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Review Article

Optimizing outcomes for patients with newly diagnosed multiple myeloma eligible for transplantation

Abstract

High-dose therapy with autologous stem cell transplantation (HDT–ASCT) has been considered to be the standard frontline treatment for younger, fit patients with multiple myeloma (MM) since the 1990s. Efforts continue to optimize the use of HDT–ASCT with the aim of improving outcomes. One strategy has been the incorporation of novel agents (thalidomide, lenalidomide and bortezomib) in the pre-transplantation setting as an induction therapy or in the post-transplantation setting as a consolidation or maintenance therapy. Given their high response rates, three-drug induction therapy regimens (for example, bortezomib–thalidomide–dexamethasone, lenalidomide–bortezomib–dexamethasone and cyclophosphamide–bortezomib–dexamethasone) are now the standard of care. Thalidomide and bortezomib are well suited for consolidation therapy, and regimens using these agents can improve the depth of response following HDT–ASCT. Lenalidomide is particularly well suited for long-term maintenance therapy following HDT–ASCT, and initial results are promising and have shown improvements in disease outcomes such as progression-free survival and overall survival in some cases, although a low incidence of second primary malignancies have been observed. Further studies are needed to determine the optimal regimen and duration of induction therapy, the impact of maintenance on overall survival and the safety of long-term treatment. Many of the studies currently underway in MM will help address these aspects.

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Acknowledgements

We thank Shanthi Jayawardena, PhD, and Eva Polk, PhD (Excerpta Medica), for the linguistic improvement of the manuscript. Editorial support in the preparation of this manuscript was funded by Celgene Corporation. PM and CT were fully responsible for all content and editorial decisions for this manuscript.

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Correspondence to P Moreau.

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Competing interests

PM has participated in the Advisory Boards for Celgene Corporation, Millennium, Janssen and Onyx Pharmaceuticals, and has received honoraria from Celgene Corporation, Millennium and Janssen. CT declares no conflicts of interest.

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Moreau, P., Touzeau, C. Optimizing outcomes for patients with newly diagnosed multiple myeloma eligible for transplantation. Leukemia Suppl 2, S15–S20 (2013). https://doi.org/10.1038/leusup.2013.4

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Keywords

  • autologous stem cell transplantation
  • multiple myeloma
  • lenalidomide
  • induction therapy

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