Current Approaches to the Initial Treatment of Symptomatic Multiple Myeloma

Jasielec, Jagoda; Jakubowiak, Andrzej

doi:10.2217/ijh.13.3

Cited by 10 publications

(11 citation statements)

References 102 publications

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“…Recently, high-dose chemotherapy with autologous hematopoietic stem-cell transplantation has become the main line of treatment for patients under the age of 65 years [27]. Prior to stem-cell transplantation, these patients receive an initial course of induction chemotherapy.…”

Section: Initial Therapymentioning

confidence: 99%

Multiple Myeloma: New Perspectives

Kabel¹,

Alqahtani²,

Alshehri³

et al. 2017

JCRT

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Multiple myeloma (MM) is the most common bone malignancy that occurs frequently in older persons.It is the second most common blood cancer in which the patient usually presents with bone pain, nausea, malaise, anemia, renal insufficiency and hypocalcaemia. There is a wide variety of risk factors that may predispose to MM. It is usually discovered on routine laboratory investigations and usually diagnosed with serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis. MM often has bad prognosis, although advances in therapy resulted in significant improvement in the overall survival rate. This review sheds light on the incidence, etiology, clinical presentation, the methods of diagnosis, prognosis and the possible lines of management of MM.

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Section: Initial Therapymentioning

confidence: 99%

Multiple Myeloma: New Perspectives

Kabel¹,

Alqahtani²,

Alshehri³

et al. 2017

JCRT

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“…18 Furthermore, the number of drugs used in each combination has been studied extensively, with a greater emphasis placed on using three-drug rather than two-drug combinations (Table 3). 15,[19][20][21] Thalidomide-based combination regimens…”

Section: Combination Regimensmentioning

confidence: 99%

“…19 This was further supported by a Phase III trial conducted later comparing TD with dexamethasone alone, with significantly higher overall response rates (ORR) in the former (63% versus 46%) as well as prolonged PFS (14.9 months versus 6.5 months). 18 As a result, TD became a commonly used induction regimen for patients prior to transplant.…”

Section: Combination Regimensmentioning

confidence: 99%

Multiple myeloma: optimal management and long-term disease control

Sriskandarajah¹,

Davies²

2014

BLCTT

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Abstract:Multiple myeloma is an incurable hematological disease previously associated with poor prognosis and survival rates. However, following the advent of the so-called novel agents, the goal of therapy has now moved to long-term disease control and potential cure. However, despite these advances, myeloma displays considerable heterogeneity and, over time, control of disease can be lost. In order to counteract this, new strategies are incorporating risk stratification to provide more individualized therapy. Furthermore, there is now increasing focus on adapting therapy in elderly and frail patients to improve compliance and maximize treatment benefit.

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“…In newly diagnosed and relapsed patients, the combination of a proteasome inhibitor with an immunomodulatory drug (IMiD) and dexamethasone is superior to treatment with dexamethasone with either an IMiD or a proteasome inhibitor only 28–32. Thalidomide is the least myelosuppressive of the IMiDs and thus, has the lowest probability of endangering engraftment.…”

Section: Introductionmentioning

confidence: 99%

VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma

Nadiminti

Abbi

Mott³

et al. 2017

OTT

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The addition of cytotoxic drugs to high-dose melphalan as a preparative regimen for autologous stem cell transplantation in multiple myeloma has not resulted in superior activity. Although novel agents have significantly improved outcome in multiple myeloma, their role in preparative regimens remains largely unknown. We have evaluated the toxicity and efficacy of combining bortezomib, thalidomide, and dexamethasone with high-dose melphalan. An institutional review board-approved retrospective analysis was performed on 100 consecutive patients receiving 153 transplants; 53 had tandem transplants; 64 patients received early transplants; and 36 had salvage transplantation. Endpoints were treatment-related toxicity and mortality, and quality of response post-transplantation with assessment of stringent complete remission (sCR) and minimal residual disease (MRD) status. Median age was 61 years, and median follow-up was 16.2 months. At 6 months, sCR was attained in 56% of patients and CR in 20%. An MRD status, assessed by sensitive (10−4) multiparameter flow cytometry, was achieved in 85%. The 100-day mortality rate was 2.6% (4/153); 1.8% for early transplants and 4.5% for salvage transplants. Grade 3–5 non-hematologic toxicities were mainly related to metabolism/nutrition; gastrointestinal and infectious problems. Median time to absolute neutrophil count of >500/µL was 12 days for both early and salvage transplantations. No significant differences in quality of response were observed between early and salvage transplantation or between single and tandem autologous stem cell transplantation. Since both sCR and MRD are excellent early surrogate markers for progression-free and overall survival, this regimen will likely be superior to melphalan alone, but it needs to be formally assessed in a randomized study.

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Current Approaches to the Initial Treatment of Symptomatic Multiple Myeloma

Cited by 10 publications

References 102 publications

Multiple Myeloma: New Perspectives

Multiple Myeloma: New Perspectives

Multiple myeloma: optimal management and long-term disease control

VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma

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