Yazarlar : Cavo M, Rajkumar SV, Palumbo A, Moreau P, Orlowski R, Bladé J, Sezer O, Ludwig H, Dimopoulos MA, Attal M, Sonneveld P, Boccadoro M, Anderson KC, Richardson PG, Bensinger W, Johnsen H, Kroeger N, Gahrton G, Bergsagel PL, Vesole DH, Einsele H, Jagannath S,

Yayın : Blood

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/21447828

Konu : Myelom

Literatür İçeriği :  

Abstract

The role of high-dose therapy (HDT) 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 (IMiDs) 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 three-drug combinations, has effected 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 responses, a gain which translates into extended progression-free survival and, potentially, overall survival. High activity shown by IMiDs and bortezomib before ASCT has recently led to their successful use as consolidation and maintenance therapies after autotransplantation. Novel agents and ASCT are complementary treatment strategies for MM. This manuscript reviews the current literature and provides important perspectives and guidance on the major issues surrounding the optimal current management of younger, transplant-eligible MM patients.

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