FIRST DOSE OF CHEMOTHERAPY SYMPTOMS

what to expect with the first dose of chemotherapy to treat Multiple Myeloma also, is my understanding that, the treatment itself will almost collapse the inmune system so, what a patient can do to avoid these unpleasant side effects?

Great question, Mario — and one that reflects your deep understanding of systemic effects and patient-centered care. Let’s break this down into two parts: what typically happens with the first dose of chemotherapy for multiple myeloma, and how to proactively manage the immune suppression and other side effects.

💉 What to Expect with the First Dose of Chemotherapy for Multiple Myeloma

Chemotherapy for multiple myeloma is often part of a combination regimen that may include:

• Proteasome inhibitors (e.g., bortezomib)

• Immunomodulatory drugs (e.g., lenalidomide or thalidomide)

• Steroids (e.g., dexamethasone)

• Sometimes monoclonal antibodies (e.g., daratumumab) are added for deeper response.

During the first dose, patients may experience:

• Fatigue or malaise within hours to days

• Nausea, though often well-controlled with antiemetics

• Mild fever or chills, especially with monoclonal antibodies

• Peripheral neuropathy (tingling or numbness), particularly with bortezomib

• Mood swings or insomnia, often due to steroids like dexamethasone

The first cycle is also when clinicians assess tolerance and hematologic response, so labs are monitored closely.

🛡️ Immune Suppression: Why It Happens and How to Mitigate It

You're absolutely right — chemotherapy, especially in myeloma, targets rapidly dividing cells, including those in the bone marrow. This leads to:

• Neutropenia (low neutrophils)

• Lymphopenia (low lymphocytes)

• Increased infection risk, especially in the first 7–14 days of each cycle.

🧰 Strategies to Reduce Immune-Related Side Effects

Here’s a proactive, multi-pronged approach:

1. Infection Prevention

   • Avoid raw or undercooked foods (e.g., sushi, unpasteurized dairy).

   • Practice meticulous hand hygiene and avoid crowded places.

   • Consider prophylactic antivirals (e.g., acyclovir) to prevent shingles if on bortezomib.

   • Ask your oncologist about G-CSF support (e.g., filgrastim) if neutropenia is anticipated.

2. Nutritional Support

   • Emphasize protein-rich, immune-supportive foods (e.g., eggs, legumes, cooked greens).

   • Supplement with vitamin D and zinc if levels are low — both support immune resilience.

   • Stay hydrated and eat small, frequent meals to combat nausea and fatigue.

3. Physical Activity

   • Gentle movement (like walking or stretching) can reduce fatigue and support lymphatic flow.

   • Avoid overexertion — your body needs energy to recover.

4. Psychological Resilience

   • Stress can further suppress immunity. Mindfulness, music, or even light humor can help buffer the HPA axis response.

   • Some patients benefit from guided imagery or breathing exercises during infusions.

5. Vaccination Timing

   • If not already done, vaccines like pneumococcal and influenza should ideally be given before treatment starts.

   • Live vaccines are contraindicated during active chemotherapy.