Nursing Considerations for Select Multiple Myeloma Treatments

There are several considerations and clinical pearls for nurses to understand when treating patients with multiple myeloma with multidrug regimens. Dosing and other considerations were discussed for certain treatments in the session “New and Emerging Therapies in Multiple Myeloma: Case Studies for Nurses” (Table 1).

Table 1. Treatment-Specific Nursing Considerations

Drug Dosing considerations Pre-/postmedication considerations Other considerations
Daratumumab
  • Subcutaneous (SC) formulation: inject into the abdomen 3” from navel on right or left side into the subcutaneous tissue over 3-5 minutes
  • IV formulation: first infusion should be slow, around 7 hours, then sped up to 3-4 hours after the first or second dose or divide first dose into 2 days
  • SC or IV schedules depend on regimens, but in general, schedules become less frequent
  • Premedication: corticosteroids, antipyretics, antihistamine
  • If there are no injection/infusion reactions after 3 doses, steroids may be discontinued
  • Postmedication: oral corticosteroid for 2 days
  • Herpes prophylaxis
  • Daratumumab may interfere with blood bank serologic tests, conduct antibody type and cross-matching before starting
Isatuximab
  • Slower first and second infusions
  • Weekly for 4 weeks then every 2 weeks
  • Premedication: dexamethasone, acetaminophen, H2 antagonist, diphenhydramine
  • Herpes prophylaxis
  • Deep vein thrombosis (DVT) prophylaxis in combination with pomalidomide
  • Isatuximab may interfere with blood bank serologic tests, conduct antibody type and cross-matching before starting
Carfilzomib
  • First dose: 20 mg/m2 then escalate
  • 10-minute or 30-minute infusion
  • Full anticoagulation, especially for high-risk of venous thromboembolism
  • Herpes prophylaxis
  • Diuretic or inhalers if needed
  • Premedicate with dexamethasone
  • To avoid dyspnea over the weekend, start new patient’s first dose early in the week
  • Monitor blood counts, response, signs of infection
Pomalidomide
  • Oral
  • DVT prophylaxis
  • Monitor blood count, liver function, treatment response
  • Counsel on oral adherence
  • Risk Evaluation and Mitigation Strategies (REMS) for refills
  • Refrain from smoking
  • Avoid NSAIDs, IV contrast
Teclistamab
  • Step-up dosing schedule: 0.06 mg/kg day 1, 0.3 mg/kg day 4, 1.5 mg/kg day 7 (first treatment dose)
  • Weekly dosing schedule: 1 week after first treatment dose: 1.5 mg/kg once weekly
  • Infection prophylaxis (acyclovir, Bactrim, IV immunoglobulin if <400 mg/dL)
  • REMS program from prescribers and institution
  • Cytokine release syndrome and neurotoxicity management

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