Initial Therapy of Multiple Myeloma in Patients who are Candidates for Stem Cell Transplantation.
Multiple myeloma (MM), a B cell hematologic malignancy involving plasma cells, responds to a variety of drugs including alkylators, steroids, anthracyclines, immunomodulators and proteosome inhibitors. The disease, however, remains largely incurable for the majority of patients. For patients who are suitable candidates, high dose chemotherapy with autologous stem cell support (ASCT) after induction therapy has been shown to improve response rates, progression free survival and overall survival compared to conventional chemotherapy. The availability of new drugs including thalidomide, lenalidomide and bortezomib has rapidly changed induction strategies. These drugs have been combined with corticosteroids, alkylators and anthracyclines to treat front-line patients with MM. Preliminary, phase 1-2 studies have indicated very high response rates and complete response rates formerly only seen with ASCT. Emerging data from randomized trials suggest that older regimens such as vincristine, adriamycin and dexamethasone (VAD) are not as effective for induction as newer combinations. Thus new regimens incorporating novel agents should improve overall response rates, increase complete responders which should translate into improved progression free and overall survival.
Bensinger
William
W
Fred Hutchinson Cancer Research Center, D5-390 1100 Fairview Avenue N., Seattle, WA 98118, USA. wbensing@fhcrc.org
D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077269:Lenalidomide; D009101:Multiple Myeloma / Q000628:therapy*; D011379:Prognosis; D011719:Pyrazines / Q000627:therapeutic use; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077269:Lenalidomide