Clinical guidelines for the treatment of multiple myeloma.

This article reviewed current treatment options for treating multiple myeloma (MM). 

MM is a form of cancer that originates from plasma cells (a form of white blood cell). This usually results in other normal cells of the bone marrow not working properly. MM is usually diagnosed in older patients. Despite new therapies being developed MM remains incurable.

Standard treatment for MM usually involves chemotherapy (CT), radiotherapy (RT), immunotherapy (IT), and stem cell transplantation (SCT). SCT usually involves RT and CT to kill cancerous cells, followed by a transplant of healthy bone marrow cells from the patient (autologous) or a donor (allogeneic). Maintenance therapy (MT) is recommended to keep the cancer from coming back in patients who have had a SCT.

Treatment for MM differs depending on what type of MM a patient has. Plasmacytoma (PA) is a localized tumor that can turn into MM. Smoldering MM (SMM) is also a precancerous condition that can turn into MM. It is important to review current recommendations for treatments for MM and other derived tumors.

This study reviewed the current recommendations from the National Comprehensive Cancer Network (NCCN) for the treatment of MM.

Solitary PA is usually treated with RT. A large study showed that patients with PA who received RT had a 12% lower risk of relapse compared to those who did not receive RT (60%). However, the optimal dose of RT to treat PA is unknown. Patients with solitary PA should be followed up every 3-6 months to detect any progression to MM.

SMM has been under investigation regarding early intervention. Several studies have suggested that early treatment could slow the progression of SMM into MM compared to observation alone. At a follow-up of 3 years patients with SMM who received lenalidomide (Revlimid) and dexamethasone (Decadron), treatment, had a 76% longer time to progression compared to patients who received observation alone. This effect was also seen in studies that used lenalidomide alone treatment.

It is recommended that patients with SMM are grouped according to risk for progression. Patients in high-risk groups may be enrolled in clinical trials or treated with lenalidomide alone.

Newly diagnosed MM (NMM) are usually treated with primary therapy followed by high-dose CT, and SCT in eligible patients. A combination of bortezomib (Velcade), lenalidomide, and dexamethasone (VRd) is the preferred treatment. This drug combination is well tolerated in NMM patients. Other drug combinations such as bortezomib, cyclophosphamide (Cytoxan), and dexamethasone have also shown high response rates in patients with NMM.

SCT is usually used following high-dose RT and CT. Trials have shown that SCT results in a longer survival without MM progression (43 months) compared to non-SCT (22 months). MT using bortezomib or lenalidomide after SCT has increased time to disease progression when compared to patients not receiving MT. 

This article reviewed current recommendations for patients with MM and other derived tumors.