title: Considerations in the treatment of multiple myeloma: a consensus statement from Italian experts.
abstract: PURPOSE AND BASIC PROCEDURE OF THE STUDY: The availability of new targeted therapies has revolutionised the treatment of multiple myeloma (MM), for both the newly diagnosed and the relapsed and refractory settings. A panel of Italian experts provided guidelines for optimal clinical practice in the treatment of MM.
  
  
  CONCLUSIONS
  The panel recommended that treatment should only be initiated in symptomatic patients. Autologous stem cell transplantation (ASCT) with melphalan is the treatment of choice in patients younger than 65 yr, and induction therapy including new drugs seems the most suitable preparatory regimen before ASCT. In patients who fail to achieve at least a very good partial response (VGPR) after transplant, a consolidation with a second transplant is of clinical benefit. Also, there is evidence that maintenance with thalidomide after ASCT in young patients failing to reach at least VGPR could prolong survival. In elderly patients, the combination of an alkylating drug with a novel agent should be considered as standard approach. Relapsed MM should be retreated after the reappearance of symptoms and signs of organ and tissue damage. Salvage regimens should include corticosteroids plus bortezomib, thalidomide or lenalidomide.
authors.affiliation: Division of Hematology and Transplant Unit Carlo Melzi, Department Morphological and Clinical Research, University of Udine, Udine, Italy. patriarca.francesca@aoud.sanita.fvg.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Maria T
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Sara
authors.initials: S
authors.lastname: Bringhen
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.forename: Tommaso
authors.initials: T
authors.lastname: Caravita
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Corso
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Raimondo
authors.forename: Antonietta
authors.initials: A
authors.lastname: Falcone
authors.forename: Felicetto
authors.initials: F
authors.lastname: Ferrara
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Mario
authors.initials: M
authors.lastname: Petrini
authors.forename: Rita
authors.initials: R
authors.lastname: Rizzi
authors.forename: Gianpietro
authors.initials: G
authors.lastname: Semenzato
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tosi
authors.forename: Angelo
authors.initials: A
authors.lastname: Vacca
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy*; D012008:Recurrence