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

Please always quote using this URN: urn:nbn:de:bvb:20-opus-117477
  • 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-versusMultiple 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).show moreshow less

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Metadaten
Author: Monika Engelhardt, Evangelos Terpos, Martina Kleber, Francesca Gay, Ralph Wäsch, Gareth Morgan, Michele Cavo, Niels van de Donk, Andreas Beilhack, Benedetto Bruno, Hans Erik Johnsen, Roman Hajek, Christoph Driessen, Heinz Ludwig, Meral Beksac, Mario Boccadoro, Christian Straka, Sara Brighen, Martin Gramatzki, Alessandra Larocca, Henk Lokhorst, Valeria Magarotto, Fortunato Morabito, Meletios A. Dimopoulos, Hermann Einsele, Pieter Sonneveld, Antonio Palumbo
URN:urn:nbn:de:bvb:20-opus-117477
Document Type:Journal article
Faculties:Medizinische Fakultät / Medizinische Klinik und Poliklinik II
Language:English
Parent Title (English):Haematologica
Year of Completion:2014
Volume:99
Issue:2
Pagenumber:232-242
Source:Haematologica 20144 99(2), 232-242. doi: Disease Models & Mechanisms (2014) 7, 299-309 doi:10.1242/dmm.014076
DOI:https://doi.org/10.3324/haematol.2013.099358
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=24497560
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:autologous transplantation; bortezomib plus dxamethasone; cereblon expression; elderly patients; monoclonal gammopathy; multiparameter flow-cytpmetry; randomized phase-3 trial; stem-cell transplantation; thalidomide maintenance; undetermined significance MGUS
Release Date:2015/08/18
Licence (German):License LogoDeutsches Urheberrecht