Therapy for Patients not Eligible for Autologous Transplant
High-dose therapy supported by autologous stem cell transplant is considered a category 1 recommendation for newly diagnosed multiple myeloma (MM) patients.1 Currently, MM is the most common indication for autologous transplant, with ~ 4,500 transplants performed yearly in North America (Center for International Blood and Marrow Transplant Research [CIBMTR] data) and 5,300 in Europe.2Therefore, one of the first steps in choosing an initial therapy for symptomatic MM patients is to determine whether they would be candidates for stem cell transplant. The criteria to define eligibility for stem cell transplant include comorbidities, age, and performance status. Abnormal cardiac, pulmonary, renal, and liver functions are generally considered exclusion criteria for transplant protocols. Sixty-five years of age is commonly the higher limit age used to define eligible patients. However, it should be noted that advanced age and renal dysfunction are not absolute...
KeywordsOverall Survival Multiple Myeloma Peripheral Neuropathy Maintenance Therapy Induction Therapy
Supported in part by the Universitá degli Studi di Torino, Fondazione Neoplasie Sangue Onlus, Associazione Italiana Leucemie, Compagnia di S Paolo, Fondazione Cassa di Risparmio di Torino, Ministero dell'Universitá della Ricerca (MIUR), and Consiglio Nazionale delle Ricerche (CNR), Italy.
- 1.Anderson KC, Alsina M, Bensinger W, et al. National Comprehensive Cancer Network(NCCN). Multiple myeloma. Clinical practice guidelines in oncology. J NatI Compr Canc Netw 2007;5:118–47.Google Scholar
- 12.GROUP MTC. Combination chemotherapy versus MP as treatment of multiple myeloma: An overview of 6,633 patients from 27 randomised trials. J Clin Oncol 1998; 16:3832–42.Google Scholar
- 19.Rajkumar SV, Blood E, Vesole D, Fonseca R, Greipp PR. Eastern Cooperative Oncology Group. Phase Ill clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: A clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 2006;24:431–36.PubMedCrossRefGoogle Scholar
- 20.Ludwig H, Drach J, Tothová E, et al. Thalidomide-dexamethasone versus melpha-lan-prednisolone as first line treatment in elderly patients with multiple myeloma: An interim analysis. Blood 2005;106:782a.Google Scholar
- 26.Palumbo A, Bringhen S, Liberati AM, et al. Oral melphalan, prednisone, thalido-mide in elderly patients with multiple myeloma: up-dated results of a randomized, controlled trial. Blood 2008;doi:10.1182/Blood-2008-04-149427.Google Scholar
- 30.Rajkumar V, Jacobus S, Callander N, et al. A randomized phase III trial of lenal-idomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexam-ethasone in newly diagnosed multiple myeloma (E4A03): A trial coordinated by the Eastern Cooperative Oncology Group. Blood 2006;108:799a.Google Scholar
- 46.Shustik C, Belch A, Robinson S, et al. Dexamethasone (dex) maintenance versus observation (obs) in patients with previously untreated multiple myeloma: A National Cancer Institute of Canada Clinical Trials Group Study: MY.7. J Clin Oncol 2004;22 (Suppl 15): 651 Oa.Google Scholar