International Myeloma Working Group Consensus Statement for the Management, Treatment, and Supportive Care of Patients With Myeloma Not Eligible for Standard Autologous Stem-Cell Transplantation

Abstract

A B S T R A C T PurposeTo provide an update on recent advances in the management of patients with multiple myeloma who are not eligible for autologous stem-cell transplantation. MethodsA comprehensive review of the literature on diagnostic criteria is provided, and treatment options and management of adverse events are summarized. ResultsPatients with symptomatic disease and organ damage (ie, hypercalcemia, renal failure, anemia, or bone lesions) require immediate treatment. The International Staging System and chromosomal abnormalities identify high-and standard-risk patients. Proteasome inhibitors, immunomodulatory drugs, corticosteroids, and alkylating agents are the most active agents. The presence of concomitant diseases, frailty, or disability should be assessed and, if present, treated with reduced-dose approaches. Bone disease, renal damage, hematologic toxicities, infections, thromboembolism, and peripheral neuropathy are the most frequent disabling events requiring prompt and active supportive care. ConclusionThese recommendations will help clinicians ensure the most appropriate care for patients with myeloma in everyday clinical practice.

A phase II, single-arm, prospective study of bendamustine plus melphalan conditioning for second autologous stem cell transplantation in de novo multiple myeloma patients through a tandem transplant strategy

“…The median number of days with ANC ⩽ 0.1, ⩽ 0.5 and ⩽ 1 × 10 9 /L was 3 (range 2-8), 5 (range 3-10) and 6 (range 3-13), respectively. The median duration of hospitalization after stem cell infusion was 16 days (range [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The engraftment kinetics observed for BENDA plus HDM conditioning at second transplant were similar to those reported previously with the first HDM (200 mg/m 2 ) conditioning regimen ( Table 2).…”

“…Response and progression were reported by investigators according to revised uniform response criteria by the International Myeloma Working Group. 26,27 In particular, we considered as a CR a negative immunofixation of serum and urine, disappearance of any soft tissue plasmacytomas and o5% plasma cells in bone marrow. In patients for whom only measurable disease was by serum free light chains level, the normal free light chains ratio of 0.26-1.65 in addition to CR criteria was required.…”

Patterns of total cost and economic consequences of progression for patients with newly diagnosed multiple myeloma

“…Over the past decade, the treatment paradigm for multiple myeloma (MM) has shifted, with the introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide (LEN; Revlimid*) and the proteasome inhibitor bortezomib (BORT; Velcade**), as standard treatment options for newly diagnosed MM (NDMM) and for relapsed disease 1,2 . In the US, clinical practice guidelines from the National Comprehensive Cancer Network (NCCN) include category 1 recommendations for BORT-based and LEN-based regimens as first-line and second-line therapy in MM patients 3 .…”

Continuous treatment with lenalidomide and low‐dose dexamethasone in transplant‐ineligible patients with newly diagnosed multiple myeloma in Asia: subanalysis of the FIRST trial

“…Lenalidomide plus low‐dose dexamethasone (Rd) is a recommended treatment option for patients with NDMM who are SCT‐ineligible (Tan et al , 2013; Palumbo et al , 2014; Moreau et al , 2015; National Comprehensive Cancer Network, 2016). Data from this randomized, phase 3 FIRST (Frontline Investigation of REVLIMID + Dexamethasone Versus Standard Thalidomide) study demonstrated that Rd until disease progression (Rd continuous) is a safe and effective treatment option for this patient population (Benboubker et al , 2014).…”