Considerations in the treatment of multiple myeloma: a consensus statement from Italian experts.
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.
Patriarca
Francesca
F
Division of Hematology and Transplant Unit Carlo Melzi, Department Morphological and Clinical Research, University of Udine, Udine, Italy. patriarca.francesca@aoud.sanita.fvg.it
Petrucci
Maria T
MT
Bringhen
Sara
S
Baldini
Luca
L
Caravita
Tommaso
T
Corradini
Paolo
P
Corso
Alessandro
A
Di Raimondo
Francesco
F
Falcone
Antonietta
A
Ferrara
Felicetto
F
Morabito
Fortunato
F
Musto
Pellegrino
P
Offidani
Massimo
M
Petrini
Mario
M
Rizzi
Rita
R
Semenzato
Gianpietro
G
Tosi
Patrizia
P
Vacca
Angelo
A
Cavo
Michele
M
Boccadoro
Mario
M
Palumbo
Antonio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy*; D012008:Recurrence