If you have recently been diagnosed, you must first be assessed by your healthcare team and undergo tests to determine the stage and the type of myeloma. If you have active, symptomatic myeloma or smoldering (asymptomatic) myeloma with one or more myeloma-defining events, you most likely should begin treatment.
These events, if present, will become apparent with standard baseline bone marrow biopsy, serum free light chain assay (the Freelite® test), and MRI. The IMF strongly recommends consulting a myeloma specialist who can determine when and how to intervene.
Frontline Treatment Options
In the past decade, many new agents in various drug classes have become available and effective in the treatment of multiple myeloma. Ideally, your initial therapy (also called induction or first-line therapy) should
- effectively control the disease
- reverse myeloma-related complications
- decrease the risk of early mortality
- be well tolerated with minimal or manageable toxicity
- and not interfere with the need for stem cell collection.
Some of the top recommendations for initial therapy include the following:
- Many studies have demonstrated the superiority of three-drug combination therapies over two-drug combinations for fit, newly-diagnosed patients.
- In the U.S., the most commonly used induction therapy for fit, transplant-eligible patients is the combination of Velcade® (bortezomib), Revlimid® (lenalidomide), and low-dose dexamethasone (VRd).
Other induction therapies include the following:
- Velcade (bortezomib), Cytoxan® (cyclophosphamide), and dexamethasone (VCD or CyBorD)
- Velcade (bortezomib), Thalomid® (thalidomide), and dexamethasone (VTD)
- Revlimid (lenalidomide) and dexamethasone (Rd)
- Velcade (bortezomib) and dexamethasone (Vd)
- VRd Lite (reduced dose and schedule of Veclade, Revlimid, and dexamethasone)
After maximum response to induction therapy has been achieved, your physician may recommend an autologous stem cell transplant (ASCT) followed by maintenance therapy. If you are not a candidate for ASCT or decline the transplant for other reasons, your healthcare team may discuss continuous therapy with you. The benefit of continuous therapy until disease progression has been amply demonstrated to improve survival, but is not necessary or appropriate for every patient. The financial, physical, and emotional implications of continuous therapy must be taken into consideration along with the characteristics of each patient’s multiple myeloma.
The Latest Standard of Care for Newly Diagnosed Multiple Myeloma Patients
- The combination of a proteasome inhibitor and an immunomodulatory agent plus the steroid dexamethasone is the standard of care for newly diagnosed patients.
- Autologous stem cell transplant should be considered early in all transplant-eligible patients.
Maintenance therapy after transplant, or continuous therapy after initial treatment, has shown progression-free survival and overall survival benefits.
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