Supportive Care in Multiple Myeloma: Evidence-Based Recommendations From the Intergroupe Francophone du Myélome (IFM).

Abstract

Multiple myeloma (MM) is a largely incurable plasma cell malignancy in which disease- and treatment-related complications substantially impair quality of life and survival, making supportive care a central determinant of outcome. This review presents unified, evidence-based recommendations from the Intergroupe Francophone du Myélome across 7 domains of supportive care and their implications for contemporary practice, including the era of T-cell-redirecting immunotherapy. With the advent of highly effective induction regimens, autologous stem cell transplantation, immunomodulatory drugs, proteasome inhibitors, anti-CD38 monoclonal antibodies, bispecific antibodies (BsAbs), and chimeric antigen receptor T-cell (CAR-T) therapies, the prevention and management of treatment-emergent toxicities and disease-related sequelae have become increasingly complex. Synthesizing a structured review of the literature, international guidelines, and formal expert consensus, we provide practical recommendations for (1) venous thromboembolism prophylaxis, (2) prevention of skeletal-related events with bone-modifying agents, (3) prevention of infectious complications, (4) vaccination, (5) management of MM-related anemia with erythropoiesis-stimulating agents, (6) adapted physical activity, and (7) practical guidance for the management of treatment-emergent peripheral neuropathy, with particular attention to the specific challenges introduced by BsAbs and CAR-T therapy. By consolidating these 7 domains into a single framework applicable across all lines of therapy, from first-line treatment to relapsed/refractory disease, this review offers a pragmatic reference intended to standardize and improve supportive care and, ultimately, patient outcomes and health-related quality of life in MM. Positions that deliberately differ from other international guidelines-notably those of the International Myeloma Working Group-are explicitly identified and justified.