From the Guidelines
Multiple myeloma treatment should prioritize a combination approach based on disease stage and patient factors, incorporating proteasome inhibitors, immunomodulatory drugs, and corticosteroids, as well as newer treatments like monoclonal antibodies, to improve survival rates and quality of life. The treatment of multiple myeloma has evolved significantly over the past decade, with the introduction of new drugs and therapeutic strategies 1. According to the latest guidelines and studies, a risk-adapted approach is essential, taking into account disease-related factors, such as cytogenetic features, and patient-related factors 1.
Key Treatment Components
- Proteasome inhibitors (bortezomib, carfilzomib)
- Immunomodulatory drugs (lenalidomide, pomalidomide)
- Corticosteroids (dexamethasone)
- Monoclonal antibodies (daratumumab, isatuximab)
- High-dose chemotherapy followed by autologous stem cell transplantation for eligible patients
- Supportive care, including bisphosphonates for bone health, pain management, and prevention of infections
The disease is characterized by bone pain, frequent infections, fatigue, kidney problems, and hypercalcemia 1. While multiple myeloma remains incurable for most patients, modern treatments have significantly improved survival rates and quality of life, with many patients living for years or even decades after diagnosis with appropriate management 1.
Disease Management
- Diagnosis and treatment should be guided by disease- and patient-related factors
- Risk stratification is crucial, primarily based on cytogenetic features
- A risk-adapted approach provides optimal therapy to patients, ensuring intense therapy for aggressive disease and minimizing toxic effects
- Emerging treatments and new drug development continue to refine patient management and improve outcomes 1.
From the Research
Treatment Options for Multiple Myeloma
- Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: a study found that lenalidomide plus low-dose dexamethasone is associated with better short-term overall survival and with lower toxicity than lenalidomide plus high-dose dexamethasone in patients with newly diagnosed myeloma 2.
- Bortezomib with lenalidomide and dexamethasone (VRd) is a standard regimen for the front-line treatment of multiple myeloma, and the addition of bortezomib to lenalidomide and dexamethasone resulted in significantly improved progression-free and overall survival and had an acceptable risk-benefit profile 3.
- The combination of VRd with panobinostat is safe and effective in patients who are newly diagnosed with multiple myeloma and who are transplant eligible, with a maximum tolerated dose of 10 mg of panobinostat 4.
Comparison of Treatment Regimens
- A study compared the KRd regimen (carfilzomib, lenalidomide, and dexamethasone) with the VRd regimen (bortezomib, lenalidomide, and dexamethasone) in patients with newly diagnosed multiple myeloma, and found that the KRd regimen did not improve progression-free survival compared with the VRd regimen, and had more toxicity 5.
- A review discussed the rationale for use of RVD (lenalidomide, bortezomib, and dexamethasone) as induction therapy and aims to provide guidance in prescribing this regimen in order to optimise efficacy while minimising the toxicities of treatment 6.
Toxicity and Efficacy
- The most common grade 3-4 treatment-related non-haematological adverse events included fatigue, hyperglycaemia, diarrhoea, peripheral neuropathy, dyspnoea, and thromboembolic events 5.
- The rates of overall response (partial response or better) were 82% in the VRd group and 72% in the Rd group, and 16% and 8% of patients who were assessable for response in these respective groups had a complete response or better 3.