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Review
. 2020 Sep 28;10(9):94.
doi: 10.1038/s41408-020-00359-2.

Multiple myeloma current treatment algorithms

S Vincent Rajkumar  1 , Shaji Kumar  2
Affiliations
Review

Multiple myeloma current treatment algorithms

S Vincent Rajkumar et al. Blood Cancer J. .

Abstract

The treatment of multiple myeloma (MM) continues to evolve rapidly with arrival of multiple new drugs, and emerging data from randomized trials to guide therapy. Along the disease course, the choice of specific therapy is affected by many variables including age, performance status, comorbidities, and eligibility for stem cell transplantation. In addition, another key variable that affects treatment strategy is risk stratification of patients into standard and high-risk MM. High-risk MM is defined by the presence of t(4;14), t(14;16), t(14;20), gain 1q, del(17p), or p53 mutation. In this paper, we provide algorithms for the treatment of newly diagnosed and relapsed MM based on the best available evidence. We have relied on data from randomized controlled trials whenever possible, and when appropriate trials to guide therapy are not available, our recommendations reflect best practices based on non-randomized data, and expert opinion. Each algorithm has been designed to facilitate easy decision-making for practicing clinicians. In all patients, clinical trials should be considered first, prior to resorting to the standard of care algorithms we outline.

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Conflict of interest statement

S.K. reports consultancy (BMS/Celgene, Takeda, and Janssen), and research funding (BMS/Celgene, Takeda, Novartis, AbbVie, Janssen, and Amgen). The other author declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1. Current Treatment Algorithms for Newly Diagnosed Myeloma.
Approach to the treatment of newly diagnosed myeloma in transplant-eligible (a) and transplant-ineligible (b) patients. VRd, Bortezomib, lenalidomide, dexamethasone; DRd, daratumumab, lenalidomide, dexamethasone; Dara-VRd, daratumumab, bortezomib, lenalidomide, dexamethasone; ASCT, autologous stem cell transplantation.
Fig. 2
Fig. 2. Current Treatment Algorithms for Relapsed Myeloma.
Approach to the treatment of relapsed multiple myeloma in first relapse (a) and second or higher relapse (b). DRd daratumumab, lenalidomide, dexamethasone; KRd carfilozomib, lenalidomide, dexamethasone; IRd ixazomib, lenalidomide, dexamethasone; ERd elotuzumab, lenalidomide, dexamethasone; DVd daratumumab, bortezomib, dexamethasone; DPd daratumumab, pomalidomide, dexamethasone; KPd carfilzomib, pomalidomide, dexamethasone; VCd bortezomib, cyclophosphamide; DKd daratumumab, carfilzomib, dexamethasone; IPd ixazomib, pomalidomide, dexamethasone.
Fig. 3
Fig. 3. Approach to the management of smoldering multiple myeloma.
SMM smoldering multiple myeloma, MM multiple myeloma, Rd lenalidomide plus dexamethasone.
See this image and copyright information in PMC

References

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