How to treat a newly diagnosed young patient with multiple myeloma.
Survival rates of young patients with myeloma have increased markedly in the last decade, mainly due to the use of autologous stem cell transplantation (ASCT) and new, highly efficient rescue treatments. In order to improve the survival of newly diagnosed young patients further, the next steps need to focus on increasing the activity of upfront or debulking regimens, improving the efficacy of ASCT, mainly through the conditioning regimen, and increasing the duration of responses through more effective maintenance or consolidation therapies. Nevertheless, this approach is being challenged by the favorable results obtained with long-term treatment with novel agents and the possibility of reserving the ASCT until relapse. Allogeneic transplantation in newly diagnosed patients should be considered as an investigational procedure and used only in well-designed clinical trials. This review covers the new strategies that are currently under investigation with the aim of optimizing the outcome for newly diagnosed young patients with myeloma.
San-Miguel
Jesús F
JF
University Hospital of Salamanca, Salamanca, Spain. sanmigiz@aida.usal.es
Mateos
María-Victoria
MV
D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D019468:Disease Management; D004317:Doxorubicin / Q000008:administration & dosage; D023381:Endpoint Determination; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077269:Lenalidomide; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D015337:Multicenter Studies as Topic; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D019653:Myeloablative Agonists / Q000009:adverse effects / Q000627:therapeutic use; D011719:Pyrazines / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods
D001897:Boronic Acids; D019653:Myeloablative Agonists; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D005047:Etoposide; D004317:Doxorubicin; D000077269:Lenalidomide