Side Effects of Multiple Myeloma Treatment

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Chemotherapy is the main form of multiple myeloma treatment. Doctors use it in all three phases of treatment—induction (to quickly kill as many cancer cells as possible), consolidation (to eliminate remaining cancer cells), and maintenance (to keep the disease in remission as long as possible). Other treatments include targeted therapy, immunotherapy, stem cell transplant, and various supportive treatments. There are benefits to all of them, but multiple myeloma treatment side effects can affect your health. Here is a look at the possible side effects of multiple myeloma treatment.


Chemotherapy—or chemo—for multiple myeloma travels through the bloodstream to reach the whole body. As a result, it can cause side effects in different body systems. However, there are some cells and systems that are more vulnerable to chemo side effects than others. Chemo will kill any rapidly dividing cell, such as cancer cells. Unfortunately, this also includes some normal cells, such as hair follicles and the cells lining the digestive tract. This action leads to many of the common chemo side effects.

There are a variety of chemo drugs and combinations to treat multiple myeloma. Side effects common to many of these drugs include appetite changes, diarrhea, fatigue, fever, infection, hair loss, memory problems, mouth and throat sores, and nausea and vomiting. Keep in mind chemo affects everyone differently. The side effects you may experience depend on your overall health before treatment and the specific chemo drugs and doses.

Be sure to tell your doctor about any new or changing symptoms. There may be causes other than chemo for the symptoms you experience. Your doctor may also be able to adjust your chemo regimen if it is the cause.

Targeted Therapy

Targeted therapy uses specific markers and characteristics of cancer cells to find them and stop or destroy them. This means targeted therapy does not affect normal cells the way traditional chemo does. However, side effects are still possible for these classes that treat multiple myeloma:

  • Histone deacetylase (HDAC) inhibitors can cause diarrhea, nausea, vomiting, appetite loss, fatigue, weakness, fever, and swelling in the arms or legs. Problems with blood cell counts and blood chemistry can also occur. In some cases, serious side effects can happen.

  • Monoclonal antibodies can result in fatigue, nausea, appetite loss, diarrhea, cough, fever, and nerve problems. These drugs can also cause a reaction that can be serious. Symptoms include fever, chills, headache, nausea, feeling dizzy or lightheaded, rash, coughing, wheezing, trouble breathing, tightness in the throat, or a runny or stuffy nose.

  • Proteasome inhibitors may cause nausea, vomiting, appetite loss, diarrhea, constipation, fatigue, fever, rash, swelling in the hands or feet, and low blood cell counts. Nerve problems leading to numbness or tingling are also possible.


Immunotherapy—or biologic therapy—uses your own immune system to fight cancer. Side effects of drugs in this category include:

  • Immunomodulators may lead to nerve damage, which can persist after treatment, fatigue, and low blood cell counts. These drugs are linked to serious birth defects. As a result, you must register in a special program to receive them. They can also cause serious blood clots, so your doctor may prescribe a blood thinner.

  • Interferons may cause such side effects as fatigue and flu-like symptoms

Stem Cell Transplant

A stem cell transplant restores your bone marrow after high-dose chemotherapy. Stem cells make healthy new blood cells, including red blood cells, white blood cells, and platelets. Your doctor collects your own stem cells before chemo treatment begins. A lab stores your stem cells until it is time for the transplant. This is an autologous transplant and it is the standard type of transplant for multiple myeloma. The other is an allogeneic transplant using donor stem cells.

Early side effects of a stem cell transplant can be severe and are usually due to the high-dose chemo. They include mouth and throat pain, nausea, vomiting, infection, bleeding requiring transfusion, and lung problems.

Special consideration for allogeneic transplant

If you receive donor stem cells, there is another serious side effect that can happen. It is graft-versus-host disease (GVHD). With an allogeneic transplant, the donor’s stem cells make the white blood cells that are part of the immune system. These donor immune system cells often react to the recipient’s body and tissues and start attacking them. This GVHD reaction can be acute and short-lived, chronic and long-lasting, or both.

Common areas of attack are the skin, digestive tract, liver, and other organs. Symptoms of acute GVHD can include appetite loss, nausea, vomiting, cramping, belly pain, watery or bloody diarrhea, weight loss, and yellowing of the skin and eyes. Symptoms of chronic GVHD are similar, but can also include dry or burning eyes, sensation of skin tightness, dry mouth, and mouth sores.

Doctors use drugs to try to prevent serious GVHD, but almost all allogeneic recipients will have some amount of reaction. As a result, this type of transplant is no longer standard care for multiple myeloma.

Supportive Treatments

Supportive treatments do not treat multiple myeloma itself. Instead, these treatments—known as palliative cancer care—help relieve or reduce symptoms of the disease or its treatment. However, some of these treatments can cause side effects of their own:

  • Blood transfusions can cause reactions with itching, shivering, headache, nausea, dizziness, difficulty breathing, throat tightness, and chest or back pain

  • Bone modifying drugs can cause flu-like symptoms and lead to anemia, kidney problems, and joint and muscle pain. Osteonecrosis—or bone death—of the jaw is a rare, but serious side effect. Symptoms include loose teeth and pain, swelling and infection of the jaw.

  • IVIG (intravenous immunoglobulin) can lead to an infusion reaction with flu-like symptoms, headache, nausea, vomiting, flushing, and wheezing

  • Plasmapheresis can cause low blood pressure, which in turn can cause dizziness, weakness, and nausea

  • Radiation therapy side effects include skin reactions, such as redness, peeling or blistering, fatigue, upset stomach, and diarrhea. These usually go away soon after treatment is complete.

Side Effect Solutions

There are often solutions to the side effects of multiple myeloma treatment. Ask your doctor beforehand what you can expect from your specific treatment. Find out how you can avoid or prevent side effects and how your doctor plans to deal with them if they occur. If you know side effects will be severe—even if it’s temporary—arrange palliative cancer care ahead of time.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 10
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

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