7 – Conclusion
Major progress has been achieved in the management of relapsed and refractory MM. A first wave of therapeutic improvement began with the introduction of bortezomib and lenalidomide. A new era is starting with novel IMiDs such as pomalidomide, second-generation of proteasome inhibitors such as carfilzomib and ixazomib and monoclonal antibodies. However, the introduction of several new agents also confronts the myeloma community with some new challenges.
It becomes clear that as with front-line treatment, more benefit is to be expected from optimal combinations of these different agents rather than using them sequentially as single agents. As it is well known that the biological behavior and drug sensitivity of myeloma cells can change at each relapse, we believe that the new biological assays can help us to optimize treatment, not only in the front-line setting but also at relapse. Finally, given the changes made in the upfront treatment with integration of newer agents, the treatment at relapse becomes a moving target requiring a high degree of individualization. Nevertheless, regularly updated national and international guidelines, together with clinical trials are required to guide clinicians and to make sure that patients can benefit maximally from novel therapeutic developments.
All topics within this chapter
1. General considerations
2. Immediate treatment initiation or watchful waiting
3. To switch or re-treat
4. Role of allogeneic transplantation
5. Optimizing drug-based treatment at relapse
6. Supportive care
Chapter 1 – Pathophysiology
Chapter 2 – Diagnosis and staging
Chapter 3 – Treatment of transplant-eligible patients
Chapter 4 – Pathophysiology
Chapter 5 – Treatment of relapsed multiple myeloma
Chapter 6 – Bone disease