Up-Front Management of Multiple Myeloma

摘要

The management of multiple myeloma (MM) has undergone rapid change with the recent emergence of several effective novel agents that have added complexity to individualized treatment decision-making. This paper reviews the initial management of 276 patients with MM diagnosed and treated by 43 US-based community oncologists since January 1, 2008. The case survey data obtained are evaluated within the broad context of published findings from major phase III randomized trials and as such reveal potential education gaps and implications for oncology CME. Overall, the results reveal that most patients were symptomatic at diagnosis and were risk-stratified by fluorescene in situ hybridization (FISH) and/or cytogenetics. When analyzed by age, the overall symptomatology and biomarker-defined risk profiles appeared similar in the three age groups studied (<65, 65-74, >=75 years). Moreover, the short-term clinical benefits and toxicity associated with the induction regimens described did not vary by age group, and the physician-reported response rates broadly corresponded to those documented in the literature for the respective treatments employed. The findings also illustrate that bothproteasome inhibitors and immu-nomomodulataory agents are widely utilized for patients who are and are not eligible for transplant, suggesting that the rapid development of newer management strategies in MM is being effectively translated into community-based patient care.