title: Addressing the questions of tomorrow: melphalan and new combinations as conditioning regimens before autologous hematopoietic progenitor cell transplantation in multiple myeloma.
abstract: BACKGROUND
  The role of high-dose chemotherapy (HDC) followed by autologous-progenitor cell transplantation (auto-HPCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. Administration of high-dose melphalan (HDM) is considered the standard conditioning regimen. Nevertheless, several attempts have recently been made to improve the conditioning phase of the HDC procedure.
  
  
  METHODS
  We reviewed all the reported experiences and illustrated current knowledge in the field of conditioning regimens.
  
  
  CONCLUSIONS
  For fit MM patients, HDC followed by auto-HPCT remains the standard of care. The available data confirm that melphalan (MEL) 200 mg/m(2) should continue to be considered the gold standard conditioning regimen, with dose reduction based on age and renal function. Targeting exposure to MEL by using area under the curve is a particularly appealing approach that could be explored to maximize efficacy and minimize toxicity of this drug. Other strategies are currently being evaluated in different trials, and the most interesting areas of research involve the incorporation of newer agents like bortezomib (BOR) into conditioning regimens. Moreover, intravenous busulfan has become available and this formulation may reduce toxicity and result in greater efficacy in association with MEL-based conditioning.
authors.affiliation: Oncology Department, Haematology and Bone Marrow Transplant Unit , Viale Europa, Reggio Calabria 89100, Italy. maxmartino65@alice.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.forename: Attilio
authors.initials: A
authors.lastname: Olivieri
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Ernesto
authors.initials: E
authors.lastname: Vigna
authors.forename: Tiziana
authors.initials: T
authors.lastname: Moscato
authors.forename: Roberta
authors.initials: R
authors.lastname: Fedele
authors.forename: Mauro
authors.initials: M
authors.lastname: Montanari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Console
authors.forename: Massimo
authors.initials: M
authors.lastname: Gentile
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Irrera
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage*; D009101:Multiple Myeloma / Q000628:therapy; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D018906:Antineoplastic Agents, Alkylating; D019653:Myeloablative Agonists; D008558:Melphalan