2017 NCCN Hematologic Malignancies Congress: Managing Newly Diagnosed Transplant-Eligible Myeloma Patients
The optimal regimen for newly diagnosed multiple myeloma continues to evolve and is often dictated by the intent to transplant, according to research presented by Shaji K. Kumar, MD, Professor of Medicine, Mayo Clinic, Rochester, Minnesota, at the National Comprehensive Cancer Network (NCCN) 12th Annual Congress on Hematologic Malignancies.
Initial therapy for these patients should decrease the risk of early death by managing renal failure, controlling hypercalcemia, identifying and treating infections, as well as managing neurologic compromise and pain. Additionally, it should not interfere with stem cell collection (if needed).
According to Dr. Kumar, the ideal initial treatment consists of a proteasome inhibitor and an immunomodulatory agent, but treatment options include combination therapy with immunomodulatory drugs, proteasome inhibitors, monoclonal antibodies, and/or traditional chemotherapy. Despite the increasing response rates seen with these new regimens, autologous stem cell transplantation still plays an important role and should be considered early in all eligible patients, he shared.
Post-transplant maintenance therapy using risk/patient-adapted strategies is vital, and bisphosphonates are an integral part of supportive care, as is management of infections and toxicities. This combination of effective initial therapy followed by autologous stem cell transplant and maintenance therapy appears to provide maximal disease control for patients with newly diagnosed multiple myeloma.