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Management of patients who develop symptoms of multiple myeloma can be grouped into the following general treatment phases:

• Induction therapy - Initial treatment (chemotherapy) that is intended to reduce the number of cancer cells (myeloma cells) in the body.

• Consolidation therapy - A second round of therapy intended to further reduce the number of cancer cells.

• Maintenance therapy - Treatment given to patients who are in remission from multiple myeloma intended to prevent a recurrence (relapse) of the disease.

• Salvage therapy - Treatment used when patients relapse after initially going into remission or when induction therapy fails to bring about a remission of the disease.

Induction Therapy for Multiple Myeloma

Chemotherapy is the standard form of induction (initial) therapy for newly diagnosed patients with multiple myeloma who exhibit symptoms of the disease. Drugs used for chemotherapy may be administered orally or intravenously and are usually given as combinations of 2 or more medications. The choice of drugs used for induction chemotherapy is individualized for each patient and can generally be grouped into the following two categories:

• Patients who are eligible for autologous stem cell transplantation
• Patients who are NOT eligible for autologous stem cell transplantation

The criteria used to determine eligibility for autologous stem cell transplantation include:

• The patient's age
• The presence of other underlying conditions (comorbidities)
• The patient's performance status - a measure of how well the patient can function independently in performing routine activities of daily living)

Induction therapy for patients with multiple myeloma who are candidates for autologous stem cell transplantation at a later time consists of 4 cycles selected from one of the following oral regimens:

• Dexamethasone alone
• Thalidomide plus dexamethasone (Thal/Dex)
• Lenalidomide (Revlimid) plus dexamethasone (Rev/Dex)

These chemotherapeutic regimens have replaced the previously standard induction regimen of vincristine plus doxorubicin plus dexamethasone (VAD) because they are more effective and cause fewer side effects.

In May 2003, the U.S. Food and Drug Administration (FDA) approved bortezomib (Velcade) as a new treatment for multiple myeloma. Bortezomib, however, was approved for use is patients with relapsed and refractory multiple myeloma and is not approved for use as initial (induction) therapy.

Induction chemotherapy for multiple myeloma patients who are not eligible for autologous stem cell transplantation consists of one of the following regimens:

• Melphalan plus prednisone (MP)
• Melphalan plus prednisone plus thalidomide (MPT)
• Thalidomide plus dexamethasone (Thal/Dex)
• Lenalidomide plus dexamethasone (Rev/Dex)
• Vincristine plus BCNU plus melphalan plus cyclophosphamide plus prednisone (VBMCP)

Consolidation Therapy for Multiple Myeloma

After completing the initial (induction) phase of chemotherapy, patients with multiple myeloma who are eligible for autologous stem cell transplantation will proceed to the next phase of treatment known as consolidation therapy. This is a second round of therapy that is intended to further reduce the number of cancer (myeloma) cells in the body. Consolidation therapy consists of high-dose chemotherapy with autologous stem cell support. The most widely used preparative (conditioning) regimen for autologous stem cell transplanation is high-dose melphalan plus prednisone (MP). Novel conditioning regimens currently under investigation include the addition of radioactive compounds such as holium (Ho166) or samarium (Sm153) as well as bortezomib (Velcade)to the standard conditioning regimen of melphalan plus prednisone (MP)

What are Stem Cells?