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__NOTOC__
__NOTOC__
__NOTOC__
==Medical Therapy==
==Medical Therapy==


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


===Active multiple myeoloma===
===Active multiple myeoloma===
*The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation.
*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>
*Deciding whether a patient is a candidate for bone marrow transplantation depends on a number of key factors that include:
*Deciding whether a patient is a candidate for bone marrow transplantation depends on a number of key factors that include:<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>
**Type of chromosomal mutation
**Type of chromosomal mutation
**Age
**Age
Line 34: Line 35:


====Bone marrow transplant eligible patients====
====Bone marrow transplant eligible patients====
*Preferred pharmacological regimes for treating such patients include:
*Preferred pharmacological regimes for treating such patients include:<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>
:*[[Bortezomib]]/[[dexamethasone]]
:*[[Bortezomib]]/[[dexamethasone]]
:*Bortezomib/dexamethasone/[[lenalidomide]]
:*Bortezomib/dexamethasone/[[lenalidomide]]
Line 43: Line 44:


====Bone marrow transplant ineligible patients====
====Bone marrow transplant ineligible patients====
*Preferred pharmacological regimes for treating such patients include:
*Preferred pharmacological regimes for treating such patients include:<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>
:*Bortezomib/dexamethasone
:*Bortezomib/dexamethasone
:*Low dose dexamethasone/lenalidomide
:*Low dose dexamethasone/lenalidomide
Line 50: Line 51:


===='''Supportive therapy'''====
===='''Supportive therapy'''====
*Supportive therapy is recommended based on patient's symptoms and medication's side effect.
*Supportive therapy is recommended based on patient's symptoms and medication's side effect.<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>
*Supportive therapy for active multiple myeloma includes:
*Supportive therapy for active multiple myeloma includes:<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>
:*[[Bisphosphonates]] to prevent [[osteoporosis]]
:*[[Bisphosphonates]] to prevent [[osteoporosis]]
:*[[Erythropoietin]] to prevent anemia  
:*[[Erythropoietin]] to prevent anemia  
Line 60: Line 61:
===='''Maintenance therapy'''====
===='''Maintenance therapy'''====
*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>
*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.<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> 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>
*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==
==Gallery==

Revision as of 23:49, 22 September 2015

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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

Active multiple myeoloma

  • The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation.[19][20]
  • Deciding whether a patient is a candidate for bone marrow transplantation depends on a number of key factors that include:[21][22]

Initial therapy

Bone marrow transplant eligible patients

  • Preferred pharmacological regimes for treating such patients include:[23][24]

Bone marrow transplant ineligible patients

  • Preferred pharmacological regimes for treating such patients include:[25][26]
  • 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.[27][28]
  • Supportive therapy for active multiple myeloma includes:[29][30]

Maintenance therapy

  • After a few months of induction therapy the advantages of continuing the same therapy seems to be limited.[31][32]
  • Therefore, this phase is being followed up with maintenance therapy with one of the newer agents such as thalidomide, lenalidomide or bortezomib.[33][34]
  • However, further clinical trials are needed to establish the efficacy of each of these agents.[35][36]

Gallery

Multiple myeloma treatment algorithim

References

  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
  17. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  18. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  19. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  20. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  21. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  22. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  23. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  24. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  25. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  26. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  27. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  28. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  29. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  30. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  31. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  32. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  33. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  34. ↑ Treatment guide smoldering multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  35. ↑ Treatment guide active multiple myeloma. National comprehensive cancer network(2015) http://www.nccn.org/patients/guidelines/myeloma/#44/z Accessed on September, 20th 2015
  36. ↑ 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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