Table 2.

Management of adverse events (AEs) in MM patients receiving cafizomib.

Toxicity	Recommended action
Hematological toxicity Neutropenia (grade 3/4) Thrombocytopenia (grade 4)	•Withhold dose •If fully recovered before next scheduled dose, continue at same dose level •Thrombocytopenia: If the patient recovers to grade 3 thrombocytopenia, reduce dose by one dose level •Neutropenia: If the patient recovers to grade 2 neutropenia, reduce dose by one dose level •If tolerated, the reduced dose may be escalated to the previous dose at the discretion of the physicia
Cardiac toxicity •Grade 3 or 4, new onset or worsening of •congestive heart failure decreased left ventricular function •or myocardial ischemia	•Withhold until resolved or returned to baseline, stop fluid administration •After resolution, consider restarting CFZ at 1 dose level reduction (KRd: 27 mg/m2→20 mg/m2→15 mg/m2, Kd: 56 mg/m2→45 mg/m2 36 mg/m2→27 mg/m2) based on a benefit/risk assessment •Resuming therapy: Follow-up EKG and biomarker monitoring (BNP or NT-pro-BNP) are recommended •If tolerated, the reduced dose may be escalated to the previous dose at the discretion of the physician
Pulmonary hypertension or Peripheral neuropathy (grad 3/4)	•Withhold until resolved or returned to baseline •Restart at the dose used prior to the event or reduced dose at the discretion of the physicians •If tolerated, the reduced dose may be escalated to the previous dose at the discretion of the physician
Renal toxicity Serum creatinine ≥2× baseline	•Withhold until renal function has recovered to Grade 1 or to baseline and monitor renal function •If attributable to CFZ, restart at the next scheduled treatment at a reduced dose •If not attributable to CFZ, restart at the dose used prior to the event •If tolerated, the reduced dose may be escalated to the previous dose at the discretion of the physician