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Considerations in the treatment of multiple myeloma: a consensus statement from Italian experts
Author(s) -
Patriarca Francesca,
Petrucci Maria T.,
Bringhen Sara.,
Baldini Luca,
Caravita Tommaso,
Corradini Paolo,
Corso Alessandro,
Di Raimondo Francesco,
Falcone Antonietta,
Ferrara Felicetto,
Morabito Fortunato,
Musto Pellegrino,
Offidani Massimo,
Petrini Mario,
Rizzi Rita,
Semenzato Gianpietro,
Tosi Patrizia,
Vacca Angelo,
Cavo Michele,
Boccadoro Mario,
Palumbo Antonio
Publication year - 2009
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2008.01179.x
Subject(s) - medicine , thalidomide , lenalidomide , melphalan , multiple myeloma , salvage therapy , autologous stem cell transplantation , bortezomib , regimen , refractory (planetary science) , oncology , surgery , intensive care medicine , chemotherapy , physics , astrobiology
Purpose and basic procedure of the study: The availability of new targeted therapies has revolutionised the treatment of multiple myeloma (MM), for both the newly diagnosed and the relapsed and refractory settings. A panel of Italian experts provided guidelines for optimal clinical practice in the treatment of MM. Main findings and conclusions: The panel recommended that treatment should only be initiated in symptomatic patients. Autologous stem cell transplantation (ASCT) with melphalan is the treatment of choice in patients younger than 65 yr, and induction therapy including new drugs seems the most suitable preparatory regimen before ASCT. In patients who fail to achieve at least a very good partial response (VGPR) after transplant, a consolidation with a second transplant is of clinical benefit. Also, there is evidence that maintenance with thalidomide after ASCT in young patients failing to reach at least VGPR could prolong survival. In elderly patients, the combination of an alkylating drug with a novel agent should be considered as standard approach. Relapsed MM should be retreated after the reappearance of symptoms and signs of organ and tissue damage. Salvage regimens should include corticosteroids plus bortezomib, thalidomide or lenalidomide.