title: Multiple myeloma treatment at relapse after autologous stem cell transplantation: A practical analysis.
abstract: Over the past decade, significant advances have been made in the field of multiple myeloma. Introduction of the so-called novel agents, proteasome inhibitors (PI) and immunomodulatory drugs (IMiD), and improved supportive care have resulted in significantly better outcome. Standard first line treatment in fit patients include PI and IMiD based induction, high dose melphalan with autologous hematopoietic stem cell transplantation (ASCT) and consolidation/maintenance. However, despite these progresses MM remains incurable for the majority of patients and most patients will relapse. Next generation PI (carfilzomib, ixazomib) and IMiD (pomalidomide) and new therapeutic classes: monoclonal antibody (elotuzumab, daratumumab) and pan-deacetylase inhibitors (panobinostat) have been successfully evaluated in relapse multiple myeloma. Some of these new agents are now approved for multiple myeloma treatment at relapse. However choosing the most appropriate treatment at relapse may be difficult. This review sum up the most important studies and provide evidence to choose the most relevant therapeutic strategy for relapse after ASCT, based on disease, patient and previous treatment related parameters.
authors.affiliation: Department of Haematology, Saint Antoine Hospital, Paris, France; INSERM UMRs 938, Paris, France; Université Pierre et Marie Curie, Paris, France. Electronic address: malardf@yahoo.fr.
authors.forename: F
authors.initials: F
authors.lastname: Malard
authors.affiliation: Centre Catherine de Sienne, Nantes, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Harousseau
authors.affiliation: Department of Haematology, Saint Antoine Hospital, Paris, France; INSERM UMRs 938, Paris, France; Université Pierre et Marie Curie, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous
keywords: Autologous stem cell transplantation; First relapse; Multiple myeloma; New agents; Transplant eligible patients; Treatment