Supportive therapy and monitoring in patients on induction or salvage therapy (not applicable to patients on periodic observation with remission, plateau, or stable disease)
| Type . |
|---|
| Infection prophylaxis |
| Fluconazole (if on corticosteroids) |
| Trimethoprim-sulfamethoxazole (if on corticosteroids) |
| Acyclovir (all patients irrespective of whether on therapy or not; J.M., S.S.) |
| Vaccination |
| Seasonal influenza vaccination is appropriate |
| Vaccination against Streptococcus pneumoniae and Haemophilus influenzae may be considered, but immune response may be suboptimal |
| The currently available zoster vaccine is contraindicated in immunocompromised patients and should not be used |
| Ulcer/gastritis prophylaxis (if on corticosteroids; proton pump inhibitor or H2-blocker) |
| Prophylaxis against deep vein thrombosis (if on thalidomide or lenalidomide) |
| Aspirin (81 or 325 mg) if no history of prior thromboembolic phenomena |
| Warfarin if history of prior thromboembolic phenomena or evidence of a high risk of thrombosis |
| Low-molecular weight heparin (a safer alternative to warfarin, particularly in patients with renal failure, although cost may be a barrier) |
| Regular blood counts and chemistry |
| At the time of every infusion of bortezomib on bortezomib-based regimens |
| Every 2 weeks on lenalidomide-containing regimens; the frequency can be reduced after a few weeks if clinical and laboratory parameters stable; if cytopenias are seen, more frequent monitoring may be needed |
| Every 2 to 4 weeks on dexamethasone and thalidomide-containing regimens; frequency can be reduced after a few weeks if clinical and laboratory parameters stable |
| Periodic Hb A1C |
| Regular clinical evaluation |
| Every 1 to 4 weeks to start with based upon the regimen; frequency can be reduced after a few weeks if clinical and laboratory parameters stable |
| Regular blood pressure monitoring if abnormal or known hypertensive (daily self-monitoring if possible) |
| Regular blood sugar monitoring if abnormal levels or known diabetic; if on corticosteroids |
| Type . |
|---|
| Infection prophylaxis |
| Fluconazole (if on corticosteroids) |
| Trimethoprim-sulfamethoxazole (if on corticosteroids) |
| Acyclovir (all patients irrespective of whether on therapy or not; J.M., S.S.) |
| Vaccination |
| Seasonal influenza vaccination is appropriate |
| Vaccination against Streptococcus pneumoniae and Haemophilus influenzae may be considered, but immune response may be suboptimal |
| The currently available zoster vaccine is contraindicated in immunocompromised patients and should not be used |
| Ulcer/gastritis prophylaxis (if on corticosteroids; proton pump inhibitor or H2-blocker) |
| Prophylaxis against deep vein thrombosis (if on thalidomide or lenalidomide) |
| Aspirin (81 or 325 mg) if no history of prior thromboembolic phenomena |
| Warfarin if history of prior thromboembolic phenomena or evidence of a high risk of thrombosis |
| Low-molecular weight heparin (a safer alternative to warfarin, particularly in patients with renal failure, although cost may be a barrier) |
| Regular blood counts and chemistry |
| At the time of every infusion of bortezomib on bortezomib-based regimens |
| Every 2 weeks on lenalidomide-containing regimens; the frequency can be reduced after a few weeks if clinical and laboratory parameters stable; if cytopenias are seen, more frequent monitoring may be needed |
| Every 2 to 4 weeks on dexamethasone and thalidomide-containing regimens; frequency can be reduced after a few weeks if clinical and laboratory parameters stable |
| Periodic Hb A1C |
| Regular clinical evaluation |
| Every 1 to 4 weeks to start with based upon the regimen; frequency can be reduced after a few weeks if clinical and laboratory parameters stable |
| Regular blood pressure monitoring if abnormal or known hypertensive (daily self-monitoring if possible) |
| Regular blood sugar monitoring if abnormal levels or known diabetic; if on corticosteroids |