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

Publication

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

Journal Paper/Review - Feb 1, 2014

Engelhardt Monika, Boccadoro Mario, Straka Christian, Brighen Sara, Gramatzki Martin, Larocca Alessandra, Lokhorst Henk, Magarotto Valeria, Morabito Fortunato, Dimopoulos Meletios A, Einsele Hermann, Sonneveld Pieter, Palumbo Antonio, Beksac Meral, Ludwig Heinz, Terpos Evangelos, Kleber Martina, Gay Francesca, Wäsch Ralph, Morgan Gareth, Cavo Michele, van de Donk Niels, Beilhack Andreas, Bruno Benedetto, Johnsen Hans Erik, Hájek Roman, Driessen Christoph, European Myeloma Network

Citation

Engelhardt M, Boccadoro M, Straka C, Brighen S, Gramatzki M, Larocca A, Lokhorst H, Magarotto V, Morabito F, Dimopoulos M, Einsele H, Sonneveld P, Palumbo A, Beksac M, Ludwig H, Terpos E, Kleber M, Gay F, Wäsch R, Morgan G, Cavo M, van de Donk N, Beilhack A, Bruno B, Johnsen H, Hájek R, Driessen C, European Myeloma Network. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma. Haematologica 2014; 99:232-42.

Type

Journal Paper/Review (English)

Journal

Haematologica 2014; 99

Publication Date

Feb 1, 2014

Issn Electronic

1592-8721

Pages

232-42

Brief description/objective

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- 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).