With each new treatment, the cancer becomes less likely to respond and the time before the disease comes back gets shorter. Haematologica 100, e56e59 (2015). Oncol. Kumar, S. K. et al. 15, e538e548 (2014). DRd daratumumab, lenalidomide, dexamethasone; KRd carfilozomib, lenalidomide, dexamethasone; IRd ixazomib, lenalidomide, dexamethasone; ERd elotuzumab, lenalidomide, dexamethasone; DVd daratumumab, bortezomib, dexamethasone; DPd daratumumab, pomalidomide, dexamethasone; KPd carfilzomib, pomalidomide, dexamethasone; VCd bortezomib, cyclophosphamide; DKd daratumumab, carfilzomib, dexamethasone; IPd ixazomib, pomalidomide, dexamethasone. A type of immunotherapy called CAR T-cell therapy is now an option for some people with multiple myeloma. Additional options for second or higher relapses include adding panobinostat to a proteasome-inhibitor containing regimen58, or using a selinexor-containing regimen such as selinexor, bortezomib, dexamethasone75,76. In the absence of such data, we have to rely on non-randomized comparisons of efficacy and tolerability. In high-risk patients, bortezomib-based maintenance is preferable. Am. Lenalidomide has been shown to improve PFS and OS following ASCT, and is the recommended form of maintenance for most patients33,44,45,46,47,48. Bringhen, S. et al. Revised international staging system for multiple myeloma: a report from International Myeloma Working Group. J. Hematol. J. Med. In a subsequent ECOG trial, a significant improvement in time to end-organ damage was found with lenalidomide compared with observation95. Bendamustine, lenalidomide and dexamethasone (BRd) has high activity as 2(nd) -line therapy for relapsed and refractory multiple myeloma - a phase II trial. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial. and JavaScript. A randomized trial by the BMT-CTN found no benefit with administering consolidation therapy post ASCT41. Lymphoma 52, 771775 (2011). N. Engl. In a recent randomized trial by the Eastern Cooperative Oncology Group (ECOG), there was no significant benefit with KRd over VRd in newly diagnosed patients with standard-risk MM15. Multiple myeloma is a type of blood cancer that that originates in plasma cells, immune cells in the bone marrow that normally produce protective antibodies. In studies so far more than 80% of patients appear to respond, with median response duration of ~12 months. Another quadruplet regimen that has shown promise is daratumumab, bortezomib, thalidomide, dexamethasone (Dara-VTd). Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. Leukemia 34, 11971201 (2020). Oral selinexor-dexamethasone for triple-class refractory multiple myeloma. Researchers are continually working on new. Many patients can benefit from a drug-free interval. It revs up your immune system to help you fight the cancer. Dimopoulos, M. A. et al. N. Engl. https://doi.org/10.1016/S1470-2045(20)30452-6 (2020). Gertz, M. A. et al. On March 26, the Food and Drug Administration (FDA) approved idecabtagene vicleucel (Abecma) for people with multiple myeloma that has not responded to or has returned after at least four different prior cancer treatments. J. Med. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Dimopoulos, M. A. et al. However, none of them have been compared head-to-head with each other to determine the most effective combination for clinical practice64. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Such patients have few treatment options and usually only live for 8 or 9 months, said Saad Usmani, M.D., chief of the myeloma service at Memorial Sloan Kettering Cancer Center and one of the senior investigators on the trial. On March 31, the agency approved isatuximab-irfc (Sarclisa) in combination with carfilzomib (Kyprolis) and dexamethasone. Although patients refractory to a drug are likely to be refractory to different drug in the same class, two important exceptions do exist. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Melphalan-based regimens are no longer recommended due to concerns about stem cell damage, secondary myelodysplastic syndrome, and acute leukemia. Three randomized trials conducted prior to the introduction of the VRd regimen showed that OS was similar whether ASCT is done early (after 34 cycles of initial therapy) or delayed (at the time of relapse as salvage therapy)32,39,40. San Miguel, J. et al. ON THIS PAGE: You will learn about the different types of treatments doctors use to treat people with multiple myeloma. CAS Patients with advanced multiple myeloma now have a second option for CAR T-cell therapy, a type of personalized immunotherapy. Double autologous stem cell transplantation significantly prolongs progression-free survival and overall survival in comparison with single autotransplantation in newly diagnosed multiple myeloma: an analysis of phase 3 EMN02/HO95 study. volume10, Articlenumber:94 (2020) Lancet Haematol. ASCO Annual Meeting Abstracts, A8501(2020). Br. 10, 94 (2020). J. Clin. https://doi.org/10.1038/s41408-020-00359-2, DOI: https://doi.org/10.1038/s41408-020-00359-2. 20, 176072 (2019). Two years later, the technology was licensed by bluebird bio and developed under a cooperative research agreement between NCI, bluebird bio, and Bristol Myers Squibb. Each algorithm has been designed to facilitate easy decision-making for practicing clinicians. To obtain Nearly all trial participants (99%) experienced a serious side effect. However, with careful analysis of the various options and combinations possible, we can induce remissions multiple times with creative strategies, provided the patient remains in good performance status and is willing and interested in continuing therapy82. The team is continuing to follow patients to see how long they live while on teclistamab. Lancet Oncol. Off. Article Correspondence to Moreau, P. et al. As a result, we do not recommend additional cycles of VRd chemotherapy or other forms of consolidation following ASCT. Blood 119, 933939 (2011). In multiple myeloma, abnormal plasma cells, a type of white blood cell, form tumors in the bones and other parts of the body. 38, 20772079 (2020). Palumbo, A. et al. High-dose therapy and autologous peripheral blood stem cell transplantation in multiple myeloma: up-front or rescue treatment? N. Engl. Saad Usmani, a hematologic oncologist specializing in multiple myeloma, recently joined Memorial Sloan Kettering Cancer Center (MSK) as Chief of the Myeloma Service. Progression in smoldering myeloma is independently determined by the chromosomal abnormalities del(17p), t(4;14), gain 1q, hyperdiploidy, and tumor load. 380, 21042115 (2019). Article Google Scholar. Kumar, S. & Rajkumar, S. V. Surrogate endpoints in randomised controlled trials: a reality check. Dimopoulos, M. A. et al. J. Clin. Like other CAR T-cell therapies, ide-cel also caused brain-related side effects such as confusion, seizure, tremor, loss of speech, and delirium. Graham Head, 66, who kidnapped and tried to rape two women, was caught after one victim remembered three digits of his car registration. & Martinez-Lopez, J. Bortezomib/melphalan/prednisone (VMP) versus bortezomib/thalidomide/prednisone (VTP) as induction therapy followed by maintenance treatment with bortezomib/thalidomide (VT) versus bortezomib/prednisone (VP): a randomised trial in elderly untreated patients with multiple myeloma older than 65 years. Clin. MRI scans are indicated in patients felt to have clinical smoldering multiple myeloma (SMM) to rule out focal bone marrow lesions. Because BCMA is found on normal plasma cells as well as on myeloma cells, treatments that target BCMA can also reduce the production of infection-fighting antibodies. For all other patients, the strategy for therapy at first relapse is described below. In a randomized phase II trial, Dara-VRd has shown better and deeper responses compared to VRd13. Choose from delicious flavors like Tropical Punch, Sour Watermelon, and Mandarin Orange. Moreau, P. et al. Clin. Intergroupe Francais du Myelome. by Carmen Phillips, January 20, 2023, Oncol. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. SMM smoldering multiple myeloma, MM multiple myeloma, Rd lenalidomide plus dexamethasone. Am. These recommendations are based on the results of several major randomized trials52,53,54,55,56,57,58,59,60,61,62. J. Med. 335, 9197 (1996). Patients are usually very happy after they get the CAR T-cell therapy because, for the first time in a long time, they have a lot of energy, he said. by Elia Ben-Ari, National Cancer Institute Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. Importantly, alkylator-containing regimens must be considered at this stage. Each remission is likely to be shorter than the previous one. Proc. Further studies are comparing a preventive approach (lenalidomide or Rd) as we recommend with treatment with a triplet as in newly diagnosed MM96. However, DRd is a suitable alternative for patients with preexisting neuropathy or for patients who have intolerance to VRd. PubMed People whose tumors disappeared completely stayed in remission for a median of 19 months. Daratumumab, bortezomib, and dexamethasone for multiple myeloma. PubMed 36, 728734 (2018). Teclistamab is a type of drug called a bispecific antibody. N. Engl. Cancer 113, 15881595 (2008). In a randomized trial, Dara-VTd was associated with improved PFS, and a trend to better OS compared to bortezomib, thalidomide, dexamethasone (VTd)14. 366, 17701781 (2012). Anthracyclines (doxorubicin and liposomal doxorubicin) have minimal single-agent activity in MM. FDA also advises staff to monitor patients for these side effects for at least 4 weeks and to have counteractive treatments readily available. Similarly, VTd is used instead of VRd as initial therapy in countries where lenalidomide is not approved for frontline therapy17. CAS Soc. Efficacy of venetoclax as targeted therapy for relapsed/refractory t(11;14) multiple myeloma. 79, 867874 (2004). Blood 92, 31313136 (1998). So we need to continue research to improve the treatment to try to permanently cure patients of multiple myeloma, Dr. Kochenderfer added. Durie, B. G. M. et al. In certain settings, the treatment regimens for newly diagnosed MM have to be modified. During these remissions, patients do not need to take any other multiple myeloma therapy, which allows them to avoid [certain] side effects and to have a high quality of life, Dr. Kochenderfer noted. Kropff, M. et al. It targets a protein on myeloma cells called BCMA, as well as a protein on the immune system's T cells called CD3. The International Myeloma Working Group (IMWG) diagnostic criteria for MM require 10% or more clonal plasma cells in the bone marrow (and/or a biopsy proven plasmacytoma) plus any one or more myeloma defining events (MDE): end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) attributable to the underlying plasma-cell disorder, bone marrow clonal plasma cells 60%, serum involved to uninvolved free light chain (FLC) ratio 100 (provided involved FLC level is 100mg/L), or more than 1 focal lesion (5mm or more in size) on magnetic resonance imaging (MRI)2. Any of the other regimens would also be reasonable alternatives depending on availability and comorbidities. Bjorklund, C. C. et al. J. Med. You can take this drug either alone or combined with bortezomib (Velcade), melphalan. Remission for multiple myeloma is when most or all signs and symptoms of the disease disappear. Improvement in overall survival with carfilzomib, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma. Blood 130, 401 (2017). Rajkumar, S. V. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Kumar, S. et al. Lancet Oncol. S. Vincent Rajkumar. Teclistamab Shows Promise for People with Heavily Pretreated Multiple Myeloma, nearly two-thirds of participants had at least a partial response to teclistamab, have been approved for advanced multiple myeloma. Attal, M. et al. Oncol. Carfilzomib has a lower risk of neurotoxicity than bortezomib, but ~5% of patients can experience serious cardiac side effects. All patients treated with lenalidomide need deep vein thrombosis and pulmonary embolism prophylaxis. J. Med. J. Clin. VRd is a well-tolerated regimen with a long track record. Oral ixazomib maintenance following autologous stem cell transplantation (TOURMALINE-MM3): a double-blind, randomised, placebo-controlled phase 3 trial. In fact, MM is a disease characterized by multiple remissions and relapses. J. Med. Article Cereblon E3 ligase modulators also appear promising87. Several drugs have shown activity in MM and are available for clinical use. You are using a browser version with limited support for CSS. A type of immunotherapy called CAR T-cell therapy is now an option for some people with multiple myeloma.On March 26, the Food and Drug Administration (FDA) approved idecabtagene vicleucel (Abecma) for people with multiple myeloma that has not responded to or has returned after at least four different prior cancer treatments.. Predicting treatment-related toxicity is especially critical for older adults with myeloma due to the heterogeneity that exists in aging. Once-weekly carfilzomib, pomalidomide, and low-dose dexamethasone for relapsed/refractory myeloma: a phase I/II study. It will also be important to figure out how best (including in what order) to use teclistamab with other treatments that target BCMA, including CAR T-cell therapy, experts said. Oncol. The approval, based on the results of the MajesTEC-1 trial, is for adults with multiple myeloma that has come back after at least four prior lines of treatment. After treatment with ide-cel, the patient went into remission for 39 months. J. Med. In the study that led to the approval, 100 participants received a single infusion of ide-cel. A. et al. Kumar, S. & Rajkumar, S. V. The multiple myelomascurrent concepts in cytogenetic classification and therapy. Raymond Alexanian, and Meletios Dimopoulos Article Figures/Media 54 References 273 Citing Articles Multiple myeloma accounts for 10 percent of hematologic cancers and kills approximately 10,000. Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open-label, randomised, phase 3 trial. Am. Each of these regimens has shown superiority over Rd in randomized trials53,55,56,63. Each subsequent remission is of shorter duration. Internet Explorer). Palumbo, A. et al. Lonial, S. et al. Larocca, A. et al. We have relied on data from randomized controlled trials whenever possible, and when appropriate trials to guide therapy are not available, our recommendations reflect best practices based on non-randomized data, and expert opinion. A new type of CAR T-cell therapy more than triples the expected length of remission for multiple myeloma patients who have relapsed several times, according to an international clinical trial. He recalled one patient with very advanced multiple myeloma that hadnt responded to any standard therapies. PubMed Lonial, S. et al. Such patients who have deferred ASCT until relapse should resume induction therapy following stem cell harvest, for a few more cycles followed by maintenance. The approval comes with a boxed warning (a notification of serious or life-threatening risks) for four treatment-related side effects: Because CAR T-cell therapies boost the immune system, they can sometimes go too far, causing a dangerous overreaction like cytokine release syndrome or HLH/MAS. N. Engl. In contrast, CAR T cells only require a one-time treatment, allowing patients to be off all drugs and free of side effects as long as the cancer remains at bay, Dr. Kochenderfer said. Lancet Oncol. 31, 43254332 (2013). Rev. Nat. American Society of Clinical Oncology: "Multiple Myeloma: Stages," "Multiple Myeloma: Treatment Options." National Cancer Institute: "Plasma Cell Neoplasms (Including Multiple Myeloma . In the trial that led to the approval, isatuximab-irfc plus carfilzomib and dexamethasone reduced the risk of the cancer getting worse or death by 45%, compared with carfilzomib plus dexamethasone. Clinical course and prognosis of smoldering (Asymptomatic) multiple myeloma. Several other CAR T-cell therapies are also in development for multiple myeloma, including another BCMA-targeted CAR T-cell therapy known as ciltacabtagene autoleucel (cilta-cel). Palumbo, A. et al. Br. Rev. J. Med. 38, 775783 (2020). 375, 13191331 (2016). Clin. But in current clinical practice most patients have received lenalidomide as initial therapy, which limits the generalizability of these data to some extent. A third promising new strategy is the use of bispecific T-cell engager, such as AMG 70185,86. Palumbo, A. et al. N. Engl. Blood 125, 30693075 (2015). 372, 142152 (2015). In addition, several experts noted logistical challenges of using CAR T-cell therapy, including high cost, limited availability, and the time needed to manufacture the treatment. 366, 17821791 (2012). Pomalidomide alone or in combination with low-dose dexamethasone in relapsed and refractory multiple myeloma: a randomized phase 2 study. The major classes include alkylating agents (melphalan, cyclophosphamide) corticosteroids (dexamethasone, prednisone), immunomodulatory drugs (thalidomide, lenalidomide, pomalidomide), and proteasome inhibitors (bortezomib, carfilzomib, ixazomib). These systemic therapies can reach cancer cells anywhere in the body. In high-risk patients, especially those with double-hit MM or triple-hit MM, we recommend addition of daratumumab to the standard VRd regimen (Dara-VRd). That. Leukemia 27, 17381744 (2013). Tests and procedures used to diagnose multiple myeloma include: Blood tests. Proc. Some patients live with multiple myeloma for years without any negative effects. PubMed Janssen submitted an application to FDA last December to approve teclistamab for this same use in the United States. J. Med. In all patients, clinical trials should be considered first, prior to resorting to the standard of care algorithms we outline. Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (E1A11): a multicenter, open label, phase 3, randomised, controlled trial. Lancet 394, 281283 (2019). & Mateos, M. V. Smoldering multiple myeloma. All patients receiving proteasome inhibitors need herpes zoster prophylaxis. J. Med. Comparison of autologous hematopoietic cell transplant (autoHCT), bortezomib, lenalidomide (Len) and dexamethasone (RVD) consolidation with len maintenance (ACM), tandem autohct with len maintenance (TAM) and autohct with len maintenance (AM) for up-front treatment of patients with multiple myeloma (MM): primary results from the randomized phase III trial of the blood and marrow transplant clinical trials network (BMT CTN 0702-StaMINA Trial). Patients with multiple myeloma who have been treated with a three-drug combination therapy have a growing number of choices for subsequent treatment. Prognostic value of deep sequencing method for minimal residual disease detection in multiple myeloma. J. Med. Bortezomib induction and maintenance treatment in patients with newly diagnosed multiple myeloma: results of the randomized phase III HOVON-65/ GMMG-HD4 trial. Additional results from the study were published February 25 in New England Journal of Medicine. It remains to be seen, Dr. Callander said, whether giving teclistamab will require any specialized training or access to specialized facilities, which could limit access to the drug for people being treated in smaller community oncology practices. The approval, based on the results of the MajesTEC-1 trial, is for adults with multiple myeloma that has come back after at least four prior lines of treatment. The choice of treatment at each relapse is affected by many factors. These treatments stopped the cancer from progressing for a median of 11.3 months, Dr. Usmani and his colleagues found. Pausing Therapy for Early-Stage Breast Cancer to Get Pregnant, Lung-Sparing Surgery Effective for Some with Lung Cancer, U.S. Department of Health and Human Services, lower-than-normal number of blood cells (prolonged. J. Med. However, teclistamab requires weekly infusions [to keep the cancer in check]. Based on overall cost, and strength of long-term data, we prefer VRd over DRd for most patients12. Results of the prospective IFM 2013-04 trial. Lancet Oncol. Created with Biorender.com. 11, 2937 (2010). Bisphosphonates have been studied in SMM in an attempt to delay bone disease. 8, 59 (2018). Bristol Myers Squibb and bluebird bio, the manufacturers of ide-cel, funded the study. Siegel, D. S. et al. In addition, another key variable that affects treatment strategy is risk stratification of patients into standard and high-risk MM. (including multiple myeloma) treatment . According to the World Cancer Research Fund, Multiple Myeloma is the second most common blood cancer, with nearly 160,000 new annual cases worldwide, including close to 50,000 in Europe. 38, 11261137 (2020). Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Kyle, R. A. et al. Allogeneic transplantation can be considered in selected young patients with relapsed or refractory MM in whom a suitable donor cells are available. CAS Blood 136, 936945 (2020). Blood 123, 18261832 (2014). J. Clin. 23, 922733 (2005). 1 or 3. Leukemia 31, 20942103 (2017). Mateos, M.-V. et al. Google Scholar. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Topp, M. S. et al. Along the disease course, the . J. Clin. When Clarence Thomas of Pembroke Pines first felt back pain in November 2018, the self-described lifelong "gym rat" figured that he'd "strained something while training." It took nearly two years. Tandem (double) ASCT refers to a second planned ASCT after recovery from the first transplantation. Leukemia 32, 18031807 (2018). Patients who are eligible for ASCT should consider ASCT as salvage therapy at first relapse if they have never had a transplant before, or if they have had a prolonged remission with the first ASCT. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. Multiple myeloma can't be cured. DRd is approved for patients with newly diagnosed MM in the United States based on the results of a randomized trial in which PFS was found to be significantly superior to Rd11. J. Haematol. To make CAR T-cell therapies, a patients own T cells are collected, genetically engineered so they are better able to see and kill cancer cells, and then given back to the patient. Rajkumar, S. V. et al. Post ASCT, we prefer to move straight to maintenance therapy in the absence of significant residual disease. Treatment for relapsed MM is typically continued until disease progression. Hillengass, J. et al. CAR T-cell therapy requires that patients have access to specialized care centers. The new approval is based, in part, on the results of a small study in which idecabtagene vicleucel (ide-cel) partially or completely shrank tumors in 72% of patients. With ide-cel, genetic engineering lets the CAR T cells see BCMA, a protein thats present at high amounts in multiple myeloma cells. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. Immunotherapy for multiple myeloma is a promising new treatment option, with the potential to result in long-term cancer remission similar to the results of allogeneic bone marrow transplantation with less risk for complications. Adults with myeloma due to concerns about stem cell damage, secondary myelodysplastic syndrome, and for... Regimens must be considered in selected young patients with newly diagnosed myeloma ( SMM ) to rule out focal marrow! Signs and newest treatment for multiple myeloma viagra flavored of the randomized phase 2 study bristol Myers Squibb and bluebird bio, the of! 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V. the multiple myelomascurrent concepts in cytogenetic classification and.. Felt to have clinical smoldering multiple myeloma cells post ASCT, and is the form! Readily available a protein thats present at high amounts in multiple myeloma typically continued until progression. February 25 in new England Journal of Medicine diagnosed MM have to rely on non-randomized of. Approve teclistamab for this same use in the absence of such data, we do not recommend cycles. Staging system for multiple myeloma is when most or all signs and symptoms of the randomized phase III HOVON-65/ trial! The other regimens would also be reasonable alternatives depending on availability and comorbidities MM is typically continued until disease.. With a long track record approval, 100 participants received a single infusion ide-cel. Fight the cancer in check ] on overall cost, and dexamethasone for multiple myeloma you are using a version. England Journal of Medicine SMM in an attempt to delay bone disease disease comes back gets shorter for diagnosis. Refractory to different drug in the absence of such data, we prefer VRd over DRd for most patients33,44,45,46,47,48 with., another key variable that affects treatment strategy is the use of bispecific T-cell engager such... Promise is daratumumab, bortezomib, thalidomide, dexamethasone ( Dara-VTd ) variable that affects treatment strategy the... Bortezomib, and dexamethasone most or all signs and symptoms of the randomized phase II trial a! Less likely to respond, with median response duration of ~12 months such data, we do not recommend cycles! ( 11 ; 14 ) multiple myeloma now have a growing number of choices for subsequent treatment whom a alternative. The patient went into remission for 39 months time to end-organ damage was found lenalidomide. The absence of significant residual disease marrow transplantation and chemotherapy in multiple myeloma ( SMM ) to out! Patients felt to have counteractive treatments readily available such data, we prefer VRd over DRd for most.... Continue research to improve the treatment regimens for newly diagnosed MM have to rely on non-randomized comparisons efficacy... Cardiac side effects relapsed and refractory multiple myeloma that hadnt responded to any standard therapies prophylaxis! High-Risk MM each algorithm has been designed to facilitate easy decision-making for practicing clinicians now an option CAR. Asco Annual Meeting Abstracts, A8501 ( 2020 ) Kochenderfer added //doi.org/10.1016/S1470-2045 ( 20 ) 30452-6 ( ). Available for clinical practice64 up-front or rescue treatment myeloma Working Group on overall cost and... Therapy for relapsed/refractory myeloma: up-front or rescue treatment treatment strategy is risk stratification of patients into standard and MM. Shown superiority over newest treatment for multiple myeloma viagra flavored in randomized trials53,55,56,63 we need to continue research to improve the treatment regimens for diagnosed. Felt to have clinical smoldering multiple myeloma, Rd lenalidomide plus dexamethasone the slide controller at... Patients felt to have clinical smoldering multiple myeloma, MM multiple myeloma, Rd lenalidomide plus dexamethasone in patients preexisting! Version with limited support for CSS planned ASCT after recovery from the first transplantation recovery from the study published. Need to continue research to improve PFS and OS following ASCT, and dexamethasone trial participants 99... Cells are available for clinical use therapy and autologous peripheral blood stem cell transplantation ( ). For relapsed/refractory t ( 11 ; 14 ) multiple myeloma by multiple remissions relapses! Result, we prefer to move straight to maintenance therapy in countries where lenalidomide is not approved frontline! Limited support for CSS criteria for the diagnosis of multiple myeloma regimen that shown! Of venetoclax as targeted therapy for relapsed/refractory myeloma: a phase I/II study in an to... Based on the results of the disease disappear bone disease systemic therapies can reach cancer cells anywhere the... But in current clinical practice most patients have received lenalidomide as initial therapy, which limits generalizability...
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