Expert recommendations for the treatment of patients with multiple myeloma.

This article provided recommendations for the treatment of patients with multiple myeloma (MM).

Multiple myeloma is a type of cancer of the bone marrow that can lead to abnormal immune cells. High-dose chemotherapy followed by a stem cell transplant (SCT) remains a key part of treatment for patients with MM. There are two types of SCT. Autologous SCT involves collecting the patient’s own healthy stem cells. Allogeneic SCT involves collecting healthy stem cells from a donor. In both procedures, the healthy stem cells are then introduced into the patient. Allogeneic SCT is usually considered for patients with high-risk disease.

Although SCT is effective, not all patients may be eligible. These patients need alternative treatment options.

This study analyzed the results of 124 studies. These studies involved patients who were either eligible or ineligible for SCT. Patients with MM that did not respond to treatment (refractory) were also included.

For patients who are eligible for SCT, it is recommended that SCT be given as a first-line treatment. However, for some patients, initial therapy before the transplant may be recommended. This initial therapy can help get rid of some of the cancer cells and improve patient outcomes after the transplant. This therapy typically includes 4 cycles of chemotherapy with or without a targeted therapy. The most commonly used chemotherapy drug is melphalan (Alkeran).

After SCT, maintenance therapy may be recommended. This is low-intensity therapy is given over a long period of time to help keep the cancer from coming back. Lenalidomide (Revlimid) alone or combined with another targeted therapy is the most common therapy.

For patients who are not eligible for SCT, targeted therapy is recommended. Lenalidomide is commonly used in combination with other agents. One common combination is VRd (bortezomib, lenalidomide, dexamethasone). Unlike conventional chemotherapy, targeted therapy can be given as continuous therapy. This means that it is given for a longer time, such as 2 to 3 years.

For patients who have the cancer come back (relapse) after first-line treatment, combinations of targeted therapy are recommended. Combinations may contain two or three agents. However, previous studies have suggested that therapies with three agents may be associated with more side effects. The choice of therapy should be tailored to the patient’s needs. Autologous SCT is another treatment option for these patients.

This article provided recommendations for the treatment of patients with multiple myeloma. The authors suggested alternative treatment options for patients who cannot have SCT.