"Until immunomodulators, patients [with myeloma] did not have a great overall survival rate. But when we introduced lenalidomide, we started seeing our patients have life expectancies between five and seven years—which was unheard of prior to these immunomodulators going forward. I think it's promising and allows patients to have quality of life versus therapy of life," ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about immunomodulators.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by June 12, 2027. Daniel Verina is on the speakers' bureau for Johnson & Johnson, GlaxoSmithKline, and Pfizer. This financial relationship has been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge about the use of immunomodulators to treat cancer.

Episode Notes

Complete this evaluation for free NCPD.
ONS Podcast™ episodes:
ONS Voice articles:
Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles
Oncology Nursing Forum articles:
- Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study
- Facilitators of Multiple Myeloma Treatment: A Qualitative Study
ONS book: Multiple Myeloma: A Textbook for Nurses (third edition)
ONS Symptom Intervention resource: Peripheral Neuropathy
Risk Evaluation and Mitigation Strategies (REMS)
International Myeloma Foundation: Using Immune Therapy to Fight Multiple Myeloma
International Myeloma Society
Multiple Myeloma Research Foundation: Treatments for Multiple Myeloma

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To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Highlights From This Episode

"We definitely want the diagnosis of multiple myeloma before initiating these drugs. We're going to look at serum protein electrophoresis. We want to make sure that we know the patient has serum free light chains and myeloma proteins to really confirm their disease. Plus, a bone marrow biopsy." TS 7:21

"Each immunomodulator has slightly different side effects. Thalidomide's biggest side effects are constipation, weakness, fatigue, somnolence, peripheral neuropathy, mood swings, hand tremors, and depression. With each generation, less of the side effects actually occurred. Most of lenalidomide's side effects, not discounting the deep vein thrombosis, are pancytopenia—the neutropenia, the anemia, and the thrombocytopenia. [The side effects] are very similar in pomalidomide." TS 15:40

"The REMS program is critical for oral immunomodulator therapies—thalidomide, pomalidomide, and lenalidomide. It was developed due to the risk of developing embryofetal toxicities. ... It is mandatory testing and counseling, so all females of reproductive potential must have two negative pregnancy tests prior to starting the therapy and then monthly pregnancy tests while on the therapy alone. Again, they must use two forms of effective contraceptives or abstain from heterosexual sex four weeks prior, during, and after. And the same thing for men. I focus on that because males may say, 'I have a vasectomy.' These therapies tend to bind to the semen. So, males must still use a latex or synthetic condom during any sexual contact with a female of reproductive potential, even if they did have a vasectomy." TS 18:31

"The capsule itself cannot be chewed, crushed, or opened. I bring that up because as healthcare professionals, we have educated our patients. If it's difficult to swallow capsules or tablets, we've always said to them, 'Oh, don't worry, just crush it into applesauce or open it up and sprinkle it on your mashed potatoes.' But because of this embryofetal toxicity, I advise my patients not to open the capsule. If they can't swallow it for any reason, they have a sore throat or they're just unable to, then [we tell them] to hold the therapy and then call us." TS 22:49

"We spoke about three generations already, but there's actually a fourth generation [of immunomodulators]. They're called cereblon E3 ligase modulators(CELMoDs). They're still in clinical trials but really showing promise in the therapy of myeloma. They're showing very good affinity to cereblons, just like the immunomodulators do. I think, in all cancer therapies, as newer generations come out or newer therapies move forward, some of the older generations might move aside, but they get integrated later on. So I don't think [immunomodulators] will disappear totally, but they will probably be modified." TS 36:39