title: International Myeloma Working Group consensus statement for the management, treatment, and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation.
abstract: OBJECTIVE
  To provide an update on recent advances in the management of patients with multiple myeloma who are not eligible for autologous stem-cell transplantation.
  
  
  METHODS
  A comprehensive review of the literature on diagnostic criteria is provided, and treatment options and management of adverse events are summarized.
  
  
  RESULTS
  Patients with symptomatic disease and organ damage (ie, hypercalcemia, renal failure, anemia, or bone lesions) require immediate treatment. The International Staging System and chromosomal abnormalities identify high- and standard-risk patients. Proteasome inhibitors, immunomodulatory drugs, corticosteroids, and alkylating agents are the most active agents. The presence of concomitant diseases, frailty, or disability should be assessed and, if present, treated with reduced-dose approaches. Bone disease, renal damage, hematologic toxicities, infections, thromboembolism, and peripheral neuropathy are the most frequent disabling events requiring prompt and active supportive care.
  
  
  CONCLUSIONS
  These recommendations will help clinicians ensure the most appropriate care for patients with myeloma in everyday clinical practice.
authors.affiliation: Antonio Palumbo and Alessandra Larocca, University of Torino, Torino; Michele Cavo, Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Jesus F. San Miguel, University Hospital of Salamanca, Salamanca, Spain; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Gareth Morgan, Royal Marsden Hospital, London, United Kingdom; Ola Landgren, National Cancer Institute, Bethesda, MD; Roman Hajek, University of Ostrava School of Medicine and University Hospital Ostrava, Ostrava, Czech Republic; Hermann Einsele, University of Wurzburg, Wurzburg, Germany; Kenneth C. Anderson and Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA; Meletios A. Dimopoulos, University of Athens School of Medicine, Athens, Greece; Andrew Spencer, Alfred Hospital, Melbourne, Victoria, Australia; A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Kazuyuki Shimizu, Aichi Gakuin Hospital, Nagoya, Japan; Sagar Lonial, Emory University, Atlanta, GA; Pieter Sonneveld, Erasmus Medical Centre, Rotterdam, the Netherlands; Brian G.M. Durie, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA; Philippe Moreau, University Hospital, Nantes, France; and Robert Z. Orlowski, MD Anderson Cancer Center, Houston, TX.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Jesus F
authors.initials: JF
authors.lastname: San Miguel
authors.forename: Alessandra
authors.initials: A
authors.lastname: Larocca
authors.forename: Ruben
authors.initials: R
authors.lastname: Niesvizky
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.forename: Ola
authors.initials: O
authors.lastname: Landgren
authors.forename: Roman
authors.initials: R
authors.lastname: Hajek
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Anderson
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: Paul G
authors.initials: PG
authors.lastname: Richardson
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Andrew
authors.initials: A
authors.lastname: Spencer
authors.forename: A Keith
authors.initials: AK
authors.lastname: Stewart
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimizu
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Brian G M
authors.initials: BG
authors.lastname: Durie
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.forename: Robert Z
authors.initials: RZ
authors.lastname: Orlowski
mesh_terms: D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000628:therapy*; D010166:Palliative Care; D011379:Prognosis