title: Treatment of relapsed and refractory multiple myeloma in the era of novel agents.
abstract: The introduction of the Immunomodulatory drugs (IMiDs) and proteasome inhibitors, used either as a single-agent or combined with classic anti-myeloma therapies, has improved the outcome for patients with relapsed myeloma. However, there is currently no generally accepted standard treatment for relapsed/refractory myeloma patients, partly because of the absence of trials comparing the efficacy of the novel agents in relapsed/refractory myeloma. Choice of a new treatment regimen depends on both patient and disease-specific characteristics. A lenalidomide-based regimen is the first choice in patients with neuropathy, while bortezomib has the highest efficacy in patients with renal insufficiency and is not associated with increased risk of thromboembolism. A second autologous stem cell transplantation (auto-SCT) can be applied in patients with a progression-free period of ≥ 18-24 months after the first auto-SCT. In high-risk relapse such as occurring early after auto-SCT consolidation with allogeneic SCT can be considered. In this review we provide an overview of the various salvage regimens and give recommendations for treatment of patients with relapsed/refractory myeloma in different clinical settings.
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. n.w.c.j.vandedonk@umcutrecht.n
authors.forename: Niels W C J
authors.initials: NW
authors.lastname: van de Donk
authors.forename: Henk M
authors.initials: HM
authors.lastname: Lokhorst
authors.forename: Meletios
authors.initials: M
authors.lastname: Dimopoulos
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Martin
authors.initials: M
authors.lastname: Kropff
authors.forename: Steve
authors.initials: S
authors.lastname: Schey
authors.forename: Hervé
authors.initials: H
authors.lastname: Avet-Loiseau
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Hans E
authors.initials: HE
authors.lastname: Johnsen
authors.forename: Joan
authors.initials: J
authors.lastname: Bladé
authors.forename: Jesús F
authors.initials: JF
authors.lastname: San-Miguel
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D009101:Multiple Myeloma / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D061988:Proteasome Inhibitors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007155:Immunologic Factors; D061988:Proteasome Inhibitors