Current Treatment Strategies for Multiple Myeloma

https://doi.org/10.3816/CLM.2007.s.014Get rights and content

Abstract

In recent years, there have been major advances in the treatment of multiple myeloma. Among previously untreated patients, different combinations of dexamethasone, lenalidomide, thalidomide, and bortezomib have produced overall response rates of 80%–90% with complete response rates of 10%–32%, and remissions are often achieved after only 2 cycles of initiating systemic therapy. Subsequent intensification with high-dose chemotherapy supported by autologous stem cell transplantation has enabled younger patients to achieve partial and complete responses with evidence of prolonged survival. Tandem autologous stem cell transplantation and reduced-intensity allogeneic stem cell transplantation are under investigation in attempts to improve outcomes. For patients unable to pursue consolidation therapy with stem cell transplantation, remissions obtained with induction therapy can often be extended with the use of maintenance systemic therapy. Despite available therapies, relapse of disease is inevitable for nearly all patients, and treatment strategies with novel agents and novel combinations of established agents are under study.

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    Dr Thomas has served as a paid consultant for Millennium Pharmaceuticals.

    Dr Alexanian has received research support from Celgene and is a member of the Speaker's Bureau for Millennium Pharmaceuticals and Celgene.

    This article includes discussion of investigational and/or unlabeled uses of drugs, including the use of lenalidomide, thalidomide, and interferon-α as single agents; bortezomib in combination with dexamethasone, dexamethasone/thalidomide, dexamethasone/doxorubicin, melphalan, thalidomide, or dexamethasone/lenalidomide; thalidomide in combination with melphalan/prednisone; and pegylated liposomal doxorubicin/vincristine/dexamethasone in multiple myeloma.

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