TY - JOUR
T1 - Multiple myeloma
T2 - Chemotherapy or transplantation in the era of new drugs
AU - Palumbo, Antonio
AU - Rajkumar, S. Vincent
PY - 2010/5
Y1 - 2010/5
N2 - Objective: To review the current results of studies incorporating novel agents in multiple myeloma (MM) and discuss the role of autologous stem-cell transplantation (ASCT) in the era of new active drugs for the treatment of this disease. The outlook for patients with symptomatic MM is changing with the introduction of bortezomib, thalidomide, and lenalidomide into the repertoire of available chemotherapeutic agents. Compared with standard chemotherapy, a survival benefit has been reported for the first time in 30 yrs. Methods: Articles published in English between 1969 and 2008 were identified by searching PubMed for 'myeloma', 'diagnosis', 'thalidomide', 'bortezomib', 'lenalidomide', 'dexamethasone', 'prednisone', 'doxorubicin', 'cyclophosphamide', 'melphalan', 'combination chemotherapy', and 'autologous transplantation'. Results: In randomized studies, bortezomib, thalidomide, and lenalidomide have each been combined with dexamethasone, alkylating agents, or doxorubicin, and such combinations resulted in significant improvement in progression-free survival. Conclusions: The incorporation of new drugs as induction therapy along with ASCT appears to produce very good partial response rates, slightly superior to those achieved by conventional chemotherapy with new drugs. How to best optimize induction, consolidation, and maintenance therapy and how to best select and prepare patients for ASCT are still to be determined. Randomized trials are needed to directly compare the current best chemotherapeutic approach with best ASCT strategies and to guide clinical practice for patients with MM.
AB - Objective: To review the current results of studies incorporating novel agents in multiple myeloma (MM) and discuss the role of autologous stem-cell transplantation (ASCT) in the era of new active drugs for the treatment of this disease. The outlook for patients with symptomatic MM is changing with the introduction of bortezomib, thalidomide, and lenalidomide into the repertoire of available chemotherapeutic agents. Compared with standard chemotherapy, a survival benefit has been reported for the first time in 30 yrs. Methods: Articles published in English between 1969 and 2008 were identified by searching PubMed for 'myeloma', 'diagnosis', 'thalidomide', 'bortezomib', 'lenalidomide', 'dexamethasone', 'prednisone', 'doxorubicin', 'cyclophosphamide', 'melphalan', 'combination chemotherapy', and 'autologous transplantation'. Results: In randomized studies, bortezomib, thalidomide, and lenalidomide have each been combined with dexamethasone, alkylating agents, or doxorubicin, and such combinations resulted in significant improvement in progression-free survival. Conclusions: The incorporation of new drugs as induction therapy along with ASCT appears to produce very good partial response rates, slightly superior to those achieved by conventional chemotherapy with new drugs. How to best optimize induction, consolidation, and maintenance therapy and how to best select and prepare patients for ASCT are still to be determined. Randomized trials are needed to directly compare the current best chemotherapeutic approach with best ASCT strategies and to guide clinical practice for patients with MM.
KW - Autologous stem-cell transplantation
KW - Chemotherapeutic agents
KW - Induction therapy
KW - Lenalidomide
KW - Multiple myeloma
KW - Response rates
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U2 - 10.1111/j.1600-0609.2010.01431.x
DO - 10.1111/j.1600-0609.2010.01431.x
M3 - Review article
C2 - 20345446
AN - SCOPUS:77951034358
SN - 0902-4441
VL - 84
SP - 379
EP - 390
JO - European Journal of Haematology
JF - European Journal of Haematology
IS - 5
ER -