How I Treat How I treat relapsed myeloma
نویسندگان
چکیده
The incorporation of the novel drugs thalidomide, bortezomib, and lenalidomide has resulted in a significant survival prolongation in patients with multiple myeloma (MM). However, MM remains incurablewith an important life-expectancy shortening.Autologous stem cell transplantation (ASCT) is the gold standard in younger patients and the incorporation of novel drugs in the induction phase has improved the post-ASCT complete remission (CR) rate and progression-free survival (PFS).However,most patients ultimately relapse.Concerning elderly patients, melphalan and prednisone (MP) or dexamethasone-based regimens have been the standard of care for many years. The novel drugs thalidomide, bortezomib, and lenalidomide have been associated with MP (MPT, MPV, and MPR) or with low-dose dexamethasone (Rd) resulting in superior PFS in almost all studies and in a significant overall survival (OS) prolongation in someof them.Although the improvement achieved is clinically relevant, it is far from satisfactory. Despite bortezomib, pegylated doxorubicin, lenalidomide, carfilzomib, and pomalidomide having been recently approved, the treatment of patients with relapse or refractory MM remains a challenge. Unfortunately, the duration of responses is limited and all patients will develop progressive disease (PD). In patients with relapsed MM, the choice of salvage therapy should be individualized and must depend on the considerations summarized in Table 1. The most frequently asked questions in the treatment of relapsed patients are listed in Table 2. In this How I Treat article, we use a case-andcomments approach with our decision processes illustrated in the context of real-world patients seen at our clinic. Case 1. A young patient with primary refractory myeloma to VTD
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