Therapy of Relapsed and Refractory Multiple Myeloma

Abstract

Despite considerable improvements in first line treatment still the majority of patients experience relapse of multiple myeloma. Treatment decisions for relapse or refractory multiple myeloma should be based on a clinical decision path taking response and adverse events to previous therapy, myeloma specific complications and organ dysfunctions, overall clinical condition, age, cytogenetic information and prognostic factors into account. Bortezomib, thalidomide and lenalidomide have improved the therapeutic armentarium for patients with refractory or relapsed disease and are often used in combination with dexamethasone or chemotherapeutic agents. Combination therapies of novel agents in drug combination regimen are currently under investigation as well. For patients with a disease free survival of 12 month or longer after initial single or tandem high dose therapy and autologous stem cell transplantation (ASCT) repeat of high dose therapy with melphalan and ASCT should be considered in case of relapse. Radiotherapy and osteoplastic procedures can be used as adjunct to systemic therapy to treat local complications in particular vertebral pain caused by osteolytic bone disease. Cytogenetic tests, molecular techniques as gene expression profiling and other diagnostic will lead to a more individualized therapy. The integration of novel compounds into established regimen will be a major challenge for future clinical studies.

Proline-mediated Proteasomal Degradation of the Prostate-specific Tumor Suppressor NKX3.1

“…For example, Velcade (bortezomib) is a global proteasome inhibitor that has shown efficacy in treating multiple myeloma and ovarian carcinoma (53)(54)(55). In a more targeted approach, MDM2 peptidomimetics have been shown to interfere with MDM2/p53 interaction, thereby restoring p53 level in hematologic malignancies (56 -60).…”

Suberoylanilide Hydroxamic Acid as a Radiosensitizer through Modulation of RAD51 Protein and Inhibition of Homology-Directed Repair in Multiple Myeloma

“…Particularly challenging are patients with progressive disease after first-line therapies (3). These patients are often considered for hematopoietic cell transplantation (HCT).…”

Multiple Myeloma in Horses, Dogs and Cats: A Comparative Review Focused on Clinical Signs and Pathogenesis

“…Treatment of patients affected by indolent MM with the anti-angiogenic agent thalidomide resulted in a 66% response rate and the drug appeared to have potential to delay the onset of clinical signs associated with the disease [261][262]. The efficacy of thalidomide for the treatment of refractory relapsed MM has also been confirmed [263][264][265]. Studies evaluating the possible efficacy of thalidomide for the treatment of MM in companion animals are lacking.…”