Advances in therapy of multiple myeloma.

PURPOSE OF REVIEW: To summarize the results of treatment of multiple myeloma in the era of novel agents.

RECENT FINDINGS: Recent publications comparing autologous stem cell transplantation (ASCT) with conventional chemotherapy in the era of 'old' drugs have shown that the contribution of ASCT in the treatment of multiple myeloma has been modest. Five trials comparing single vs. double ASCT showed an increased progression-free survival in three of them, whereas the overall survival was significantly prolonged in one. The benefit would be only for patients failing to achieve very good partial response with the first transplant. The results of allogeneic transplantation with reduced-intensity conditioning, particularly after debulking with an ASCT, are encouraging. On the contrary, the impact of pretransplant induction regimens with novel agents (thalidomide, bortezomib and lenalidomide) on the posttransplant outcome is being investigated in several large phase III trials. For elderly patients, the combination of 'old' therapies with thalidomide, bortezomib or lenalidomide has resulted in the melphalan-prednisone-thalidomide, melphalan-prednisone-Velcade, melphalan-prednisone-Revlimid and lenalidomide/dexamethasone regimens, which are highly effective.

SUMMARY: ASCT has resulted in a modest contribution in the treatment of multiple myeloma. Hopefully, its impact will be increased with the incorporation of novel agents in the pretransplant induction regimens. The combination of thalidomide, bortezomib or lenalidomide with melphalan-prednisone or with dexamethasone has resulted in highly effective regimens for patients not eligible for high-dose therapy/stem cell transplantation.