Sandbox: treatment: Difference between revisions

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Revision as of 23:38, 22 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pharmacological regimes for patients with active (symptomatic) multiple myeloma include steroid therapy, immune modulator therapy, and chemotherapy.^[1]^[2] Whereas patients with smoldering (asymptomatic) multiple myeloma are managed by observation and undergoing follow up tests every 3 to 6 months.^[3]^[4] The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation.^[5]^[6] Pharmacologic medical therapy for active multiple myeloma patients who are eligible for a bone marrow transplant include either dexamethasone, lenalidomide, bortezomib, thalidomide, carfilzomib, cyclophosphamide, vincristine, or doxorubicin.^[7]^[8] In addition to the aforementioned agents, pharmacological regimes used for treatment of active multiple myeloma patients who are not eligible for a bone marrow transplant include either melphalan or prednisone.^[9]^[10] Alkylating agents are not recommended among transplant eligible patients, as the toxicity of such agents makes the harvest process of bone marrow stem cell difficult later in the course of the disease.^[11]^[12]

Medical Therapy

Smoldering multiple myeloma

Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months.
Follow up tests of asymptomatic multiple myeloma patients include:
- Laboratory studies such as complete blood count, electrolytes, 24 hour urine collection, electrophoresis, and quantitative immunoglobulin analysis
- Imaging studies such as skeletal survey, MRI, and PET scan
- Flow cytometry as needed
- Bone marrow aspiration and biopsy as needed
Treatment should be differed until such patients develop symptoms.

Active multiple myeoloma

The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation.
Deciding whether a patient is a candidate for bone marrow transplantation depends on a number of key factors that include:
- Type of chromosomal mutation
- Age
- Presence of current associated diseases
- Patient's liver function
- Patient's kidney function

Initial therapy

Bone marrow transplant eligible patients

Preferred pharmacological regimes for treating such patients include:

Bortezomib/dexamethasone
Bortezomib/dexamethasone/lenalidomide
Dexamethasone/lenalidomide
Bortezomib/dexamethasone/doxorubicin
Bortezomib/dexamethasone/thalidomide
Bortezomib/dexamethasone/cyclophosphamide

Bone marrow transplant ineligible patients

Preferred pharmacological regimes for treating such patients include:

Bortezomib/dexamethasone
Low dose dexamethasone/lenalidomide
Melphalan/prednisone/thalidomide
Melphalan/prednisone/bortezomib

Supportive therapy

Supportive therapy is recommended based on patient's symptoms and medication's side effect.
Supportive therapy for active multiple myeloma includes:

Bisphosphonates to prevent osteoporosis
Erythropoietin to prevent anemia
Vaccines to prevent recurrent infections
Blood thinners to prevent blood clots
Plasmapheresis to prevent hyperviscosity and renal failure

Maintenance therapy

After a few months of induction therapy the advantages of continuing the same therapy seems to be limited.^[13]^[14]

Therefore, this phase is being followed up with maintenance therapy with one of the newer agents such as thalidomide, lenalidomide or bortezomib. *However, further clinical trials are needed to establish the efficacy of each of these agents.^[15]^[16]

Gallery

References

↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

Template:WikiDoc Sources

[1] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[2] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[3] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[4] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[5] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[6] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[7] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[8] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[9] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[10] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[11] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[12] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[13] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[14] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[15] Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

[16] Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015

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@@ Line 4: / Line 4: @@
 ==Overview==
-Pharmacological regimes for patients with active (symptomatic) multiple myeloma include [[steroid therapy]], immune modulator therapy, and [[chemotherapy]].
+Pharmacological regimes for patients with active (symptomatic) multiple myeloma include [[steroid therapy]], immune modulator therapy, and [[chemotherapy]].<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref> Whereas patients with smoldering (asymptomatic) multiple myeloma are managed by observation and undergoing follow up tests every 3 to 6 months.<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref> The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for [[bone marrow transplantation]].<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref>
-Whereas patients with smoldering (asymptomatic) multiple myeloma are managed by observation and undergoing follow up tests every 3 to 6 months. The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for [[bone marrow transplantation]]. Pharmacologic medical therapy for active multiple myeloma patients '''who are''' eligible for a bone marrow transplant include either [[dexamethasone]], [[lenalidomide]], [[bortezomib]], [[thalidomide]], [[carfilzomib]], [[cyclophosphamide]], [[vincristine]], or [[doxorubicin]]. In addition to the aforementioned agents, pharmacological regimes used for treatment of active multiple myeloma patients '''who are not''' eligible for a bone marrow transplant include either [[melphalan]] or [[prednisone]]. [[Alkylating antineoplastic agents|Alkylating agents]] are not recommended among transplant eligible patients, as the toxicity of such agents makes the harvest process of bone marrow [[stem cell]] difficult later in the course of the disease.
+Pharmacologic medical therapy for active multiple myeloma patients '''who are''' eligible for a bone marrow transplant include either [[dexamethasone]], [[lenalidomide]], [[bortezomib]], [[thalidomide]], [[carfilzomib]], [[cyclophosphamide]], [[vincristine]], or [[doxorubicin]].<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref> In addition to the aforementioned agents, pharmacological regimes used for treatment of active multiple myeloma patients '''who are not''' eligible for a bone marrow transplant include either [[melphalan]] or [[prednisone]].<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref>
+[[Alkylating antineoplastic agents|Alkylating agents]] are not recommended among transplant eligible patients, as the toxicity of such agents makes the harvest process of bone marrow [[stem cell]] difficult later in the course of the disease.<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref>
 ==Medical Therapy==
@@ Line 55: / Line 58: @@
 ===='''Maintenance therapy'''====
-*After a few months of induction therapy the advantages of continuing the same therapy seems to be limited.
+*After a few months of induction therapy the advantages of continuing the same therapy seems to be limited.<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref>
-*Therefore, this phase is being followed up with maintenance therapy with one of the newer agents such as thalidomide, lenalidomide or bortezomib. *However, further clinical trials are needed to establish the efficacy of each of these agents.<ref></ref>
+*Therefore, this phase is being followed up with maintenance therapy with one of the newer agents such as thalidomide, lenalidomide or bortezomib. *However, further clinical trials are needed to establish the efficacy of each of these agents.<ref> Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref><ref> Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015</ref>
 ==Gallery==