Presentation and risk stratification--improving prognosis for patients with multiple myeloma.

Abstract

Major improvement milestones in the treatment of patients with multiple myeloma (MM) include the introduction of the melphalan/prednisone combination in the 1960s; high-dose chemotherapy supported by autologous stem cell transplant in the 1980s; and the more recent introduction of the novel agents, thalidomide, lenalidomide, bortezomib, and pegylated liposomal doxorubicin. While, historically, age and eligibility for autologous stem cell transplantation were the primary basis for treatment selection, cytogenetics and other risk stratification methods are increasingly being used to guide treatment, especially with the newer agents. This trend reflects our improved understanding of the numerous genetic and biological abnormalities that mark this complex disease. In the absence of prospective, randomised studies assessing the value of risk stratification in guiding treatment decisions, and the use of the newest therapies, results of a number of studies provide a rationale for this approach. Currently available data indicate that the use of novel therapies in both the induction and maintenance settings, accompanied by risk stratification, may improve prognosis for patients with MM. Large, prospective randomised studies are needed to confirm these early pilot studies.

• Authors: Sagar Lonial
• Journal: Cancer treatment reviews (Cancer Treat Rev) Vol. 36 Suppl 2 Pg. S12-7 (May 2010) ISSN: 1532-1967 [Electronic] Netherlands
• PMID: 20472183 (Publication Type: Journal Article, Review)
• Copyright: Copyright 2010 Elsevier Ltd. All rights reserved.

Chemical References

• Antineoplastic Agents

Topics

• Age Factors
• Antineoplastic Agents (therapeutic use)
• Cytogenetic Analysis
• Humans
• Multiple Myeloma (complications, diagnosis, physiopathology, therapy)
• Pilot Projects
• Prognosis
• Renal Insufficiency (etiology)
• Risk