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Adverse Events Change Myeloma Induction
Adverse events change myeloma induction therapy. What percentage of NDMM patients change their induction therapy because of adverse events, aka side effects? I’m not asking about an NDMM patient who stopped induction therapy completely. I’m talking about the discontinuation of one drug. Or perhaps reducing the dose of one or more drugs in your induction chemo cocktail.
When I researched the information for this post, I found possible answers to my question range from 13% to 87%. Clinical trial info simply says that adverse events are “tolerable.”
Clearly, induction therapy can cause serious adverse events in newly diagnosed MM patients. I think it is important for NDMM patients to understand that they can change their therapy plan.
Starting Myeloma Treatment: What to Know About Induction Therapy and Its Goals
What percentage of newly diagnosed myeloma patients change their induction therapy due to adverse events?
The percentage of newly diagnosed multiple myeloma (NDMM) patients who change their induction therapy due to adverse events (AEs) varies across studies and treatment regimens, but a reasonable estimate is approximately 10–25%, depending on the regimen, patient population, and toxicity profile.
Here’s a breakdown from the literature:
🔹 Key Study Findings:
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SWOG S0777 Trial (VRd vs Rd):
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Regimen: Bortezomib, lenalidomide, dexamethasone (VRd)
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AE-related discontinuation of at least one drug: ~18% in VRd arm
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Source: Durie et al., Lancet 2017
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IFM 2009 Trial (VRd + ASCT vs VRd alone):
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Regimen: 3 cycles of VRd induction
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Treatment discontinuation due to AEs during induction: ~10%
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Source: Attal et al., NEJM 2017
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MAIA Trial (Daratumumab-Rd vs Rd):
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In transplant-ineligible patients
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AE-related discontinuation of lenalidomide: ~15% (mostly due to cytopenias or fatigue)
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Source: Facon et al., NEJM 2019
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Real-world studies (e.g., Flatiron Health database, retrospective cohorts):
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Rate of switching or modifying induction therapy due to AEs: 15–25%
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Often higher in older or frailer patients, or those with renal dysfunction.
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🔹 Common Reasons for Induction Change:
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Peripheral neuropathy (especially with bortezomib)
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Myelosuppression (neutropenia, thrombocytopenia)
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Renal toxicity
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Infections
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Fatigue or GI toxicity
✅ Summary:
| Study/Source | Induction Regimen | AE-related Change (%) |
|---|---|---|
| SWOG S0777 | VRd | ~18% |
| IFM 2009 | VRd | ~10% |
| MAIA | Rd/Dara-Rd | ~15% |
| Real-world cohorts | Mixed | 15–25% |
So, 10–25% of NDMM patients are likely to change, reduce, or discontinue induction therapy due to adverse events, depending on regimen and patient factors. I think this is a significant proportion of NDMM who will change their induction therapy plan.
Consider evidence-based non-conventional therapies shown to reduce the risk of treatment-related side effects. Consider anti-angiogenic nutrition, exercise, prehabilitation, supplementation, and more.
I am a long-term MM survivor. Email me at David.PeopleBeatingCancer@gmail.com to learn more about managing your MM with both conventional and non-conventional therapies.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Adverse events change myeloma induction Adverse events change myeloma induction Adverse events change myeloma induction