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Treatment strategies in relapsed and refractory multiple myeloma: a focus on drug sequencing and ‘retreatment’ approaches in the era of novel agents

Leukemia volume 26, pages 73–85 (2012)Cite this article

Abstract

Treatment of multiple myeloma has evolved over the last decade, most notably with the introduction of highly effective novel agents. It is now possible to aim for deep disease responses in a greater number of patients in an attempt to prolong remission duration and survival. Initially introduced in the relapsed setting, the novel agents, namely thalidomide, bortezomib and lenalidomide, are now being increasingly incorporated into upfront treatment strategies, raising questions about the feasibility of ‘retreatment’ with such agents. Also, in a disease that is characterized by multiple relapses, the ‘sequencing’ of the different effective options is an important question. In the frontline setting, the first remission is likely to be the period during which patients will enjoy the best quality of life. Thus, the goal should be to achieve a first remission that is the longest possible by using the most effective treatment upfront. At relapse, the challenge is to select the optimal treatment for each patient while balancing efficacy and toxicity. The decision will depend on both disease- and patient-related factors. This review aimed to assess the available research data addressing ‘retreatment’ approaches, drug ‘sequencing’ and the long-term impact of upfront therapy with novel drugs.

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Acknowledgements

MM would like to thank the ‘Région Pays de Loire’, the ‘Association pour la Recherche sur le Cancer (ARC)’, the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’, the ‘Association Laurette Fuguain’, the association IRGHET and the ‘Ligue contre le Cancer’ for their generous and continuous support for our clinical and basic research work. The Nantes group is supported by several grants from the French national cancer institute (PHRC, INCa). We would like to acknowledge the continuous support of the cell banking facility (‘tumurotheque’) of the CHU de Nantes. We would like to apologize for those colleagues whose work could not be cited because of space limitation.

Author contributions BM performed bibliographic search, analyzed data and wrote the manuscript; JEC, IYA, HAL and PM commented on the manuscript; MM designed research, performed bibliographic search, provided funding, analyzed data and wrote the manuscript. All authors approved the manuscript for publication purposes.

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  1. P Moreau and M Mohty: These authors share senior authorship.

Authors and Affiliations

  1. Service d’Hématologie, Hôpital Universitaire de Genève, Geneva, Switzerland

    B Mohty

  2. Département d’Hématologie, Institut Paoli-Calmettes, Marseille, France

    J El-Cheikh

  3. Service d’Hématologie, CHRU de Lille, Lille, France

    I Yakoub-Agha

  4. Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France

    H Avet-Loiseau, P Moreau & M Mohty

  5. INSERM CRCNA, UMR 892, Nantes, France

    H Avet-Loiseau, P Moreau & M Mohty

  6. Université de Nantes, Faculté de Médecine, Nantes, France

    H Avet-Loiseau, P Moreau & M Mohty

  7. Centre d’Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, Nantes, France

    P Moreau & M Mohty

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MM, HAL and PM have received honoraria for lectures and research grants from the Janssen Pharmaceuticals and Celgene whose products are discussed in this article.

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Mohty, B., El-Cheikh, J., Yakoub-Agha, I. et al. Treatment strategies in relapsed and refractory multiple myeloma: a focus on drug sequencing and ‘retreatment’ approaches in the era of novel agents. Leukemia 26, 73–85 (2012). https://doi.org/10.1038/leu.2011.310

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