The introduction of the Immunomodulatory drugs (IMiDs) and proteasome inhibitors, used either as a single-agent or combined with classic anti-myeloma therapies, has improved the outcome for patients with relapsed myeloma. However, there is currently no generally accepted standard treatment for relapsed/refractory myeloma patients, partly because of the absence of trials comparing the efficacy of the novel agents in relapsed/refractory myeloma. Choice of a new treatment regimen depends on both patient and disease-specific characteristics. A lenalidomide-based regimen is the first choice in patients with neuropathy, while bortezomib has the highest efficacy in patients with renal insufficiency and is not associated with increased risk of thromboembolism. A second autologous stem cell transplantation (auto-SCT) can be applied in patients with a progression-free period of ≥18-24. months after the first auto-SCT. In high-risk relapse such as occurring early after auto-SCT consolidation with allogeneic SCT can be considered. In this review we provide an overview of the various salvage regimens and give recommendations for treatment of patients with relapsed/refractory myeloma in different clinical settings.

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Keywords Bortezomib, Guidelines, Lenalidomide, Multiple myeloma, Novel agents, Refractory disease, Relapse treatment, Thalidomide
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van de Donk, N.W.C.J., Lokhorst, H.M., Dimopoulos, M.A., Cavo, M., Morgan, G., Einsele, H., … Palumbo, A.. (2011). Treatment of relapsed and refractory multiple myeloma in the era of novel agents. Cancer Treatment Reviews, 37(4), 266–283. doi:10.1016/j.ctrv.2010.08.008