Considerations in the treatment of multiple myeloma: a consensus statement from Italian experts

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...

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Published in:European journal of haematology 2009-02, Vol.82 (2), p.93-105
Main Authors: 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
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
chemotherapy
clinical practice guidelines
Humans
Italy
Middle Aged
Multiple Myeloma - pathology
Multiple Myeloma - therapy
myeloma
Recurrence
transplantation
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Summary: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.
ISSN:0902-4441
1600-0609
DOI:10.1111/j.1600-0609.2008.01179.x