Early (onset days to weeks)
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Neutropenia
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Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively.
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Thrombocytopenia
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Thrombocytopenia is a reduction in the normal levels of functional platelets. It is associated with bortezomib treatment, particularly in patients who have had a number of prior therapies. However, it is rarely severe enough to postpone subsequent cycles.
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Thromboembolism
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Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) is significantly increased in multiple myeloma patients treated with thalidomide in combination with other therapies including doxorubicin, melphalan and prednisolone or dexamethasone; and lenalidomide and pomalidomide in combination with dexamethasone.
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Arthralgia and myalgia
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Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. May be mild or severe, intermittent or constant and accompanied by inflammation.
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Diarrhoea
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Peripheral neuropathy
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Typically symmetrical sensory neuropathy, affecting the fingers and toes, sometimes progressing to the hands and feet. It is associated with several classes of anti-cancer drugs. These include taxanes, platinum-based compounds, vinca alkaloids and some drugs used to treat multiple myeloma.
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Side effects of corticosteroids
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Insomnia, oedema, increased risk of infection e.g. oral thrush, gastric irritation, worsening of peptic ulcer disease, increased blood sugar levels, loss of diabetic control, mood and behavioural changes - including anxiety, euphoria, depression, mood swings, increased appetite and weight gain, osteoporosis and fractures (long term use), bruising and skin fragility are associated with corticosteroid use.
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Skin rash
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Anti-cancer drugs can cause a number of changes in the skin with maculo-papular rash the most common type of drug-induced skin reaction.
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