Novel treatment approaches in multiple myeloma
Disclosure : Scientific Advisory Board and Speakers’ Bureau from Celgene, Janssen-Cilag, Pharmion
35 slide(s) – 00:27:29 – English – 2007-06-08
High-dose melphalan followed by autologous stem cell transplantation in the younger patients and oral melphalan-prednisone in the elderly have been considered the standard of care for the initial therapy of myeloma. Survival after transplant appears to be related to the achievement of CR or GPR. An improved response rate after induction treatment, prior to transplant, could translate into better results after high-dose therapy and into a prolonged survival. In younger patients, ombinations incorporating thalidomide or lenalidomide or bortezomib with dexamethasone or doxorubicin significantly increase the pre-transplant CR rate before high-dose melphalan and autologous transplantation. These combinations might further improve the CR rate achieved after transplant.
In elderly patients, the melphalan, prednisone and thalidomide (MPT) combination has been shown to achieve more rapid and higher response rates and, most significantly, achieved improved EFS compared with conventional MP in two independent randomized trials. The MPT regimen is now recommended as the new standard of care for the elderly and for patients who are not candidates for high-dose chemotherapy with stem cell support. Other regimens incorporating MP and lenalidomide or bortezomib are currently under investigation and might be introduced in the clinical practice in the near future.
The combination incorporating Dexamethasone plus thalidomide or lenalidomide or bortezomib are currently recommended in the setting of relapsed myeloma patients. The choice of combination relies on previous exposure to such drugs as well as concomitant co-morbidities which might contraindicate the delivery of a specific compound.