title: Hematological approaches to multiple myeloma: trends from a Brazilian subset of hematologists. A cross-sectional study.
abstract: OBJECTIVE
  For the last nine years, hematologists and oncologists have gathered annually at an educational symposium organized by a Brazilian and an American hospital. During the 2015 Board Review, a survey among the attendees evaluated the differences in management and treatment methods for multiple myeloma (MM).
  
  
  METHODS
  Cross-sectional study during an educational hematology symposium in São Paulo, Brazil.
  
  
  METHODS
  Hematologists present at the symposium gave responses to an electronic survey by means of mobile phone.
  
  
  RESULTS
  Among the 350 attendees, 217 answered the questionnaire. Most of the participants believed that immunotargeting agents (iTA) might be effective for slowing MM progression in heavily pretreated patients (67%) and that continued exposure to therapy might lead to emergence of resistant clones in patients with MM (76%). Most of the physicians use maintenance therapy after hematopoietic stem cell transplantation (95%) and 45% of them would further restrict it to post-transplantation patients with underlying high-risk disease. The first-line drugs used for transplantation-ineligible patients (TI-MM) were bortezomib-thalidomide-dexamethasone (31%), bortezomib-dexamethasone (28%), lenalidomide-dexamethasone (Rd; 17%) and melphalan-based therapy (10%). Lenalidomide was the drug of choice for post-transplantation maintenance for half of the participants. No significant differences were observed regarding age or length of experience.
  
  
  CONCLUSIONS
  The treatment choices for TI-MM patients were highly heterogenous and the melphalan-based regimen represented only 10% of the first-line options. Use of maintenance therapy after transplantation was a common choice. Some results from the survey were divergent from the evidence in the literature.
authors.affiliation: MD. Attending Physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Lucila Nassif
authors.initials: LN
authors.lastname: Kerbauy
authors.affiliation: MD, MSCI. Associate Professor of Medicine, Department of Stem Cell Transplant and Cellular Therapy, University of Texas at MD Anderson Cancer Center, Houston, Texas. United States.
authors.forename: Simrit
authors.initials: S
authors.lastname: Parmar
authors.affiliation: MD, PhD. Attending physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: José Mauro
authors.initials: JM
authors.lastname: Kutner
authors.affiliation: MD. Attending Physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Breno Moreno de
authors.initials: BM
authors.lastname: Gusmão
authors.affiliation: MD, PhD. Attending physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Hamerschlak
mesh_terms: D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001938:Brazil; D003226:Congresses as Topic / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006405:Hematology / Q000706:statistics & numerical data*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents