Treatment of relapsed and refractory multiple myeloma in the era of novel agents.
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.
van de Donk
Niels W C J
NW
Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. n.w.c.j.vandedonk@umcutrecht.n
Lokhorst
Henk M
HM
Dimopoulos
Meletios
M
Cavo
Michele
M
Morgan
Gareth
G
Einsele
Hermann
H
Kropff
Martin
M
Schey
Steve
S
Avet-Loiseau
Hervé
H
Ludwig
Heinz
H
Goldschmidt
Hartmut
H
Sonneveld
Pieter
P
Johnsen
Hans E
HE
Bladé
Joan
J
San-Miguel
Jesús F
JF
Palumbo
Antonio
A
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
D000970:Antineoplastic Agents; D007155:Immunologic Factors; D061988:Proteasome Inhibitors