Therapy of Relapsed and Refractory Multiple Myeloma

  • Thomas MoehlerEmail author
  • Hartmut Goldschmidt
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 183)


Despite considerable improvements in first line treatment still the majority of patients experience relapse of multiple myeloma. Treatment decisions for relapse or refractory multiple myeloma should be based on a clinical decision path taking response and adverse events to previous therapy, myeloma specific complications and organ dysfunctions, overall clinical condition, age, cytogenetic information and prognostic factors into account. Bortezomib, thalidomide and lenalidomide have improved the therapeutic armentarium for patients with refractory or relapsed disease and are often used in combination with dexamethasone or chemotherapeutic agents. Combination therapies of novel agents in drug combination regimen are currently under investigation as well. For patients with a disease free survival of 12 month or longer after initial single or tandem high dose therapy and autologous stem cell transplantation (ASCT) repeat of high dose therapy with melphalan and ASCT should be considered in case of relapse. Radiotherapy and osteoplastic procedures can be used as adjunct to systemic therapy to treat local complications in particular vertebral pain caused by osteolytic bone disease. Cytogenetic tests, molecular techniques as gene expression profiling and other diagnostic will lead to a more individualized therapy. The integration of novel compounds into established regimen will be a major challenge for future clinical studies.


Overall Survival Multiple Myeloma Maximum Tolerate Dose Autologous Stem Cell Transplantation Allogeneic Stem Cell Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of Medicine VUniversity Hospital HeidelbergHeidelbergGermany

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