title: The treatment of relapsed and refractory multiple myeloma.
abstract: Relapsed and refractory multiple myeloma (MM) constitutes a specific and unmet medical need. Median survival ranges from as little as 6 to 9 months, and responses to treatment are characteristically short. Patients with relapsed/refractory disease are defined as those who, having achieved minor response or better, relapse and then progress while on salvage therapy, or experience progression within 60 days of their last therapy. In the era prior to the development of novel biologically based therapies for MM, relapse from successive treatment regimens resulted in progressively shorter response durations, which typically reflected emerging drug resistance, as well as changes in disease biology within each patient, with tumor cells expressing a more aggressive phenotype, higher proliferative fraction and lower apoptotic rates. Both bortezomid- and lenalidomide-based therapies are expecially active, with bortezomib in particular being shown to provide a platform for combinations able to overcome resistance in this setting. The addition of novel and conventional agents to the treatment backbone of lenalidomide, thalidomide, and bortezomib are areas of active study, with participation in clincial trials a clear priority for such patients. Clinical challenges in the relapsed/refractory population include light chain and IgA isotype, renal failure, extramedullary disease, hyposecretory myeloma, and advanced bone disease.
authors.affiliation: Dana-Farber Cancer Institute, 44 Binney St., Dana D1B08, Boston, MA 02115-6084, USA. paul_richardson@dfci.harvard.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Richardson
authors.forename: Constantine
authors.initials: C
authors.lastname: Mitsiades
authors.forename: Robert
authors.initials: R
authors.lastname: Schlossman
authors.forename: Irene
authors.initials: I
authors.lastname: Ghobrial
authors.forename: Teru
authors.initials: T
authors.lastname: Hideshima
authors.forename: Dharminder
authors.initials: D
authors.lastname: Chauhan
authors.forename: Nikhil
authors.initials: N
authors.lastname: Munshi
authors.forename: Kenneth
authors.initials: K
authors.lastname: Anderson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D006801:Humans; D000077269:Lenalidomide; D009101:Multiple Myeloma / Q000188:drug therapy*; D011719:Pyrazines / Q000627:therapeutic use*; D012008:Recurrence; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide