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12 - Treatment of relapsed/refractory myeloma

from Section 3 - Myeloma: clinical entities

Published online by Cambridge University Press:  18 December 2013

By
Matthew J. Streetly ,
Jacob Laubach ,
Paul Richardson  and
Stephen A. Schey
Edited by
Stephen A. Schey ,
Kwee L. Yong ,
Robert Marcus  and
Kenneth C. Anderson
Stephen A. Schey
Affiliation:
Department of Haematology, King’s College Hospital, London
Kwee L. Yong
Affiliation:
Department of Haematology, University College Hospital, London
Robert Marcus
Affiliation:
Department of Haematology, King’s College Hospital, London
Kenneth C. Anderson
Affiliation:
Dana-Farber Cancer Institute, Boston
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Summary

Introduction

Modern treatment of newly diagnosed MM has led to improved responses and markedly improved survival[1,2]. However, despite excellent responses and disease control most patients will eventually relapse and require further therapy. Management of relapsed disease is therefore a critical aspect of overall care. This chapter provides a comprehensive overview of the determinants of and general approaches to therapy as well as a review of specific treatment regimens.

Definition of relapsed and relapsed/refractory MM

The European Group for Blood and Marrow Transplantation (EBMT)[3] criteria and International Myeloma Working Group (IMWG) uniform criteria[4] define progressive disease as ≥25% increase (or reappearance from complete response) in the measurable biochemical component (serum monoclonal protein, urine Bence Jones protein or Serum Free Light chain), an increase in bone marrow plasma cells to >10% or the development of new lytic bone lesions/soft tissue plasmacytomas. Clinical relapse is defined as the development of progressive disease and/or myeloma associated end organ dysfunction (CRAB criteria). Primary refractory myeloma refers to disease that fails to achieve at least a minimal response (MR) with initial therapy whilst relapsed and refractory MM is defined as disease that is non-responsive to salvage therapy, or progresses within 60 days of last treatment in patients who previously achieved at least a minimal response (MR).

Type
Chapter
Information
Myeloma
Pathology, Diagnosis, and Treatment
 , pp. 144 - 166
Publisher: Cambridge University Press
Print publication year: 2013

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References

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