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Treatment of multiple myeloma

Nature Reviews Clinical Oncology volume 8, pages 479–491 (2011)Cite this article

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Abstract

The treatment of multiple myeloma has changed dramatically in the past decade. The increase in the number of active agents has generated numerous possible drug combinations that can be used in the first-line and relapsed settings. As a result, there is considerable confusion about the choice of regimens for initial therapy, role of transplantation in the era of new drugs, end points for therapy, and the role of maintenance therapy. A hotly debated area is whether treatment approaches should achieve cure or disease control, which impacts greatly on the treatment strategy employed. This article provides an update on the treatment of multiple myeloma, with a focus on recent advances, newly diagnosed disease, role of transplantation and maintenance therapy. A synthesized approach to the treatment of myeloma is presented, along with a discussion of key paradigms that need to be challenged.

Key Points

  • The treatment of multiple myeloma has changed dramatically in the past decade with several new active agents and numerous possible drug combinations

  • Based on specific cytogenetic features, myeloma can be classified into high, intermediate, and standard-risk categories

  • Patients with 17p deletion, t(14;16), and t(14;20) are considered to have high-risk disease, while those with t(4;14) in the absence of high-risk features represent intermediate-risk disease

  • Two and three drug combinations incorporating immunomodulatory agents (thalidomide, lenalidomide) and/or bortezomib are the mainstay of initial therapy

  • The intensity and duration of treatment is dictated by the baseline risk stratification and eligibility for stem-cell transplantation; autologous stem-cell transplantation is not curative but prolongs survival

  • The most promising new agents include pomalidomide, carfilzomib, elotuzumab, MLN9708, histone deacetylase inhibitors, PI3K pathway inhibitors, and heat shock protein 90 inhibitors

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Figure 1: Treatment algorithm

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Change history

  • 06 July 2011

    In the version of this article initially published online the headings for the median progression-free survival and overall survival shown in parentheses in Tables 4 and 5 should have been months not years. The error has been corrected for the print, HTML and PDF versions of the article.

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Rajkumar, S. Treatment of multiple myeloma. Nat Rev Clin Oncol 8, 479–491 (2011). https://doi.org/10.1038/nrclinonc.2011.63

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  • DOI: https://doi.org/10.1038/nrclinonc.2011.63

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