title: Practical Considerations in Managing Relapsed Multiple Myeloma.
abstract: Considerable advances have been made in the treatment of relapsed and relapsed/refractory multiple myeloma, with numerous novel agents and combination strategies receiving regulatory approval worldwide during the past several years. An increasing body of phase III data has clearly demonstrated increased overall response rates, improved depths of response, and more durable responses when a third novel agent is incorporated into lenalidomide-dexamethasone and bortezomib-dexamethasone platforms, in most cases with acceptable toxicity. The carfilzomib-dexamethasone doublet has also demonstrated promising activity. With this rapid progress has come many new questions. We review the data supporting the use of these novel treatment paradigms for relapsed/refractory multiple myeloma, discuss the place of autologous and allogeneic hematopoietic stem cell transplantation in this rapidly evolving treatment space, and propose strategies to best use these regimens, considering the disease, host, and previous treatment factors.
authors.affiliation: Division of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
authors.forename: Eric
authors.initials: E
authors.lastname: Chow
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
authors.forename: Manisha
authors.initials: M
authors.lastname: Bhutani
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Voorhees
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
authors.forename: Reed
authors.initials: R
authors.lastname: Friend
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC. Electronic address: saad.usmani@carolinashealthcare.org.
authors.forename: Saad Z
authors.initials: SZ
authors.lastname: Usmani
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069286:Bortezomib / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D000077269:Lenalidomide; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D009842:Oligopeptides / Q000008:administration & dosage; D012008:Recurrence; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D009842:Oligopeptides; D013792:Thalidomide; D000069286:Bortezomib; C524865:carfilzomib; D003907:Dexamethasone; D000077269:Lenalidomide
keywords: Carfilzomib; Daratumumab; Elotuzumab; Pomalidomide; Refractory; Transplant; Treatment