title: How to treat patients with relapsed/refractory multiple myeloma: evidence-based information and opinions.
abstract: BACKGROUND
  Relapsed/refractory multiple myeloma (rrMM) remains a difficult condition to treat despite the availability of new drugs. This review aims to provide evidence to guide physicians in the choice of salvage therapy in certain subgroups of patients.
  
  
  METHODS
  The review attempts to present evidence-based information and suggest possible approaches based on data on previous therapies, previous remission duration and toxicity of previous treatments, patient's co-morbidities and disease characteristics at relapse. Unfortunately, little evidence is available; there are no large and/or randomized trials, direct comparisons of drugs or combinations for rrMM patients to draw any definite conclusion.
  
  
  CONCLUSIONS
  Almost all the studies presented here suggest that depth of response is a key factor also for patients with rrMM. Identifying the best approach between combinations and sequential therapies remains controversial. Several studies favor the former approach in early relapse as it leads to a higher complete response rate, regardless of previous therapies. However, in both strategies, achieving maximal response should always remain a main goal. Consolidation/maintenance therapy is beneficial both in combination and sequential therapies also in rrMM. Second generation new drugs, such as pomalidomide, carfilzomib, bendamustine and HDAC inhibitors, will probably expand the rescue possibilities also in this setting.
authors.affiliation: Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Laura
authors.initials: L
authors.lastname: Corvatta
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
authors.forename: Massimo
authors.initials: M
authors.lastname: Gentile
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Pietro
authors.initials: P
authors.lastname: Leoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002869:Chromosome Aberrations; D020732:Cytogenetic Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome