Coping and managing—more to understand

When dealing with the physical and emotional difficulties of multiple myeloma or mantle cell lymphoma, you may feel overwhelmed and need extra support.

You are not alone - treatment and support are available to help you through this difficult time.

It may be helpful to learn more about how to deal with your emotions, manage your energy level, and talk with your friends and family.

Dealing with emotions

A diagnosis of multiple myeloma or mantle cell lymphoma can be frightening. It is understandable that you might feel many different emotions when you are diagnosed. Fortunately, you are not alone; treatment and support are available to help you through this difficult time.

Some of the emotions you may be feeling include:


You may struggle with believing that you have multiple myeloma or mantle cell lymphoma. This is a natural reaction. Allow yourself time to accept the diagnosis.


If you have any of the following symptoms, you could have depression. Talk with your doctor or nurse if you:

  • Feel sad, empty, irritable, or tearful for most of the day
  • Lose interest and pleasure in most activities
  • Gain or lose a significant amount of weight
  • Have a decrease or increase in appetite
  • Sleep too much or are unable to sleep
  • Are physically restless or have slowed movement
  • Feel worthless or have overwhelming feelings of guilt associated with perceived burden on caregivers, friends, or family
  • Are unable to concentrate or make decisions
  • Have thoughts of suicide or plan suicide


After a time of denial and sadness, many people find themselves very angry about their diagnosis. This anger may be directed at doctors, healthy family and friends, or the cancer itself. This natural reaction can be lessened by talking with a trusted loved one or counselor.

Stress and anxiety

Cancer may make you feel afraid. Some people fear things like pain, financial problems, looking different from treatment, or death. It may be helpful to educate yourself about your treatment and possible side effects so you can prepare for what may or may not happen. Doing so may help you worry less and become more hopeful.


Guilt is a natural emotion when you have cancer. People may feel guilty for the burden they think their families must endure. If you have these feelings, talk with your doctor or healthcare team about support groups and counseling. Sometimes talking with someone can help overcome unnecessary feelings of guilt.


Some people have a feeling of loneliness while they learn to live with cancer. Trained healthcare professionals can help you understand and process this and other emotions. Do not hesitate to discuss how you are feeling with your doctor or nurse.

Ways to cope with change

Being diagnosed with multiple myeloma or mantle cell lymphoma can mean some changes in your life. Here are some tips for coping with them.

Talking with your loved ones

Talking with your family and friends about multiple myeloma or mantle cell lymphoma can be both comforting and challenging. They too may need time to process their feelings about your diagnosis. They may have trouble handling their feelings or have difficulty talking about it.

If you would rather not talk about your diagnosis, that's all right, too. It can be difficult to share your own emotions. If this is the case, there are support groups available with people going through similar situations.

Finding a support group

Some people have found formal support groups helpful in dealing with their diagnosis. It can be helpful to know that you are not alone and to talk with other people in similar situations. Anxiety and frustration are difficult issues to overcome alone, and the bonds and friendships developed in these groups can be strong. These groups can also be a wonderful source of information for friends and families.

Keeping yourself informed

Educating yourself about multiple myeloma or mantle cell lymphoma will help you make decisions about your treatment. If you know what to expect, it may help remove any unnecessary doubt or confusion. You can ask your doctor or nurse for suggestions for learning more about your condition.

Staying active

Having multiple myeloma or mantle cell lymphoma does not mean your life has to be put on hold. If you feel well enough to enjoy activities that you enjoyed before being diagnosed, continue doing them. Exercise will keep your bones strong and help combat fatigue. You can attend group exercise classes at a local gym. You can even ask a neighbor if he or she is interested in walking with you. Be sure to talk with your healthcare team before you begin any exercise program or if you experience any new pain.

Setting practical goals

You may find it helpful to resume some activities that you did before being diagnosed with multiple myeloma or mantle cell lymphoma. These might include activities like going back to work or exercising regularly. Discuss the possibilities with your doctor or nurse and make a plan; you may not be ready to perform these tasks at the levels you did before. Focus on easing back into your normal routines at a reasonable pace.

Resting when necessary

Your energy levels may decrease during treatment. Although it is important to stay active and continue doing the activities you enjoy in your everyday life, your body may need more of a chance to rest throughout the day.

Staying positive

Even in difficult times, it is important to do the things that you enjoy. Don’t forget to treat yourself to the things that make you happy! If you’ve enjoyed funny movies, card games, and gardening before your diagnosis, you will probably still enjoy them—and the feelings associated with enjoyment can have a positive impact on your well-being.

Talking with family

It may be difficult to discuss multiple myeloma or mantle cell lymphoma with those you love. Family life may be changed. There may be emotional stress, changes in family roles, interruptions in what used to be daily activities, or financial strain. It is natural for family members to be concerned, or even alarmed, when first hearing your diagnosis. For this reason, communication with family members is very important.

  • Help with everyday tasks. Get your family involved. They can do things like shop, help you check the mail, or pay bills. Even small chores, like watering the plants or helping to wash dishes, may help children feel good about contributing to a loved one’s recovery

Managing your energy level

Having multiple myeloma or mantle cell lymphoma can affect your daily life in many ways. You may not have as much energy as you did before. It is helpful to keep your energy levels as high as possible to get the most from your days. This can help your body and mind heal. There are many ways to do this, such as:

  • Focusing on only the most important aspects of life. Now is the time to think about what you want from life. What stressful activities can you do without? What hobbies do you like?
  • Organizing and planning your days. Keeping lists and diaries may help you identify times when you are most energetic or feel most tired. Try to take advantage of your periods of high energy, and reserve relaxation for other times

Coping strategies can help you manage fatigue:

  • Make a weekly diary to discover times of the day when you have more energy. Try to schedule activities
    around those times
  • Limit naps to less than an hour to not interfere with nighttime sleeping
  • Set realistic goals, and cut back on nonessential activities
  • Use labor-saving techniques such as a walker and grabbing tools
  • Eat a well-balanced diet rich in the nutrients you need to stay active

Preparing for appointments

Treatment for multiple myeloma or mantle cell lymphoma may mean regular visits to the doctor. To help you and your family prepare and stay organized with your medical care, we suggest these tips:

  • Keep a record of your medical information in a journal or file. Record dates of procedures and tests, and bring this information to your appointments
  • Keep a list of names and doses of your medicines. Include the names, doses, and how often they are taken. Be sure to bring this information to the doctor’s office
  • Make a list of questions and concerns ahead of time. List the most important questions first, so you can be sure to get the answers. Click here for a tool to help you make a list of questions for your healthcare team
  • If you believe a question isn’t being answered clearly, try asking it in a different way. The healthcare team may have misunderstood your concern, and expressing yourself in a different way could help make your question more understandable
  • Call ahead of time to verify information. Be sure that necessary test results, records, and other paperwork are at the doctor’s office. You might also need directions, transportation, and hotel information. This can save you some time and trouble later
  • Discuss advice that you receive from outside sources with your healthcare team. Some advice you may find from other sources (for example, from websites or friends) may not be appropriate for you, or it could conflict with your doctor’s advice
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Please see below for Important Safety Information.

Indications and Important Safety Information for VELCADE® (bortezomib)

What is VELCADE used for?

VELCADE (bortezomib) is approved for the treatment of adults with multiple myeloma (a cancer of the plasma cells). VELCADE is also approved for the treatment of adults with mantle cell lymphoma (a cancer of the lymph nodes).

How is VELCADE administered?

VELCADE is prescribed by a doctor experienced in the use of medications to treat cancer. It is administered by a healthcare professional as an injection into your vein (intravenously, or IV) or under your skin (subcutaneously, or SC). VELCADE must not be administered into your spinal fluid (intrathecally).

Who should not receive VELCADE?

Before you receive treatment with VELCADE, tell your doctor about all of your medical conditions. You should not receive VELCADE if you are allergic to bortezomib, boron, or mannitol.

What are the possible side effects of VELCADE?

VELCADE can cause serious side effects, including:

  • Nerve problems (peripheral neuropathy). VELCADE can cause damage to the nerves, a condition called peripheral neuropathy. You may feel muscle weakness, tingling, burning, pain, and loss of feeling in your hands and feet, any of which can be severe. Tell your doctor if you notice any of these symptoms. Your doctor may change the dose and/or schedule of VELCADE or stop it altogether. If you have peripheral neuropathy before starting VELCADE, your doctor could consider giving you VELCADE subcutaneously.
  • Low blood pressure (hypotension). VELCADE can cause a drop in blood pressure. Tell your doctor if you have low blood pressure, feel dizzy, or feel as though you might faint. If you are taking drugs that lower blood pressure, your medications might need to be adjusted. If you are not drinking enough liquids, your doctor may need to administer IV fluids.
  • Heart problems (cardiac toxicity). Treatment with VELCADE can cause or worsen heart rhythm problems and heart failure. Your doctor may closely monitor you if you have, or are at risk for, heart disease. Tell your doctor if you experience chest pressure or pain, palpitations, swelling of your ankles or feet, or shortness of breath.
  • Lung problems (pulmonary toxicity). There have been reports of lung disorders in people receiving VELCADE. Some of these events have been fatal. Tell your doctor if you experience any cough, shortness of breath, wheezing, or difficulty breathing.
  • Brain swelling (Posterior Reversible Encephalopathy Syndrome— PRES). There have been reports of a rare, reversible condition involving the brain, called PRES, in people treated with VELCADE. People with PRES can have seizures, high blood pressure, headaches, tiredness, confusion, blindness, or other vision problems. Treatment with VELCADE should be stopped in cases of PRES. It is not known whether restarting VELCADE therapy in patients previously experiencing this complication is safe.
  • Stomach and Intestinal problems (gastrointestinal toxicity). VELCADE treatment can cause nausea, vomiting, diarrhea, and constipation. If your symptoms are severe, your doctor may recommend IV fluids and/or medications.
  • Low platelet counts (thrombocytopenia). VELCADE can cause low levels of platelets (clot-forming cells). If platelets become very low, there is an increased risk of bleeding. Your doctor may recommend a platelet transfusion or other supportive care.
  • Lowered white blood cells (neutropenia). VELCADE can cause low levels of neutrophils which are a type of white blood cells that help to fight infections. If your white blood cells become low, you can be at higher risk for infections. Tell your doctor if you develop a fever or believe you have an infection.
    You will have regular blood tests to check your cell counts during your treatment with VELCADE. If the number of these cells is very low, your doctor may change the dose and/or schedule of VELCADE.
  • Tumor Lysis Syndrome (TLS). TLS is a syndrome that causes a chemical imbalance in the blood that could lead to heart and/or kidney problems. TLS can occur with cancer treatments, and your doctor will be monitoring your blood and urine for any signs of this syndrome. If you develop TLS, your doctor will take appropriate steps to treat it.
  • Liver problems (hepatic toxicity). If you have liver problems, it can be harder for your body to get rid of VELCADE. VELCADE has caused sudden liver failure in people who were taking many medications or had other serious medical conditions. Symptoms of liver problems include a yellow discoloration of the eyes and skin (jaundice) and changes in liver enzymes measured in blood tests. Your doctor will closely monitor you if you have liver disease. It is not known whether restarting VELCADE therapy in patients previously experiencing this complication is safe.
  • Hematologic disease (Thrombotic Microangiopathy, TMA). VELCADE can lead to the formation of blood clots in small blood vessels. These clots can result in low platelets, kidney damage, confusion, and an increased risk of bleeding. Tell your doctor if you develop pinpoint-sized purple dots (petechiae), larger bruises, or you see blood in your urine. Your doctor may stop treatment with VELCADE. It is not known whether restarting VELCADE therapy in patients previously experiencing this complication is safe.

More than 1 in 5 people (20%) receiving VELCADE have experienced the following side effects in one or more clinical trials: neutropenia, thrombocytopenia, peripheral neuropathy, fatigue, nausea, diarrhea, leukopenia (low levels of white blood cells), anemia, constipation, neuralgia (nerve pain), vomiting, lymphopenia (low levels of a certain type of white blood cells), rash, pyrexia (fever), and anorexia.

What other information should you tell your doctor?

Women should avoid becoming pregnant while being treated with VELCADE as it could harm your unborn baby. Females should use effective birth control during treatment and for at least seven months after the final dose of VELCADE. If using hormonal contraceptives (for example, the pill), an additional barrier method of contraception (for example, diaphragm or condom) must be used. Males should use effective contraception during treatment with VELCADE and for four months following treatment. Tell your doctor immediately if you think you are pregnant. Do not breastfeed during treatment with VELCADE and for seven months after your final dose of VELCADE.

You should also tell your doctor if you:

  • Have kidney disease. If you are on dialysis, your doctor will administer VELCADE after the dialysis procedure.
  • Are taking medication for diabetes. VELCADE can affect your blood glucose levels. Your doctor may require close monitoring of your blood glucose levels and change the dose of your diabetes medicine while you are being treated with VELCADE.
  • Have liver disease.
  • Are using any other medications, including prescription and nonprescription medications, herbal or dietary supplements, or holistic treatments. St. John’s wort should be avoided.
  • Develop a rash of any type or have skin pain while receiving VELCADE.

The side effects of VELCADE may impair your ability to drive or operate machinery.

These are not all of the possible side effects with VELCADE. It is important to always contact your doctor if you experience any side effects while on VELCADE. If you have any questions about VELCADE, contact your doctor. Additional information is available on the website at

Please see accompanying VELCADE® (bortezomib) full Prescribing Information.

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