendation against doing so because of potentially fatal bleeding complications and infections. The approval was based on a single-arm clinical study of 83 patients with RRMM that yielded a 25.3% overall response rate and a median duration of response of 3.8 months. Common side effects included leukopenia, neutropenia, thrombocytopenia, anemia, upper respiratory tract infections, hyponatremia, vomiting, nausea, fatigue, fever, diarrhea, constipation, and weight loss.

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3. The irreversible proteasome inhibitor carfilzomib has seen reports of which of the following since its 2012 FDA approval for treating patients with multiple myeloma?

A.Cardiac arrhythmias

B.Severe hypertension

C.Cardiac arrest

D.All of the above

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D. All of the above. Older age and obesity are risk factors for both multiple myeloma and cardiovascular disease, and many patients diagnosed with multiple myeloma have preexisting heart disease. Carfilzomib-associated cardiovascular adverse events (CVAE) include cardiac arrhythmias, severe hypertension, heart failure, cardiac arrest, and ischemic events. According to a 2018 meta-analysis of data from 22 studies, heart failure and hypertension were the most frequent forms of carfilzomib-associated CVAEs.

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4. Peripheral neuropathy exacerbation is rarely observed with which of the following antimyeloma agents?

A.Bortezomib

B.Pomalidomide

C.Thalidomide

D.None of the above

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B. Pomalidomide. Peripheral neuropathy is a side effect of bortezomib, thalidomide, and panobinostat, but is rarely observed with pomalidomide.

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5. Which of the following toxicities are elevated for patients undergoing palliative radiotherapy with concurrent antimyeloma biologic agents?

A.Anemia

B.Fatigue

C.Erythema

D.None of the above

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D. None of the above. According to a recent retrospective study of 130 patients, treatment with biologic agents does not increase the risk of palliative radiotherapy toxicities and biologic agents need not be suspended or held before, during or after radiotherapy.

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