title: Therapy of relapsed and refractory multiple myeloma.
abstract: Despite considerable improvements in first line treatment still the majority of patients experience relapse of multiple myeloma. Treatment decisions for relapse or refractory multiple myeloma should be based on a clinical decision path taking response and adverse events to previous therapy, myeloma specific complications and organ dysfunctions, overall clinical condition, age, cytogenetic information and prognostic factors into account. Bortezomib, thalidomide and lenalidomide have improved the therapeutic armentarium for patients with refractory or relapsed disease and are often used in combination with dexamethasone or chemotherapeutic agents. Combination therapies of novel agents in drug combination regimen are currently under investigation as well. For patients with a disease free survival of 12 month or longer after initial single or tandem high dose therapy and autologous stem cell transplantation (ASCT) repeat of high dose therapy with melphalan and ASCT should be considered in case of relapse. Radiotherapy and osteoplastic procedures can be used as adjunct to systemic therapy to treat local complications in particular vertebral pain caused by osteolytic bone disease. Cytogenetic tests, molecular techniques as gene expression profiling and other diagnostic will lead to a more individualized therapy. The integration of novel compounds into established regimen will be a major challenge for future clinical studies.
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany. thomas.moehler@i3global.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Moehler
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D000077269:Lenalidomide; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D046988:Proteasome Endopeptidase Complex / Q000627:therapeutic use; D061988:Proteasome Inhibitors; D011719:Pyrazines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D055502:Secondary Prevention; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D001897:Boronic Acids; D007783:Lactones; D061988:Proteasome Inhibitors; D011719:Pyrazines; D011758:Pyrroles; D013792:Thalidomide; D000069286:Bortezomib; C475865:marizomib; D003907:Dexamethasone; D046988:Proteasome Endopeptidase Complex; D000077269:Lenalidomide