Treatment of multiple myeloma: An emphasis on new developments

Robert A. Kyle, S Vincent Rajkumar

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Not all patients who fulfill the minimal criteria for diagnosis of multiple myeloma should be treated. If doubt exists about beginning therapy, one should wait and re-evaluate the patient in 2 or 3 months. There is no evidence that early treatment of multiple myeloma is advantageous. All patients should be considered possible candidates for an autologous stem cell transplantation. If they are deemed to be eligible, they should be treated for 3 to 4 months with therapy that does not damage the hematopoietic stem cells. Currently, most physicians use thalidomide plus dexamethasone or dexamethasone alone for induction. Vincristine, doxorubicin (Adriamycin), and dexamethasone (VAD) have been used in the past. Autologous stem cell transplantation prolongs disease-free survival and overall survival. The treatment-related mortality rate is 1% to 2%. Melphalan, 200 mg/m2, is the most widely used preparative regimen. Although allogeneic transplantation is attractive, the mortality rate (about 20%) is too high to recommend conventional allogeneic transplantation. Non-myeloablative transplantation is currently under investigation. If the patient is not a candidate for autologous stem cell transplantation, therapy with melphalan and prednisone is a good choice. Patients with relapsed or refractory disease may be treated with dexamethasone, thalidomide and dexamethasone, bortezomib (Velcade, PS-341), or lenalidomide (Revlimid, not yet approved by the Food and Drug Administration).

Original languageEnglish (US)
Pages (from-to)111-115
Number of pages5
JournalAnnals of Medicine
Volume38
Issue number2
DOIs
StatePublished - Apr 2006

Fingerprint

Multiple Myeloma
Dexamethasone
Stem Cell Transplantation
Melphalan
Thalidomide
Homologous Transplantation
Doxorubicin
Therapeutics
Mortality
Vincristine
United States Food and Drug Administration
Cell- and Tissue-Based Therapy
Hematopoietic Stem Cells
Prednisone
Disease-Free Survival
Transplantation
Physicians
Survival
Bortezomib
lenalidomide

Keywords

  • Autologous stem cell transplantation
  • Diagnosis
  • Multiple myeloma
  • Therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Treatment of multiple myeloma : An emphasis on new developments. / Kyle, Robert A.; Rajkumar, S Vincent.

In: Annals of Medicine, Vol. 38, No. 2, 04.2006, p. 111-115.

Research output: Contribution to journalArticle

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