Supportive therapies are important in the management of MM and should be offered where indicated concurrently with anti-myeloma therapies from the beginning of treatment. The following should be considered:

• bisphosphonate therapy for all patients requiring MM treatment unless contraindicated, with calcium and vitamin D supplements where indicated for bone strengthening
• venous thromboembolism (VTE) prophylaxis is recommended for patients who are treated with IMiDs (e.g. thalidomide, lenalidomide or pomalidomide)
• recombinant erythropoietin (rEpo) may be considered in selected patients with transfusion dependent anaemia, especially in those with renal failure
• infection prophylaxis should be considered where indicated, including:

• immunoglobulin replacement therapy for patients with frequent infections – see the National Blood Authority website for criteria for the clinical use of intravenous immunoglobulin in Australia
• pharmaceutical prophylaxis including that against varicella zoster reactivation and

Pneumocystis jiroveci should follow institutional guidelines

• vaccinations against hepatitis B, pneumococcus, influenza and other pathogens that are deemed necessary because of epidemiologic prevalence (live vaccines should be avoided)
  • for symptomatic localised bone lesions:
• localised radiation may be beneficial in patients with bone pain who have a well-defined focal process
• patients with lytic lesions threatening long-bone fractures should be referred to orthopaedics for consideration of prophylactic internal fixation
• patients with spinal compression fractures and disabling pain may benefit from balloon kyphoplasty; the benefit of vertebroplasty is unclear.

For MM-specific supportive care, please refer to the MSAG Clinical practice guideline: multiple myeloma (Quach & Prince 2019).