title: Initial therapy in multiple myeloma: investigating the new treatment paradigm.
abstract: The development of three novel chemotherapeutic agents - thalidomide, lenalidomide, and bortezomib - has resulted in a fundamental shift in the management of multiple myeloma. Despite this tremendous advancement, the selection of initial treatment must still be made with a degree of uncertainty as a true standard therapy has yet to be established. Although challenging, the relative abundance of therapeutic options, when taken into consideration with unique patient characteristics, creates the potential for individualization of care.For patients eligible for autologous stem cell transplantation, various combinations of novel agents with dexamethasone or traditional chemotherapy have supplanted the previous standard regimen consisting of vincristine, doxorubicin, and dexamethasone. In elderly patients or others that are deemed ineligible for the transplant procedure, the addition of a novel agent to melphalan-prednisone has demonstrated significant improvements in response rates. Due to the immaturity of the available data, it is perhaps best to regard the era of novel agents with a degree of rational enthusiasm, as the ultimate impact on patient care remains undetermined. Although further research is clearly implicated, recent advancements have resulted in significant progress toward obtaining optimum outcomes in a historically challenging disease.
authors.affiliation: Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Kettle
authors.forename: Karen L
authors.initials: KL
authors.lastname: Finkbiner
authors.forename: Susan E
authors.initials: SE
authors.lastname: Klenke
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Baker
authors.forename: Dave W
authors.initials: DW
authors.lastname: Henry
authors.forename: Casey B
authors.initials: CB
authors.lastname: Williams
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003131:Combined Modality Therapy; D015897:Comorbidity; D019317:Evidence-Based Medicine / Q000639:trends; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077269:Lenalidomide; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D011719:Pyrazines / Q000627:therapeutic use*; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide