Treatment of myeloma: recent developments.
Melphalan was the first described treatment for patients with multiple myeloma in the 1960s and is still being used in clinical practice. However, the use of melphalan in combination with prednisone resulted in a median survival of only 2-3 years. Therefore, the dose of melphalan has been intensified since then (140-200 mg/m(2)). In order to diminish treatment-related morbidity and mortality due to severe myelosuppression induced by these regimens, high-dose melphalan is currently supported with autologous stem cells. Indications for high-dose therapy and the role of further intensification by performing second or allogeneic transplantations are discussed. Furthermore, new therapeutic modalities, such as inhibitors of angiogenesis, also showing direct antiproliferative, cytokine-related and immunomodulatory effects on plasma cells (thalidomide and its newer derivatives), inhibitors of the transcription factor NF-kappa B (proteasome inhibitors) and immunotherapy are described.
Zweegman
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Department of Hematology, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands. s.zweegman@vumc.nl
Huijgens
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D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use*; D009101:Multiple Myeloma / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000627:therapeutic use
D018906:Antineoplastic Agents, Alkylating; D018931:Antineoplastic Agents, Hormonal; D013792:Thalidomide; D007372:Interferons; D008558:Melphalan; D011241:Prednisone