Abstract
Multiple myeloma (MM) is a malignant hematological neoplasmand constitutes 10% of blood cancers. Recently, it has become evident that almost all cases of MM are preceded by gammopathy of undetermined significance (MGUS). MM is diagnosed by the presence of paraprotein in serum or urine, detected by serum electrophoresis and immunofixation, infiltration of malignant plasma cells in the bone marrow and related organ, or tissue damage. Cytogenetic status, International Staging System (ISS) and the quality of response to therapy are the most important prognostic factors. In the last decade the availability of new effective drugs, such as thalidomide, lenalidomide and bortezomib have provided a new therapeutic scenario expected to impact favorably on the outcome of MM patients. Today, for younger patients a triple-agent induction regimen incorporating novel agents followed by autologous stem cell transplantation (ASCT) is the best approach. In this setting ongoing clinical trials are evaluating the efficacy of consolidation and maintenance therapy based on the use of new drugs. For patients noteligible for ASCT the best initial regimens are combination therapy with melphalan and prednisone plus either thalidomide or bortezomibor the combination of lenalidomide and dexamethasone. Supportive therapy includes the use of erythropoietin and bisphosphonates according to the updated guidelines. In the future the identification of candidate therapeutic targets through gene expression profiling (GEP) and single-nucleotide polymorphism (SNP) analysis, as well as the availability of the targeted investigative agents will lead to a substantial progress in the development and implementation of personalized medicine in MM.
Keywords: Bortezomib, lenalidomide, multiple myeloma, stem cell transplantation, thalidomide, therapy, Allogeneic transplantation with reducedintensity conditioning, Autologous stem cell transplantation, Beta2-microglobulin, Conventional cytogenetics, International Staging System, Receptor activator of nuclear factorkappa B ligand, Very good partial remission, Positron emission tomography, Monoclonal gammopathy of undetermined significance.
Current Cancer Drug Targets
Title:Targeted Therapy of Multiple Myeloma: The Changing Paradigm at the Beginning of the New Millennium
Volume: 12 Issue: 7
Author(s): Fortunato Morabito, Anna Grazia Recchia, Carla Mazzone and Massimo Gentile
Affiliation:
Keywords: Bortezomib, lenalidomide, multiple myeloma, stem cell transplantation, thalidomide, therapy, Allogeneic transplantation with reducedintensity conditioning, Autologous stem cell transplantation, Beta2-microglobulin, Conventional cytogenetics, International Staging System, Receptor activator of nuclear factorkappa B ligand, Very good partial remission, Positron emission tomography, Monoclonal gammopathy of undetermined significance.
Abstract: Multiple myeloma (MM) is a malignant hematological neoplasmand constitutes 10% of blood cancers. Recently, it has become evident that almost all cases of MM are preceded by gammopathy of undetermined significance (MGUS). MM is diagnosed by the presence of paraprotein in serum or urine, detected by serum electrophoresis and immunofixation, infiltration of malignant plasma cells in the bone marrow and related organ, or tissue damage. Cytogenetic status, International Staging System (ISS) and the quality of response to therapy are the most important prognostic factors. In the last decade the availability of new effective drugs, such as thalidomide, lenalidomide and bortezomib have provided a new therapeutic scenario expected to impact favorably on the outcome of MM patients. Today, for younger patients a triple-agent induction regimen incorporating novel agents followed by autologous stem cell transplantation (ASCT) is the best approach. In this setting ongoing clinical trials are evaluating the efficacy of consolidation and maintenance therapy based on the use of new drugs. For patients noteligible for ASCT the best initial regimens are combination therapy with melphalan and prednisone plus either thalidomide or bortezomibor the combination of lenalidomide and dexamethasone. Supportive therapy includes the use of erythropoietin and bisphosphonates according to the updated guidelines. In the future the identification of candidate therapeutic targets through gene expression profiling (GEP) and single-nucleotide polymorphism (SNP) analysis, as well as the availability of the targeted investigative agents will lead to a substantial progress in the development and implementation of personalized medicine in MM.
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Morabito Fortunato, Grazia Recchia Anna, Mazzone Carla and Gentile Massimo, Targeted Therapy of Multiple Myeloma: The Changing Paradigm at the Beginning of the New Millennium, Current Cancer Drug Targets 2012; 12 (7) . https://dx.doi.org/10.2174/156800912802429373
DOI https://dx.doi.org/10.2174/156800912802429373 |
Print ISSN 1568-0096 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5576 |
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