Authors: Heinz Ludwig, Pieter Sonneveld, Faith Davies, Joan Bladé, Mario Boccadoro, Michele Cavo, Gareth Morgan, Javier de la Rubia, Michel Delforge, Meletios Dimopoulos, Hermann Einsele, Thierry Facon, Hartmut Goldschmidt, Philippe Moreau, Hareth Nahi, Torben Plesner, Jesús San-Miguel, Roman Hajek, Pia Sondergeld and Antonio Palumbo.
The treatment of multiple myeloma has undergone significant changes and has resulted in the achievement of molecular remissions,the prolongationof remission duration,and extended survival becoming realistic goals, with a cure being possible in a small but growing numberof patients.
In addition, nowadays it is possible to categorize patients more precisely into different risk groups, thus allowing the evaluation of therapies in different settings and enabling a better comparison of results across trials. Here, we review the evidence from clinical studies, which forms the basis for our recommendations for the management of patients with myeloma.
Treatment approaches depend on “fitness”, with chronological age still being an important discriminator for selecting therapy. In younger, fit patients, a short three drug-based induction treatment followed byautologous stem cell transplantation (ASCT) remains the preferred option. Consolidation and maintenance therapy are attractive strategies not yet approved by the European Medicines Agency, and a decision regarding post-ASCT therapy should only be made after detailed discussion of the pros and cons with the individual patient. Two- and three-drug combinations are recommended for patients not eligible for transplantation. Treatment should be administered for at least nine cycles, although different durations of initial therapy have only rarely been compared so far.
Comorbidity and frailty should be thoroughly assessed in elderly patients, and treatment must be adapted to individual needs, carefully selecting appropriate drugs and doses. A substantial number of new drugs and novel drug classes in early clinical development have shown promising activity. Their introduction into clinical practice will most likely further improve treatment results.