34 NCCN Guidelines for Patients ® : Multiple Myeloma, 2018 3 Myeloma treatments Clinical trials Prompt treatment of myeloma is required to prevent permanent kidney damage. To prevent kidney failure, your doctor may recommend staying hydrated. This means drinking plenty of fluids, especially water. He or she may ask you to avoid using certain medications (NSAIDs [ n on s teroidal a nti- i nflammatory d rugs]) and IV contrast, which is often given before an imaging test. Your doctor will watch you closely for signs of kidney damage, especially if you are taking bisphosphonates for a long time. Anemia Myeloma cells may crowd out the normal blood cells in the bone marrow. This can cause anemia—a condition in which the number of red blood cells is too low. With treatment of myeloma, the anemia will improve. Sometimes anemia may be treated with a drug called erythropoietin. Erythropoietin helps the bone marrow to make more red blood cells. Your doctor will measure your blood cell levels at different times of your care. He or she may also do a “type and screen” test to make sure your red blood cells will not react to a donor’s blood during a transfusion. This should also be done before receiving treatment with daratumumab. Infections Myeloma and certain myeloma treatments can increase the risk of infection. The risk of infection can be reduced with vaccines for pneumonia, the flu, and shingles. Shingles is an infection that causes a painful skin rash. Shingles can be a side effect of bortezomib, carfilzomib, ixazomib, and daratumumab. You might be given pills to take to prevent shingles from starting while you are getting these myeloma treatments. Intravenous immunoglobulins may be given to prevent frequent, and serious infections. Blood clots Some drugs, specifically thalidomide, lenalidomide, and pomalidomide, can cause serious blood clots. If these drugs are used, then treatment with blood thinners or antiplatelet agents may be needed. Blood thinners are medicines that thin out the blood to lower the risk of blood clots. NCCN experts recommend taking aspirin while being treated with these immunomodulators; however, talk with your doctor before taking any new medication—even a drug such as aspirin. Clinical trials New tests and treatments aren’t offered to the public as soon as they’re made. They first need to be studied. A clinical trial is a type of research that studies a test or treatment. Clinical trials study how safe and helpful tests and treatments are. When found to be safe and helpful, they may become tomorrow’s standard of care. Because of clinical trials, the tests and treatments in this book are now widely used to help people with myeloma. Future tests and treatments that may have better results than today’s treatments will depend on clinical trials. New tests and treatments go through a series of clinical trials to make sure they’re safe and work. Without clinical trials, there is no way to know if a test or treatment is safe or helpful. Clinical trials are done in four steps, called phases. Some examples of the four phases of clinical trials for treatment are: Phase I trials aim to find the best dose and way to give a new drug with the fewest side effects. Phase II trials assess if a drug works to treat a specific type of cancer.