International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation

• Published in: Blood 2011-06, Vol.117 (23), p.6063-6073
• Main Authors: Cavo, Michele, Rajkumar, S. Vincent, Palumbo, Antonio, Moreau, Philippe, Orlowski, Robert, Bladé, Joan, Sezer, Orhan, Ludwig, Heinz, Dimopoulos, Meletios A., Attal, Michel, Sonneveld, Pieter, Boccadoro, Mario, Anderson, Kenneth C., Richardson, Paul G., Bensinger, William, Johnsen, Hans E., Kroeger, Nicolaus, Gahrton, Gösta, Bergsagel, P. Leif, Vesole, David H., Einsele, Hermann, Jagannath, Sundar, Niesvizky, Ruben, Durie, Brian G.M., San Miguel, Jesus, Lonial, Sagar
• Format: Article
• Language: English
• Subjects: Age Factors; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Clinical Trials and Observations; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Hematologic and hematopoietic diseases; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoid Neoplasia; Medical sciences; Multiple Myeloma - mortality; Multiple Myeloma - therapy; Pharmacology. Drug treatments; Stem Cell Transplantation; Survival Rate; Transplantation; Transplantation, Autologous
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2011-02-297325

The role of high-dose therapy followed by autologous stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. The choice of induction therapy has moved from conventional chemotherapy to newer regimens incorporating the immunomodulatory derivatives thalidomide or lenalidomide and the proteasome inhibitor bortezomib. These drugs combine well with traditional therapies and with one another to form various doublet, triplet, and quadruplet regimens. Up-front use of these induction treatments, in particular 3-drug combinations, has affected unprecedented rates of complete response that rival those previously seen with conventional chemotherapy and subsequent ASCT. Autotransplantation applied after novel-agent-based induction regimens provides further improvement in the depth of response, a gain that translates into extended progression-free survival and, potentially, overall survival. High activity shown by immunomodulatory derivatives and bortezomib before ASCT has recently led to their use as consolidation and maintenance therapies after autotransplantation. Novel agents and ASCT are complementary treatment strategies for MM. This article reviews the current literature and provides important perspectives and guidance on the major issues surrounding the optimal current management of younger, transplantation-eligible MM patients.