Essentials for Tailoring Multiple Myeloma Therapy

Hematologists/oncologists and other physicians can expect to encounter an increasing number of patients with multiple myeloma in the coming years. Between 1997 and 2006, the incidence rate of myeloma declined in the United States, but the burden (the number of incident cases) increased.

Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.

No survival advantage of autologous stem cell transplantation (ASCT) has been documented for patients older than 65 years, and in the era of thalidomide (Thalomid), bortezomib (Velcade), and len­alidomide (Revlimid), ASCT has a diminished role in the front-line treatment of older patients with myeloma.

High-dose melphalan (Alkeran) and autologous stem cell transplantation are commonly incorporated into the initial line of therapy for patients newly diagnosed with multiple myeloma.