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Review Article

Challenges in multiple myeloma diagnosis and treatment

Abstract

Although multiple myeloma (MM) remains an incurable disease, the advent of novel treatment paradigms has improved survival outcomes in the past two decades. This includes widespread use of high-dose chemotherapy with autologous stem cell transplantation (HDT–ASCT) and the development of the novel agents thalidomide, lenalidomide and bortezomib. The efficacy and tolerability of these novel agents have allowed for the exploration of continuous therapy approaches. Maintenance therapy after HDT–ASCT, for example, may help prolong progression-free survival by providing sustained control of residual disease. Trials are also under way to evaluate lenalidomide in patients with high-risk smoldering MM, with the aim of delaying progression to symptomatic MM. Other research is focusing on improving HDT–ASCT protocols and integrating novel agents, such as bortezomib, as an induction or consolidation therapy. Despite these advances, more effective strategies are needed, particularly for the management of older, less fit patients who are ineligible for HDT–ASCT. Preliminary results on the use of lenalidomide maintenance therapy in elderly patients are encouraging. Taken together, these observations indicate that in this era of novel agents, optimal treatment of MM requires a long-term perspective that focuses on providing sustained disease control while maintaining quality of life.

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References

  1. 1

    Greenlee RT, Murray T, Bolden S, Wingo PA . Cancer statistics, 2000. CA Cancer J Clin 2000; 50: 7–33.

    CAS  Article  PubMed  Google Scholar 

  2. 2

    Palumbo A, Rajkumar SV . Treatment of newly diagnosed myeloma. Leukemia 2009; 23: 449–456.

    CAS  Article  PubMed  Google Scholar 

  3. 3

    Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W et al. (eds) SEER Cancer Statistics Review, 1975-2008. National Cancer Institute: Bethesda, MD http://seer.cancer.gov/csr/1975_2008/, based on the November 2010 SEER data submission, posted to the SEER website, 2011.

  4. 4

    Brenner H, Gondos A, Pulte D . Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 2008; 111: 2521–2526.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  5. 5

    Lokhorst H, Einsele H, Vesole D, Bruno B, San Miguel J, Pérez-Simon JA et al. International Myeloma Working Group consensus statement regarding the current status of allogeneic stem-cell transplantation for multiple myeloma. J Clin Oncol 2010; 28: 4521–4530.

    Article  PubMed  Google Scholar 

  6. 6

    Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516–2520.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7

    Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21–33.

    Article  PubMed  Google Scholar 

  8. 8

    Dimopoulos M, Kyle R, Fermand JP, Rajkumar SV, San Miguel J, Chanan-Khan A et al. Consensus recommendations for standard investigative workup: report of the International Myeloma Working Group Consensus Panel 3. Blood 2011; 117: 4701–4705.

    CAS  Article  PubMed  Google Scholar 

  9. 9

    Engelhardt M, Kleber M, Udi J, Wäsch R, Spencer A, Patriarca F et al. Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches. Leuk Lymphoma 2010; 51: 1424–1443.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  10. 10

    Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J et al. International staging system for multiple myeloma. J Clin Oncol 2005; 23: 3412–3420.

    Article  PubMed  Google Scholar 

  11. 11

    Dimopoulos MA, Barlogie B, Smith TL, Alexanian R . High serum lactate dehydrogenase level as a marker for drug resistance and short survival in multiple myeloma. Ann Intern Med 1991; 115: 931–935.

    CAS  Article  PubMed  Google Scholar 

  12. 12

    Avet-Loiseau H, Attal M, Moreau P, Charbonnel C, Garban F, Hulin C et al. Genetic abnormalities and survival in multiple myeloma: the experience of the Intergroupe Francophone du Myélome. Blood 2007; 109: 3489–3495.

    CAS  Article  PubMed  Google Scholar 

  13. 13

    Fonseca R, Blood E, Rue M, Harrington D, Oken MM, Kyle RA et al. Clinical and biologic implications of recurrent genomic aberrations in myeloma. Blood 2003; 101: 4569–4575.

    CAS  Article  PubMed  Google Scholar 

  14. 14

    Kapoor P, Kumar S, Fonseca R, Lacy MQ, Witzig TE, Hayman SR et al. Impact of risk stratification on outcome among patients with multiple myeloma receiving initial therapy with lenalidomide and dexamethasone. Blood 2009; 114: 518–521.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  15. 15

    Jagannath S, Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA et al. Bortezomib appears to overcome the poor prognosis conferred by chromosome 13 deletion in phase 2 and 3 trials. Leukemia 2007; 21: 151–157.

    CAS  Article  PubMed  Google Scholar 

  16. 16

    Dispenzieri A, Kyle R, Merlini G, Miguel JS, Ludwig H, Hajek R et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009; 23: 215–224.

    CAS  Article  PubMed  Google Scholar 

  17. 17

    Beetham R, Wassell J, Wallage MJ, Whiteway AJ, James JA . Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies? Ann Clin Biochem 2007; 44: 516–522.

    CAS  Article  PubMed  Google Scholar 

  18. 18

    Katzmann JA, Dispenzieri A, Kyle RA, Snyder MR, Plevak MF, Larson DR et al. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc 2006; 81: 1575–1578.

    CAS  Article  PubMed  Google Scholar 

  19. 19

    Rajkumar SV, Kyle RA, Therneau TM, Melton 3rd LJ, Bradwell AR, Clark RJ et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood 2005; 106: 812–817.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  20. 20

    Dispenzieri A, Kyle RA, Katzmann JA, Therneau TM, Larson D, Benson J et al. Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma. Blood 2008; 111: 785–789.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  21. 21

    van Rhee F, Bolejack V, Hollmig K, Pineda-Roman M, Anaissie E, Epstein J et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood 2007; 110: 827–832.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  22. 22

    Snozek CL, Katzmann JA, Kyle RA, Dispenzieri A, Larson DR, Therneau TM et al. Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: proposed incorporation into the international staging system. Leukemia 2008; 22: 1933–1937.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  23. 23

    Munshi NC, Anderson KC, Bergsagel PL, Shaughnessy J, Palumbo A, Durie B et al. Consensus recommendations for risk stratification in multiple myeloma: report of the International Myeloma Workshop Consensus Panel 2. Blood 2011; 117: 4696–4700.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  24. 24

    Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM et al. Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. N Engl J Med 2007; 356: 2582–2590.

    CAS  Article  PubMed  Google Scholar 

  25. 25

    Pérez-Persona E, Vidriales MB, Mateo G, García-Sanz R, Mateos MV, de Coca AG et al. New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells. Blood 2007; 110: 2586–2592.

    Article  CAS  PubMed  Google Scholar 

  26. 26

    Wang M, Alexanian R, Delasalle K, Weber D . Abnormal MRI of spine is the dominant risk factor for early progression of asymptomatic multiple myeloma. Blood 2003; 102: (abstract 2546).

  27. 27

    Hjorth M, Hellquist L, Holmberg E, Magnusson B, Rödjer S, Westin J . Initial versus deferred melphalan-prednisone therapy for asymptomatic multiple myeloma stage I–a randomized study. Myeloma Group of Western Sweden. Eur J Haematol 1993; 50: 95–102.

    CAS  Article  PubMed  Google Scholar 

  28. 28

    Barlogie B, van Rhee F, Shaughnessy Jr JD, Epstein J, Yaccoby S, Pineda-Roman M et al. Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease. Blood 2008; 112: 3122–3125.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  29. 29

    Mateos MV, López-Corral L, Hernández M, Giraldo P, De La Rubia J, de Arriba F et al. Smoldering multiple myeloma (SMM) at high-risk of progression to symptomatic disease: a phase III, randomized, multicenter trial based on lenalidomide-dexamethasone (Len-Dex) as induction therapy followed by maintenance therapy with Len alone vs no treatment. Blood 2010; 116: (abstract 1935).

  30. 30

    Haessler J, Shaughnessy Jr JD, Zhan F, Crowley J, Epstein J, van Rhee F et al. Benefit of complete response in multiple myeloma limited to high-risk subgroup identified by gene expression profiling. Clin Cancer Res 2007; 13: 7073–7079.

    CAS  Article  PubMed  Google Scholar 

  31. 31

    Rajkumar SV, Gahrton G, Bergsagel PL . Approach to the treatment of multiple myeloma: a clash of philosophies. Blood 2011; 118: 3205–3211.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  32. 32

    Bladé J, Rosiñol L, Cibeira MT, Rovira M, Carreras E . Hematopoietic stem cell transplantation for multiple myeloma beyond 2010. Blood 2010; 115: 3655–3663.

    Article  CAS  PubMed  Google Scholar 

  33. 33

    Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N Engl J Med. 1996; 335: 91–97.

    CAS  Article  PubMed  Google Scholar 

  34. 34

    Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    CAS  Article  PubMed  Google Scholar 

  35. 35

    Koreth J, Cutler CS, Djulbegovic B, Behl R, Schlossman RL, Munshi NC et al. High-dose therapy with single autologous transplantation versus chemotherapy for newly diagnosed multiple myeloma: a systematic review and meta-analysis of randomized controlled trials. Biol Blood Marrow Transplant 2007; 13: 183–196.

    CAS  Article  PubMed  Google Scholar 

  36. 36

    Stewart AK, Richardson PG, San-Miguel JF . How I treat multiple myeloma in younger patients. Blood 2009; 114: 5436–5443.

    CAS  Article  PubMed  Google Scholar 

  37. 37

    Cavo M, Zamagni E, Tosi P, Tacchetti P, Cellini C, Cangini D et al. Superiority of thalidomide and dexamethasone over vincristine-doxorubicin-dexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma. Blood 2005; 106: 35–39.

    CAS  Article  PubMed  Google Scholar 

  38. 38

    Vogl DT, Liu SV, Chong EA, Luger SM, Porter DL, Schuster SJ et al. Post-transplant outcomes of induction therapy for myeloma: thalidomide and dexamethasone versus doxorubicin, vincristine, and dexamethasone prior to high-dose melphalan with autologous stem cell support. Am J Hematol 2007; 82: 1071–1075.

    CAS  Article  PubMed  Google Scholar 

  39. 39

    Lokhorst HM, Schmidt-Wolf I, Sonneveld P, van der Holt B, Martin H, Barge R et al. Thalidomide in induction treatment increases the very good partial response rate before and after high-dose therapy in previously untreated multiple myeloma. Haematologica 2008; 93: 124–127.

    CAS  Article  PubMed  Google Scholar 

  40. 40

    Gay F, Hayman SR, Lacy MQ, Buadi F, Gertz MA, Kumar S et al. Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patients. Blood 2010; 115: 1343–1350.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  41. 41

    Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME et al. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol 2010; 11: 29–37.

    CAS  Article  PubMed  Google Scholar 

  42. 42

    Cavallo F, Bringhen S, Milone G, Ben-Yehuda D, Nagler A, Calabrese E et al. Stem cell mobilization in patients with newly diagnosed multiple myeloma after lenalidomide induction therapy. Leukemia 2011; 25: 1627–1631.

    CAS  Article  PubMed  Google Scholar 

  43. 43

    Harousseau JL, Attal M, Avet-Loiseau H, Marit G, Caillot D, Mohty M et al. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol 2010; 28: 4621–4629.

    CAS  Article  PubMed  Google Scholar 

  44. 44

    Richardson PG, Weller E, Lonial S, Jakubowiak AJ, Jagannath S, Raje NS et al. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood 2010; 116: 679–686.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  45. 45

    Kumar SK, Flinn I, Noga SJ, Hari P, Rifkin R, Callander N et al. Bortezomib, dexamethasone, cyclophosphamide and lenalidomide combination for newly diagnosed multiple myeloma: phase 1 results from the multicenter EVOLUTION study. Leukemia 2010; 24: 1350–1356.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  46. 46

    Einsele H, Liebisch P, Langer C, Kropff M, Wandt H, Jung W et al. Velcade, intravenous cyclophosphamide and dexamethasone (VCD) induction for previously untreated multiple myeloma (German DSMM XIa Trial). Blood 2009; 114: (abstract 131).

  47. 47

    Cavo M, Tacchetti P, Patriarca F, Petrucci MT, Pantani L, Galli M et al. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet 2010; 376: 2075–2085.

    CAS  Article  PubMed  Google Scholar 

  48. 48

    Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012; 366: 1782–1791.

    CAS  Article  PubMed  Google Scholar 

  49. 49

    McCarthy PL, Owzar K, Hofmeister CC, Hurd DD, Hassoun H, Richardson PG et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med 2012; 366: 1770–1781.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  50. 50

    Kapoor P, Rajkumar SV, Dispenzieri A, Gertz MA, Lacy MQ, Dingli D et al. Melphalan and prednisone versus melphalan, prednisone and thalidomide for elderly and/or transplant ineligible patients with multiple myeloma: a meta-analysis. Leukemia 2011; 25: 689–696.

    CAS  Article  PubMed  Google Scholar 

  51. 51

    Morgan GJ, Davies FE, Gregory WM, Russell NH, Bell SE, Szubert AJ et al. Cyclophosphamide, thalidomide, and dexamethasone (CTD) as initial therapy for patients with multiple myeloma unsuitable for autologous transplantation. Blood 2011; 118: 1231–1238.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  52. 52

    Gay F, Vincent Rajkumar S, Falco P, Kumar S, Dispenzieri A, Petrucci MT et al. Lenalidomide plus dexamethasone vs. lenalidomide plus melphalan and prednisone: a retrospective study in newly diagnosed elderly myeloma. Eur J Haematol 2010; 85: 200–208.

    CAS  Article  PubMed  Google Scholar 

  53. 53

    Gay F, Rajkumar SV, Coleman M, Kumar S, Mark T, Dispenzieri A et al. Clarithromycin (Biaxin)-lenalidomide-low-dose dexamethasone (BiRd) versus lenalidomide-low-dose dexamethasone (Rd) for newly diagnosed myeloma. Am J Hematol 2010; 85: 664–669.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  54. 54

    Palumbo A, Hajek R, Delforge M, Kropff M, Petrucci MT, Catalano J et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 2012; 366: 1759–1769.

    CAS  Article  PubMed  Google Scholar 

  55. 55

    Niesvizky R, Jayabalan DS, Christos PJ, Furst JR, Naib T, Ely S et al. BiRD (Biaxin [clarithromycin]/Revlimid [lenalidomide]/dexamethasone) combination therapy results in high complete- and overall-response rates in treatment-naive symptomatic multiple myeloma. Blood 2008; 111: 1101–1109.

    CAS  Article  PubMed  Google Scholar 

  56. 56

    San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008; 359: 906–917.

    CAS  Article  PubMed  Google Scholar 

  57. 57

    Mateos MV, Richardson PG, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O et al. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol 2010; 28: 2259–2266.

    CAS  Article  PubMed  Google Scholar 

  58. 58

    Palumbo A, Bringhen S, Petrucci MT, Musto P, Rossini F, Nunzi M et al. Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70: results of a randomized controlled trial. Blood 2004; 104: 3052–3057.

    CAS  Article  PubMed  Google Scholar 

  59. 59

    Palumbo A, Sezer O, Kyle R, Miguel JS, Orlowski RZ, Moreau P et al. International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation. Leukemia 2009; 23: 1716–1730.

    CAS  Article  PubMed  Google Scholar 

  60. 60

    Palumbo A, Mateos MV, Bringhen S, San Miguel JF . Practical management of adverse events in multiple myeloma: can therapy be attenuated in older patients? Blood Rev 2011; 25: 181–191.

    CAS  Article  PubMed  Google Scholar 

  61. 61

    Hicks LK, Haynes AE, Reece DE, Walker IR, Herst JA, Meyer RM et al. A meta-analysis and systematic review of thalidomide for patients with previously untreated multiple myeloma. Cancer Treat Rev 2008; 34: 442–452.

    CAS  Article  PubMed  Google Scholar 

  62. 62

    Palumbo A, Cavo M, Bringhen S, Zamagni E, Romano A, Patriarca F et al. Aspirin, warfarin, or enoxaparin thromboprophylaxis in patients with multiple myeloma treated with thalidomide: a phase III, open-label, randomized trial. J Clin Oncol 2011; 29: 986–993.

    CAS  Article  PubMed  Google Scholar 

  63. 63

    Palumbo A, Anderson K . Multiple myeloma. N Engl J Med 2011; 364: 1046–1060.

    CAS  Article  PubMed  Google Scholar 

  64. 64

    Palumbo A, Gay F . How to treat elderly patients with multiple myeloma: combination of therapy or sequencing. Hematology Am Soc Hematol Educ Program 2009, 566–577.

  65. 65

    Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B et al. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet 2007; 370: 1209–1218.

    CAS  Article  PubMed  Google Scholar 

  66. 66

    Palumbo A, Falco P, Benevolo G, Rossi D, Carella AM, Guglielmelli T et al. A multicenter, open label study of oral lenalidomide and prednisone (RP) followed by oral lenalidomide melphalan and prednisone (MPR) and oral lenalidomide maintenance in newly diagnosed elderly multiple myeloma patients. Blood 2010; 116: (abstract 1940).

  67. 67

    Reeder CB, Reece DE, Kukreti V, Chen C, Trudel S, Hentz J et al. Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: high response rates in a phase II clinical trial. Leukemia 2009; 23: 1337–1341.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  68. 68

    Morgan GJ, Jackson GH, Davies FE, Drayson MT, Owen RG, Gregory WM et al. Maintenance thalidomide may improve progression free but not overall survival: results from the Myeloma IX maintenance randomisation. Blood 2008; 112: (abstract 656).

  69. 69

    Palumbo A, Bringhen S, Caravita T, Merla E, Capparella V, Callea V et al. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006; 367: 825–831.

    CAS  Article  PubMed  Google Scholar 

  70. 70

    Wijermans P, Schaafsma M, Termorshuizen F, Ammerlaan R, Sinnige H, Zweegman S et al. Phase III study of the value of thalidomide added to melphalan plus prednisone in elderly patients with newly diagnosed multiple myeloma: the HOVON 49 Study. J Clin Oncol 2010; 28: 3160–3166.

    CAS  Article  PubMed  Google Scholar 

  71. 71

    Hulin C, Facon T, Rodon P, Pegourie B, Benboubker L, Doyen C et al. Efficacy of melphalan and prednisone plus thalidomide in patients older than 75 years with newly diagnosed multiple myeloma: IFM 01/01 trial. J Clin Oncol 2009; 27: 3664–3670.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  72. 72

    Dimopoulos M, Spencer A, Attal M, Prince HM, Harousseau JL, Dmoszynska A et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 2007; 357: 2123–2132.

    CAS  Article  PubMed  Google Scholar 

  73. 73

    Weber DM, Chen C, Niesvizky R, Wang M, Belch A, Stadtmauer EA et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med 2007; 357: 2133–2142.

    CAS  Article  PubMed  Google Scholar 

  74. 74

    Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005; 352: 2487–2498.

    CAS  Article  PubMed  Google Scholar 

  75. 75

    Palumbo A, Bringhen S, Rossi D, Cavalli M, Larocca A, Ria R et al. Bortezomib-melphalan-prednisone-thalidomide followed by maintenance with bortezomib-thalidomide compared with bortezomib-melphalan-prednisone for initial treatment of multiple myeloma: a randomized controlled trial. J Clin Oncol 2010; 28: 5101–5109.

    CAS  Article  PubMed  Google Scholar 

  76. 76

    Palumbo A, Adam Z, Kropff M, Foà R, Catalano J, Gisslinger H et al. A phase 3 study evaluating the efficacy and safety of lenalidomide (Len) combined with melphalan and prednisone followed by continuous lenalidomide maintenance (MPR-R) in patients (pts) 65 years (yrs) with newly diagnosed multiple myeloma (NDMM): updated results for pts aged 65–75 yrs enrolled in MM-015. Blood 2011; 118: (abstract 475).

  77. 77

    Mateos MV, Oriol A, Martínez-López J, Gutiérrez N, Teruel AI, de Paz R et al. Bortezomib, melphalan, and prednisone versus bortezomib, thalidomide, and prednisone as induction therapy followed by maintenance treatment with bortezomib and thalidomide versus bortezomib and prednisone in elderly patients with untreated multiple myeloma: a randomised trial. Lancet Oncol 2010; 11: 934–941.

    CAS  Article  PubMed  Google Scholar 

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Acknowledgements

NM was supported by a grant from the Department of Veterans Affairs Merit Review Award I01-BX001584 and the National Institutes of Health grants RO1-124929, PO1-155258, P50-100007 and PO1-78378M.

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Correspondence to N C Munshi.

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SG has no conflicts of interest to report. NM serves on advisory committees for Millenium, Celgene, Onyx and Merck. NM also owns equity in OncoPep.

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Girnius, S., Munshi, N. Challenges in multiple myeloma diagnosis and treatment. Leukemia Suppl 2, S3–S9 (2013). https://doi.org/10.1038/leusup.2013.2

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Keywords

  • multiple myeloma
  • challenges
  • novel agents
  • elderly

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