Treatment of relapsed and refractory multiple myeloma in the era of novel agents

NWCJ v.d. Donk, HM Lokhorst, M Dimopoulos, M Cavo, G Morgan, H Einsele, M Kropff, S Schey, H Avet-Loiseau, H Ludwig, H Goldschmidt, Pieter Sonneveld, HE Johnsen, J Blade, JF San-Miguel, AA Palumbo

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The introduction of the Immunomodulatory drugs (IMiDs) and proteasome inhibitors, used either as a single-agent or combined with classic anti-myeloma therapies, has improved the outcome for patients with relapsed myeloma. However, there is currently no generally accepted standard treatment for relapsed/refractory myeloma patients, partly because of the absence of trials comparing the efficacy of the novel agents in relapsed/refractory myeloma. Choice of a new treatment regimen depends on both patient and disease-specific characteristics. A lenalidomide-based regimen is the first choice in patients with neuropathy, while bortezomib has the highest efficacy in patients with renal insufficiency and is not associated with increased risk of thromboembolism. A second autologous stem cell transplantation (auto-SCT) can be applied in patients with a progression-free period of >= 18-24 months after the first auto-SCT. In high-risk relapse such as occurring early after auto-SCT consolidation with allogeneic SCT can be considered. In this review we provide an overview of the various salvage regimens and give recommendations for treatment of patients with relapsed/refractory myeloma in different clinical settings. (C) 2010 Elsevier Ltd. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)266-283
Number of pages18
JournalCancer Treatment Reviews
Issue number4
Publication statusPublished - 2011

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