Current Therapy of Multiple Myeloma.

Abstract

Not all patients who fulfill the minimal criteria for the diagnosis of multiple myelomashould be treated. If a patient is younger than 70 years, autologous peripheral blood stem cell transplantation should be seriously considered. Major challenges for stem cell transplantation are: 1) the inability to eradicate multiple myelomafrom the patient, and 2) removal of myelomacells and their precursors from the rein fused stem cells. Allogeneic transplantation cannot be recommendedat present because of the excessive mortality. Nonmyeloablativeapproaches are promising. There is no evidence that combinations of alkylating agents are superior to melphalan and prednisone. The use of thalidomide and intermittently administered prednisone for maintenance is being explored. Newagents include the immunomodulatory drugs, inhibitors of the ubiquitin proteasone pathway such as PS-341, antiangiogenesis drugs including 2-methoxy-estradiol, and farnesyl transferase inhibitors. Management of skeletal complications, hypercalcemia, anemia, infection, spinal cord compression, and renal insufficiency is discussed. (Internal Medicine 41: 175-180, 2002)

Can opportunistic case-finding of paraproteins be clinically justified?

“…bisphosphonates), and novel agents. 16 It has been speculated that there is potential here for inhibiting the development of myeloma at the MGUS stage.…”

“…Treatment aimed at inducing remission and prolonging survival over untreated cohorts is based on melphalan and prednisolone in the elderly and high-dose chemotherapy usually complemented by autologous stem cell transplantation (median survival 5 years) in younger patients (o65 years). 5,16 A range of new agents, including thalidomide, proteosome inhibitors and immunomodulatory drugs, have recently been introduced, or are undergoing trials, and are used either when patients relapse from conventional treatment, or as ¢rst-line agents in combination with standard chemotherapy. 16,17 These new agents are targeted at key molecular and immunological aberrations which are being unravelled, and these new agents appear to prolong survival.…”

“…5,16 A range of new agents, including thalidomide, proteosome inhibitors and immunomodulatory drugs, have recently been introduced, or are undergoing trials, and are used either when patients relapse from conventional treatment, or as ¢rst-line agents in combination with standard chemotherapy. 16,17 These new agents are targeted at key molecular and immunological aberrations which are being unravelled, and these new agents appear to prolong survival. 11,16,17 Bisphosphonates and localized radio- therapy remain as e¡ective adjunctive agents to alleviate bone disease and symptoms.…”

“…16,17 These new agents are targeted at key molecular and immunological aberrations which are being unravelled, and these new agents appear to prolong survival. 11,16,17 Bisphosphonates and localized radio- therapy remain as e¡ective adjunctive agents to alleviate bone disease and symptoms. 5 Standard chemotherapy is not indicated for patients with MGUS where it may be harmful and o¡ers no advantage in terms of survival in patients with asymptomatic myeloma.…”

Nephrotic Syndrome Due to Primary AL Amyloidosis, Successfully Treated with VAD and Subsequent High-dose Melphalan Followed by Autologous Peripheral Blood Stem Cell Transplantation.

“…The other critical point was that a relapse might occur after auto-PBSCTif pathogenetic plasma cells contaminated the hematopoietic stem cells collected by leukaphesis. Allogeneic stem cell transplantation is, of course, superior to auto-PBSCTfor preventing relapse, but this therapy is generally not acceptable for primary AL amyloidosis at the present time because of manypossible serious complications, including graft versus host disease (22)(23)(24)(25). The relapse rate after auto-PBSCT is around 10%or less according to previous reports (12,15).…”