Current treatment options for myeloma.
In most cases multiple myeloma is an incurable plasma cell malignancy. Despite the use of conventional therapy or high-dose chemotherapy with autologous stem cell transplantation (ASCT), patients continue to relapse at a constant rate. A small minority of patients are cured by allogeneic transplantation. Novel drugs targeting not only the myeloma cell but also its interactions with the malignant microenvironment have recently been used in patients with relapsed/refractory disease. So far, ASCT has been the treatment of choice for eligible myeloma patients. However, many questions regarding the management of myeloma patients remain unanswered. How safe is ASCT in elderly patients? Is there a role for non-myeloablative allogeneic transplantation in multiple myeloma? What is the role of novel agents, such as thalidomide, its analogues and bortezomib, in the treatment of newly diagnosed patients or as maintenance post-ASCT? This review summarises all available data for the current treatment options for myeloma providing a useful algorithm for its management.
Terpos
Evangelos
E
Department of Haematology, 1251 General Air Force Hospital, 5 Marathonomahon Street, Drossia Attikis, 14572, Greece. e.terpos@imperial.ac.uk
Rahemtulla
Amin
A
Dimopoulos
Meletios-Athanassios
MA
D000367:Age Factors; D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D010014:Osteolysis / Q000188:drug therapy / Q000209:etiology; D011239:Prednisolone / Q000008:administration & dosage; D011719:Pyrazines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D013792:Thalidomide / Q000627:therapeutic use; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D001897:Boronic Acids; D004164:Diphosphonates; D011719:Pyrazines; D013792:Thalidomide; D014750:Vincristine; D000069286:Bortezomib; D004317:Doxorubicin; D011239:Prednisolone; D008558:Melphalan