title: Therapy for Relapsed Multiple Myeloma: Guidelines From the Mayo Stratification for Myeloma and Risk-Adapted Therapy.
abstract: Life expectancy in patients with multiple myeloma is increasing because of the availability of an increasing number of novel agents with various mechanisms of action against the disease. However, the disease remains incurable in most patients because of the emergence of resistant clones, leading to repeated relapses of the disease. In 2015, 5 novel agents were approved for therapy for relapsed multiple myeloma. This surfeit of novel agents renders management of relapsed multiple myeloma more complex because of the occurrence of multiple relapses, the risk of cumulative and emergent toxicity from previous therapies, as well as evolution of the disease during therapy. A group of physicians at Mayo Clinic with expertise in the care of patients with multiple myeloma regularly evaluates the evolving literature on the biology and therapy for multiple myeloma and issues guidelines on the optimal care of patients with this disease. In this article, the latest recommendations on the diagnostic evaluation of relapsed multiple myeloma and decision trees on how to treat patients at various stages of their relapse (off study) are provided together with the evidence to support them.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: dingli.david@mayo.edu.
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL.
authors.forename: Sikander
authors.initials: S
authors.lastname: Ailawadhi
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ.
authors.forename: P Leif
authors.initials: PL
authors.lastname: Bergsagel
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Francis K
authors.initials: FK
authors.lastname: Buadi
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Wilson I
authors.initials: WI
authors.lastname: Gonsalves
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hayman
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kapoor
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Taxiarchis
authors.initials: T
authors.lastname: Kourelis
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: John A
authors.initials: JA
authors.lastname: Lust
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Mikhael
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Craig B
authors.initials: CB
authors.lastname: Reeder
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL.
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Russell
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL.
authors.forename: Taimur
authors.initials: T
authors.lastname: Sher
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ.
authors.forename: A Keith
authors.initials: AK
authors.lastname: Stewart
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Rahma
authors.initials: R
authors.lastname: Warsame
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Zeldenrust
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL.
authors.forename: Asher A
authors.initials: AA
authors.lastname: Chanan Khan
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology; D000066491:Clinical Decision-Making; D019468:Disease Management; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000628:therapy; D009101:Multiple Myeloma / Q000175:diagnosis / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012008:Recurrence; D020379:Risk Adjustment / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents