Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group

Philippe Moreau¹, Shaji K Kumar², Jesús San Miguel³, Faith Davies⁴, Elena Zamagni⁵, Nizar Bahlis⁶, Heinz Ludwig⁷, Joseph Mikhael⁸, Evangelos Terpos⁹, Fredrik Schjesvold¹⁰, Thomas Martin¹¹, Kwee Yong¹², Brian G M Durie¹³, Thierry Facon¹⁴, Artur Jurczyszyn¹⁵, Surbhi Sidana¹⁶, Noopur Raje¹⁷, Niels van de Donk¹⁸, Sagar Lonial¹⁹, Michele Cavo⁵, Sigurdur Y Kristinsson²⁰, Suzanne Lentzsch²¹, Roman Hajek²², Kenneth C Anderson²³, Cristina João²⁴, Hermann Einsele²⁵, Pieter Sonneveld²⁶, Monika Engelhardt²⁷, Rafael Fonseca²⁸, Annette Vangsted²⁹, Katja Weisel³⁰, Rachid Baz³¹, Vania Hungria³², Jesus G Berdeja³³, Fernando Leal da Costa³⁴, Angelo Maiolino³⁵, Anders Waage³⁶, David H Vesole³⁷, Enrique M Ocio³⁸, Hang Quach³⁹, Christoph Driessen⁴⁰, Joan Bladé⁴¹, Xavier Leleu⁴², Eloisa Riva⁴³, Peter Leif Bergsagel²⁸, Jian Hou⁴⁴, Wee Joo Chng⁴⁵, Ulf-Henrik Mellqvist⁴⁶, Dominik Dytfeld⁴⁷, Jean-Luc Harousseau⁴⁸, Hartmut Goldschmidt⁴⁹, Jacob Laubach²³, Nikhil C Munshi²³, Francesca Gay⁵⁰, Meral Beksac⁵¹, Luciano J Costa⁵², Martin Kaiser⁵³, Parameswaran Hari⁵⁴, Mario Boccadoro⁵⁰, Saad Z Usmani⁵², Sonja Zweegman¹⁸, Sarah Holstein⁵⁵, Orhan Sezer⁵⁶, Simon Harrison⁵⁷, Hareth Nahi⁵⁸, Gordon Cook⁵⁹, Maria-Victoria Mateos⁶⁰, S Vincent Rajkumar², Meletios A Dimopoulos⁹, Paul G Richardson²³

Affiliations

¹ Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France. Electronic address: philippe.moreau@chu-nantes.fr.
² Department of Hematology, Mayo Clinic, Rochester, MN, USA.
³ Applied Medical Research, Clínica Universidad de Navarra, University of Navarra, and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
⁴ Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.
⁵ Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy.
⁶ University of Calgary, Calgary, AB, Canada.
⁷ First Department of Medicine Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Ottakring Clinic, Vienna, Austria.
⁸ Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA.
⁹ Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹⁰ Oslo Myeloma Center, Oslo University Hospital, and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway.
¹¹ University of California San Francisco Medical Center, San Francisco, CA, USA.
¹² Department of Haematology, Cancer Institute, University College London, London, UK.
¹³ Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁴ Blood Disease Department, University Hospital of Lille, University of Lille, Lille, France.
¹⁵ Department of Hematology, Jagiellonian University Medical College, Krakow, Poland.
¹⁶ Department of Hematology, Stanford University, Stanford, CA, USA.
¹⁷ Massachusetts General Hospital, Boston, MA, USA.
¹⁸ Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands.
¹⁹ Emory University Medical School, Emory University, Atlanta, GA, USA.
²⁰ Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
²¹ Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
²² Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
²³ Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
²⁴ Clinical Centre Champalimaud, Lisbon, Portugal.
²⁵ Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.
²⁶ Erasmus Medical Center, Rotterdam, Netherlands.
²⁷ Department of Haematology, Oncology, and Stem-Cell Transplantation, Interdisciplinary Cancer Center, University of Freiburg, Freiburg, Germany.
²⁸ Mayo Clinic, Scottsdale, AZ, USA.
²⁹ Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
³⁰ University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
³¹ Moffitt Cancer Center, Tampa, FL, USA.
³² Department of Hematology, São Germano Clinic, São Paulo, Brazil.
³³ Sarah Cannon Research Institute, Nashville, TN, USA.
³⁴ Division of Hematology and Oncology, School of Medicine, and O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
³⁵ Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
³⁶ Department of Hematology, St Olavs Hospital, Trondheim, Norway.
³⁷ Hackensack University Medical Center, New Jersey Medical School, Rutgers University, Hackensack, NJ, USA.
³⁸ University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
³⁹ Department of Haematology, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.
⁴⁰ Kantosspital St Gallen, St Gallen, Switzerland.
⁴¹ Hospital Clinic of Barcelona, Barcelona, Spain.
⁴² Service d'Hématologie et Thérapie Cellulaire, Hôpital La Milétrie, and Centre d'investigation Clinique INSERM 1402, Poitiers University Hospital, Poitiers, France.
⁴³ Clinical Hospital Dr Manuel Quintela, University of the Republic, Montevideo, Uruguay; British Hospital, Montevideo, Uruguay.
⁴⁴ Shanghai Chang Zheng Hospital, Shanghai, China.
⁴⁵ Cancer Science Institute of Singapore, and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴⁶ Department of Hematology, South Elfsborg Hospital, Borås, Sweden.
⁴⁷ Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.
⁴⁸ Western Cancer Institute, Nantes University Hospital, Saint-Herblain, France.
⁴⁹ Department of Internal Medicine V, and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
⁵⁰ Oncology and Hematology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
⁵¹ Department of Hematology, Ankara University, Ankara, Turkey.
⁵² Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
⁵³ Division of Molecular Pathology, Institute of Cancer Research, London, UK.
⁵⁴ Medical College of Wisconsin, Milwaukee, WI, USA.
⁵⁵ Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
⁵⁶ Memorial Sisli Hastanesi, Istanbul, Turkey.
⁵⁷ Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.
⁵⁸ Karolinska University Hospital, Stockholm, Sweden.
⁵⁹ St James's Institute of Oncology, St James's University Hospital, Leeds Teaching Hospital's NHS Trust, Leeds, UK.
⁶⁰ Department of Hematology, and Center for Cancer Research, University Hospital of Salamanca, Salamanca, Spain.

PMID: 33662288
DOI: 10.1016/S1470-2045(20)30756-7

Review

Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group

Philippe Moreau et al. Lancet Oncol. 2021 Mar.

. 2021 Mar;22(3):e105-e118.

doi: 10.1016/S1470-2045(20)30756-7.

Authors

Affiliations

¹ Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France. Electronic address: philippe.moreau@chu-nantes.fr.
² Department of Hematology, Mayo Clinic, Rochester, MN, USA.
³ Applied Medical Research, Clínica Universidad de Navarra, University of Navarra, and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
⁴ Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.
⁵ Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy.
⁶ University of Calgary, Calgary, AB, Canada.
⁷ First Department of Medicine Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Ottakring Clinic, Vienna, Austria.
⁸ Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA.
⁹ Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹⁰ Oslo Myeloma Center, Oslo University Hospital, and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway.
¹¹ University of California San Francisco Medical Center, San Francisco, CA, USA.
¹² Department of Haematology, Cancer Institute, University College London, London, UK.
¹³ Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁴ Blood Disease Department, University Hospital of Lille, University of Lille, Lille, France.
¹⁵ Department of Hematology, Jagiellonian University Medical College, Krakow, Poland.
¹⁶ Department of Hematology, Stanford University, Stanford, CA, USA.
¹⁷ Massachusetts General Hospital, Boston, MA, USA.
¹⁸ Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands.
¹⁹ Emory University Medical School, Emory University, Atlanta, GA, USA.
²⁰ Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
²¹ Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
²² Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
²³ Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
²⁴ Clinical Centre Champalimaud, Lisbon, Portugal.
²⁵ Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.
²⁶ Erasmus Medical Center, Rotterdam, Netherlands.
²⁷ Department of Haematology, Oncology, and Stem-Cell Transplantation, Interdisciplinary Cancer Center, University of Freiburg, Freiburg, Germany.
²⁸ Mayo Clinic, Scottsdale, AZ, USA.
²⁹ Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
³⁰ University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
³¹ Moffitt Cancer Center, Tampa, FL, USA.
³² Department of Hematology, São Germano Clinic, São Paulo, Brazil.
³³ Sarah Cannon Research Institute, Nashville, TN, USA.
³⁴ Division of Hematology and Oncology, School of Medicine, and O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
³⁵ Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
³⁶ Department of Hematology, St Olavs Hospital, Trondheim, Norway.
³⁷ Hackensack University Medical Center, New Jersey Medical School, Rutgers University, Hackensack, NJ, USA.
³⁸ University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
³⁹ Department of Haematology, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.
⁴⁰ Kantosspital St Gallen, St Gallen, Switzerland.
⁴¹ Hospital Clinic of Barcelona, Barcelona, Spain.
⁴² Service d'Hématologie et Thérapie Cellulaire, Hôpital La Milétrie, and Centre d'investigation Clinique INSERM 1402, Poitiers University Hospital, Poitiers, France.
⁴³ Clinical Hospital Dr Manuel Quintela, University of the Republic, Montevideo, Uruguay; British Hospital, Montevideo, Uruguay.
⁴⁴ Shanghai Chang Zheng Hospital, Shanghai, China.
⁴⁵ Cancer Science Institute of Singapore, and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴⁶ Department of Hematology, South Elfsborg Hospital, Borås, Sweden.
⁴⁷ Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.
⁴⁸ Western Cancer Institute, Nantes University Hospital, Saint-Herblain, France.
⁴⁹ Department of Internal Medicine V, and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
⁵⁰ Oncology and Hematology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
⁵¹ Department of Hematology, Ankara University, Ankara, Turkey.
⁵² Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
⁵³ Division of Molecular Pathology, Institute of Cancer Research, London, UK.
⁵⁴ Medical College of Wisconsin, Milwaukee, WI, USA.
⁵⁵ Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
⁵⁶ Memorial Sisli Hastanesi, Istanbul, Turkey.
⁵⁷ Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia.
⁵⁸ Karolinska University Hospital, Stockholm, Sweden.
⁵⁹ St James's Institute of Oncology, St James's University Hospital, Leeds Teaching Hospital's NHS Trust, Leeds, UK.
⁶⁰ Department of Hematology, and Center for Cancer Research, University Hospital of Salamanca, Salamanca, Spain.

PMID: 33662288
DOI: 10.1016/S1470-2045(20)30756-7

Abstract

This Policy Review presents the International Myeloma Working Group's clinical practice recommendations for the treatment of relapsed and refractory multiple myeloma. Based on the results of phase 2 and phase 3 trials, these recommendations are proposed for the treatment of patients with relapsed and refractory disease who have received one previous line of therapy, and for patients with relapsed and refractory multiple myeloma who have received two or more previous lines of therapy. These recommendations integrate the issue of drug access in both low-income and middle-income countries and in high-income countries to help guide real-world practice and thus improve patient outcomes.

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Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group

Affiliations

Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group

Authors

Affiliations

Abstract

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MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical