Stratification for RRMM and Risk-Adapted Therapy: Sequencing of Therapies in RRMM

Abstract

The treatment landscape for relapsed multiple myeloma (RRMM) has experienced an unprecedented wave of innovation. Implementation of numerous new substances and drug classes with different modes of action is made possible in routine clinical practice. Next generation proteasome inhibitors, monoclonal antibodies, as well as first in class agents such as selinexor and venetoclax have widened the therapeutic spectrum. This has led to an increase in progression-free and overall survival. Consequently, new challenges for treating physicians in choosing the right treatment at the right stage of the disease have been generated. Several trials support the use of novel agents in the frontline treatment of newly diagnosed multiple myeloma. The use of lenalidomide or bortezomib as a backbone in the first-line setting, requires strategies for treatment once these patients relapse and are refractory to these drugs. Despite the variety of options, selecting the optimal treatment strategy is difficult, since multiple factors have to be considered: patient-specific factors such as age and co-morbidities, as well as myeloma/tumor specific factors such as cytogenetics and relapse kinetics. This review intends to summarize the existing data and guidelines regarding the optimal sequencing of treatments of RRMM using already approved agents as well as agents under investigation.

Assessing Pretransplant and Posttransplant Therapy Response in Multiple Myeloma Patients

“…Multiple myeloma is typically sensitive to a variety of cytotoxic drugs, both as an initial treatment and as a treatment for recurrent disease, although the treatments’ effects are transitory, and the MM is not considered curable with current approaches [ 21 ]. However, MM treatment has evolved rapidly due to the introduction of new drugs, such as carfilzomib, daratumumab, and pomalidomide [ 22 , 23 , 24 ]. When deciding on a treatment for multiple myeloma (MM), it is important to take into account a number of criteria that pertain to both the patient and the illness.…”

Nutritional status, muscle strength and functional capacity in patients with multiple myeloma

“…Alterações clínicas como lesões osteolíticas, lesão renal e hipercalcemia também podem estar presentes 9 . Apesar dos avanços no tratamento, o MM permanece praticamente incurável e os pacientes enfrentam uma doença refratária, com sintomas progressivos e problemas relacionados à terapia 10 . Tanto a enfermidade, que cursa para aumento da demanda nutricional e alterações metabólicas, quanto o seu tratamento podem prejudicar a ingestão alimentar adequada e, consequentemente, levar ao comprometimento do estado nutricional 11,12 .…”