A comprehensive set of lifestyle management guidelines has been developed to help multiple myeloma patients better cope with side effects while receiving talquetamab-tgvs (Talvey) treatment. The guidelines, curated by Samatha Shenoy, NP, MSN, from years of clinical experience, offer detailed strategies for managing common treatment-related challenges.
Managing Taste Alterations
Patients receiving talquetamab often experience taste changes, including metallic or bitter tastes and loss of taste sensation. The guidelines recommend specific interventions such as:
- Regular oral hygiene with gentle toothbrushes
- Baking soda and salt rinses before and after meals
- Implementation of the FASS (fat, acid, salt, sweet) formula for flavor balancing
- Alternative protein sources when meat tastes metallic
- Temperature modifications, suggesting cold or room temperature foods
Addressing Oral Complications
For patients experiencing dry mouth (xerostomia) and swallowing difficulties, the guidelines outline several approaches:
- Regular hydration with clear beverages throughout the day
- Use of specialized products like XyliMelts and Biotene
- Consumption of soft, moisture-rich foods
- Implementation of cool-mist humidifiers
- Strategic meal modifications including smaller, frequent portions
Skin and Nail Care Protocol
The guidelines provide detailed recommendations for managing dermatological side effects:
- Immediate post-shower application of heavy moisturizers
- Specific treatments for skin peeling using AmLactin and topical steroids
- Management protocols for rashes and itching
- Preventive nail care strategies
- Clear guidance on products and activities to avoid
Nutritional Support Strategies
Weight management and nutritional support receive particular attention:
- Frequent, small meals every 2-3 hours
- Strategic timing of liquid consumption
- Emphasis on protein intake with each meal
- Integration of nutrient-dense and calorie-rich foods
- Recommendations for appropriate nutritional supplements
"This is not an all-encompassing list," notes Shenoy. "We update it frequently based on feedback from patients and colleagues on what works best." The guidelines represent a collaborative effort, incorporating input from various specialists including dermatologists and dietitians at UCSF.
Monitoring and Adjustments
The guidelines emphasize the importance of ongoing communication with the medical team, particularly when:
- Taste alterations persist despite interventions
- Weight loss becomes significant
- Skin reactions require additional management
- Nail changes show signs of infection
Healthcare providers are encouraged to consider dose modifications or additional interventions when necessary, always taking into account the patient's response to treatment and quality of life.
