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Diarrhoea and constipation can have an extremely negative impact on quality of life, particularly if persistent. Myeloma treatments causing diarrhoea include lenalidomide, bortezomib and panobinostat and it is important that patients with persistent diarrhoea are investigated for underlying bowel disease, AL amyloidosis and bile acid malabsorption (if on lenalidomide treatment).
Constipation can also be an ongoing problem for patients on thalidomide, opioids, anticholinergics or 5-HT3 receptor antagonists. It is also a symptom of hypercalcaemia, along with nausea.
Myeloma patients can experience nutritional deficiencies due to poor appetite and dietary intake and require input from a dietitian. A considerable proportion of patients have vitamin D insufficiency, and folate and vitamin B12 levels can often be low. Iron deficiency anaemia is less common.