Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group
Laubach J (1), Garderet L (2), Mahindra A (3), Gahrton G (4), Caers J (5), Sezer O (6), Voorhees P (7), Leleu X (8), Johnsen HE (9), Streetly M (10), Jurczyszyn A (11), Ludwig H (12), Mellqvist UH (13), Chng WJ (14), Pilarski L (15), Einsele H (16), Hou J (17), Turesson I (18), Zamagni E (19), Chim CS (20), Mazumder A (21), Westin J (13), Lu J (22), Reiman T (23), Kristinsson S (4), Joshua D (24), Roussel M (25), O'Gorman P (26), Terpos E (27), McCarthy P (28), Dimopoulos M (27), Moreau P (29), Orlowski RZ (30), Miguel JS (31), Anderson KC (1), Palumbo A (32), Kumar S (33), Rajkumar V (33), Durie B (34), Richardson PG (1).
(1) Dana-Farber Cancer Institute, Boston, MA, USA.
(2) Hôpital Saint Antoine, Paris, France.
(3) University of California San Francisco, San Francisco, CA, USA.
(4) Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
(5) Department of Hematology, CHU Liège, Belgium.
(6) Memorial Hospital, Hematology Department, Istanbul, Turkey.
(7) Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
(8) Maladies du sang, hôpital Huriez, CHRU, Lille, France.
(9) Aalborg University Hospital, Aalborg, Denmark.
(10) King's College Hospital, London, UK.
(11) Jagiellonian University Medical College, Kraków, Poland.
(12) Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria.
(13) Sahlgrenska University Hospital, Gothenburg, Sweden.
(14) Cancer Science Institute, National University of Singapore, Singapore, Republic of Singapore.
(15) University of Alberta and Cross Cancer Institute, Edmonton, Canada.
(16) Department of Internal Medicine II, Division of Hematology, University Hospital of Würzburg, Würzburg, Germany.
(17) The Myeloma and Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
(18) Skano University Hospital, Malmo, Sweden.
(19) "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
(20) Department of Medicine, Queen Mary Hospital, Hong Kong, China.
(21) NYU Comprehensive Cancer Center, New York, NY, USA.
(22) Peking University People's Hospital, Beijing, China.
(23) Saint John Regional Hospital and Dalhousie University, Saint John, NB.
(24) Royal Prince Alfred Hospital, Camperdown, Australia.
(25) Hématologie clinique, hôpital Purpan, Toulouse, France.
(26) National Institute for cellular Biotechnology, Dublin City University, Dublin, Ireland.
(27) National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
(28) Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY, USA.
(29) University Hospital Hotel-Dieu, Nantes, France.
(30) Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
(31) Centro de Investigación Médica Aplicada, University of Navarra, Clínica Universidad de Navarra, Pamplona, Spain.
(32) Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy.
(33) Mayo Clinic, Rochester, MN, USA.
(34) Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA, USA.
The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity.
In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research.
This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics.
In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant.
Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM.
CITATION Leukemia. 2016 May;30(5):1005-17. doi: 10.1038/leu.2015.356