Advances in therapy of multiple myeloma
- 1 November 2008
- journal article
- review article
- Published by Wolters Kluwer Health in Current Opinion in Oncology
- Vol. 20 (6), 697-704
- https://doi.org/10.1097/cco.0b013e3283136984
Abstract
To summarize the results of treatment of multiple myeloma in the era of novel agents.Recent publications comparing autologous stem cell transplantation (ASCT) with conventional chemotherapy in the era of 'old' drugs have shown that the contribution of ASCT in the treatment of multiple myeloma has been modest. Five trials comparing single vs. double ASCT showed an increased progression-free survival in three of them, whereas the overall survival was significantly prolonged in one. The benefit would be only for patients failing to achieve very good partial response with the first transplant. The results of allogeneic transplantation with reduced-intensity conditioning, particularly after debulking with an ASCT, are encouraging. On the contrary, the impact of pretransplant induction regimens with novel agents (thalidomide, bortezomib and lenalidomide) on the posttransplant outcome is being investigated in several large phase III trials. For elderly patients, the combination of 'old' therapies with thalidomide, bortezomib or lenalidomide has resulted in the melphalan-prednisone-thalidomide, melphalan-prednisone-Velcade, melphalan-prednisone-Revlimid and lenalidomide/dexamethasone regimens, which are highly effective.ASCT has resulted in a modest contribution in the treatment of multiple myeloma. Hopefully, its impact will be increased with the incorporation of novel agents in the pretransplant induction regimens. The combination of thalidomide, bortezomib or lenalidomide with melphalan-prednisone or with dexamethasone has resulted in highly effective regimens for patients not eligible for high-dose therapy/stem cell transplantation.Keywords
This publication has 58 references indexed in Scilit:
- Improved survival in multiple myeloma and the impact of novel therapiesBlood, 2008
- Recent major improvement in long-term survival of younger patients with multiple myelomaBlood, 2008
- Lenalidomide plus Dexamethasone for Relapsed Multiple Myeloma in North AmericaNew England Journal of Medicine, 2007
- Lenalidomide plus Dexamethasone for Relapsed or Refractory Multiple MyelomaNew England Journal of Medicine, 2007
- Bortezomib in combination with thalidomide-dexamethasone for previously untreated multiple myelomaHematology, 2007
- Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trialThe Lancet, 2006
- Phase III Clinical Trial of Thalidomide Plus Dexamethasone Compared With Dexamethasone Alone in Newly Diagnosed Multiple Myeloma: A Clinical Trial Coordinated by the Eastern Cooperative Oncology GroupJournal of Clinical Oncology, 2006
- Bortezomib or High-Dose Dexamethasone for Relapsed Multiple MyelomaNew England Journal of Medicine, 2005
- PAD combination therapy (PS‐341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myelomaBritish Journal of Haematology, 2005
- Single versus Double Autologous Stem-Cell Transplantation for Multiple MyelomaNew England Journal of Medicine, 2003