Treatment of multiple myeloma

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.

Figure 1

Treatment algorithm a | Treatment approach for newly diagnosed transplant candidates. b | Treatment approach for newly diagnosed elderly, nontransplant candidates. Abbreviations: ASCT, autologous stem-cell transplantation; CR, complete response; VCD, bortezomib–cyclophosphamide–dexamethasone; VGPR, very good partial response; VMP, bortezomib–melphalan–prednisone; VRd, bortezomib–lenalidomide–dexamethasone.