Article open access publication

European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma

Haematologica, Ferrata Storti Foundation (Haematologica), ISSN 1466-4860

Volume 99, 2, 2014

DOI:10.3324/haematol.2013.099358, Dimensions: pub.1035802531, PMC: PMC3912952, PMID: 24497560,

Affiliations

Organisations

  1. (1) University Medical Center Freiburg, grid.7708.8
  2. (2) National and Kapodistrian University of Athens, grid.5216.0
  3. (3) Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
  4. (4) Royal Marsden Hospital, grid.424926.f
  5. (5) University of Bologna, grid.6292.f
  6. (6) University Medical Center Utrecht, grid.7692.a
  7. (7) University Hospital Würzburg, grid.411760.5
  8. (8) Aalborg Hospital, grid.27530.33, North Denmark Region
  9. (9) University Hospital Ostrava, grid.412727.5
  10. (10) Canton of St. Gallen-Hospital, grid.413349.8
  11. (11) Wilhelminen Hospital, grid.417109.a
  12. (12) Ankara University, grid.7256.6
  13. (13) Hematology and Oncology, Schön Klinik Starnberger See, Berg, Germany
  14. (14) Kiel University, grid.9764.c
  15. (15) Hematology Unit, Hospital of Cosenza, Italy
  16. (16) Department of Hematology, Rotterdam, Netherlands

Description

Multiple myeloma management has undergone profound changes in the past thanks to advances in our understanding of the disease biology and improvements in treatment and supportive care approaches. This article presents recommendations of the European Myeloma Network for newly diagnosed patients based on the GRADE system for level of evidence. All patients with symptomatic disease should undergo risk stratification to classify patients for International Staging System stage (level of evidence: 1A) and for cytogenetically defined high- versus standard-risk groups (2B). Novel-agent-based induction and up-front autologous stem cell transplantation in medically fit patients remains the standard of care (1A). Induction therapy should include a triple combination of bortezomib, with either adriamycin or thalidomide and dexamethasone (1A), or with cyclophosphamide and dexamethasone (2B). Currently, allogeneic stem cell transplantation may be considered for young patients with high-risk disease and preferably in the context of a clinical trial (2B). Thalidomide (1B) or lenalidomide (1A) maintenance increases progression-free survival and possibly overall survival (2B). Bortezomib-based regimens are a valuable consolidation option, especially for patients who failed excellent response after autologous stem cell transplantation (2A). Bortezomib-melphalan-prednisone or melphalan-prednisone-thalidomide are the standards of care for transplant-ineligible patients (1A). Melphalan-prednisone-lenalidomide with lenalidomide maintenance increases progression-free survival, but overall survival data are needed. New data from the phase III study (MM-020/IFM 07-01) of lenalidomide-low-dose dexamethasone reached its primary end point of a statistically significant improvement in progression-free survival as compared to melphalan-prednisone-thalidomide and provides further evidence for the efficacy of lenalidomide-low-dose dexamethasone in transplant-ineligible patients (2B).

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Times Cited: 135

Field Citation Ratio (FCR): 39.25

Relative Citation ratio (RCR): 5.87

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