This review synthesizes evidence on lifestyle domains—physical activity, weight management/nutrition, sleep, and substance use—in multiple myeloma (MM). Exercise is generally safe and feasible during and after treatment and, in small trials and pilots, has improved fatigue, strength, aerobic fitness, and quality of life. However, MM-specific data remain limited, and disability from bone disease, older age, and treatment effects suppress activity levels. Given lytic lesions and fracture risk, programs should be individualized with physical therapy/rehab input and bone-directed therapy where indicated.

Excess adiposity is linked to higher MM incidence and may worsen outcomes, underscoring the need for weight control and nutrition counseling. Body mass index alone can miss sarcopenic obesity, so body-composition assessment is valuable and common deficiencies (eg, vitamin D, folate) warrant monitoring. Sleep problems are prevalent due to pain, corticosteroids, neuropathy, and mood disorders. Sleep-disordered breathing appears common, and sleep hygiene, cognitive behavioral therapy for insomnia, and exercise can help. Smoking shows no clear association with MM risk, while observational data hint at a protective effect of light/moderate alcohol, but guidance still favors avoidance or strict limits. Cannabis may relieve symptoms but carries risks and legal issues—so counseling should be cautious and individualized within multidisciplinary plans emphasizing safe activity, weight/nutrition support, and sleep optimization, with rigorous trials needed to clarify effects on disease outcomes.

Reference: Shapiro YN, Peppercorn JM, Yee AJ, et al. Lifestyle considerations in multiple myeloma. Blood Cancer J. 2021;11(10):172. doi: 10.1038/s41408-021-00560-x.

Researchers of a recent retrospective study evaluated 71 patients with multiple myeloma (MM) receiving the 2020/2021 quadrivalent influenza vaccine; 52 opted for a second (“prime-boost”) dose approximately 29 days later. Hemagglutination inhibition (HAI) titers were measured pre-vaccination, pre-dose-2, and 3 to 4 weeks after dose-2 (or 6–8 weeks after a single dose). Significant titer increases occurred after the first shot across strains, with 63.3% achieving a “sufficient” serologic response (≥4-fold rise or titer ≥1:40). At the cohort level, a second dose did not significantly improve titers or responder rates versus a single dose, and no short-term (6–8 week) waning was observed.

Response was linked to disease control and immune competence: responders were more often in complete remission (CR) or very good partial remission (VGPR), off active therapy (or on maintenance only), and lacked immunoparesis. Multivariable analysis identified absent immunoparesis (OR 5.37) and CR/VGPR (OR 4.07) as independent predictors. Higher baseline CD19+ B-cell and CD4+ T-cell counts correlated with better serologic responses. Prior anti-CD38 exposure trended toward poorer response. Patients closer to high-dose chemotherapy/autologous transplant were more likely to be non-responders after one dose—but some converted after the second, suggesting a prime-boost strategy is most beneficial for recently transplanted or otherwise immunosuppressed patients with MM.

Reference: Enssle JC, Brinkschmidt T, Dürrwald R, et al. Immune responses after one versus two Influenza A/B vaccinations in patients with multiple myeloma. Ann Hematol. 2025;104(5):2813-2821. doi: 10.1007/s00277-025-06367-1.

Authors of this scoping review examined exercise-based rehabilitation for patients with multiple myeloma (MM), a population prone to impaired motor function and reduced quality of life. Following Preferred Reporting Items for systematic reviews and meta-analysis extension for scoping reviews Scoping Reviews methods, the authors searched Chinese (CNKI, Wanfang, Chinese Biomedical) and international databases (Cochrane, PubMed, Embase) through October 1, 2024, identifying 17 studies: 10 randomized controlled trials, 4 single-arm trials, 1 retrospective cohort, and 2 quasi-experimental studies. Interventions most commonly included aerobic training, resistance exercise, and Nordic walking performed 3 to 5 times weekly for 30 to 60 minutes per session.

Across studies, exercise was associated with improvements in fatigue, functional capacity, quality of life, and psychological well-being, supporting its clinical relevance and addressing common safety concerns in MM. However, heterogeneity in exercise type, dosing, supervision, and modest evidence quality limit firm guideline development. The authors advocate for standardized, yet individualized protocols tailored to treatment stage and patient profile—especially for those with bone involvement—so clinicians can deliver safer, evidence-based, stage-appropriate programs. Larger, well-controlled multicenter trials with standardized outcome sets and explicit skeletal safety criteria are needed to define optimal exercise dosing and supervision.

Reference: Li J, Peng Y, Zhan D, Zhang Y, Yu S. Exercise interventions in patients with multiple myeloma: a scoping review. BMC Sports Sci Med Rehabil. 2025;17(1):148. doi: 10.1186/s13102-025-01193-4.