The Newly Diagnosed Myeloma Patient – Therapeutic Approaches

Abstract

The outcome for myeloma patients has significantly improved over the last decade, mainly due to the introduction of new drugs with a singular mechanism of action such as thalidomide and lenalidomide (revlimid), both immunomodulatory drugs (IMIDs), and the proteasome inhibitor bortezomib (velcade). In newly diagnosed young patients, induction regimens such as bortezomib–thalidomide or lenalidomide plus dexamethasone will replace vincristine, doxorubicin and dexamethasone (VAD), followed by high-dose melphalan. Maintenance with IMIDs may represent the new standard of care for young multiple myeloma (MM) patients. This approach is being challenged by continuous treatment with novel agents and the postponement of a transplant until relapse. Allogeneic transplant should be conducted within the context of clinical trials. In elderly patients or non-transplant candidates, new regimens based on melphalan–prednisone plus thalidomide, velcade or lenalidomide have become new standards. The reduction of side effects while maintaining efficacy of treatment is most important in the elderly population.