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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) criteria and International Myeloma Working Group (IMWG) uniform criteria 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).
Myeloma is the second-most common hematologic cancer, accounting for approximately 1 percent of all cancers and 2 percent of all deaths from cancer. In recent years there have been major and significant advances in the diagnosis, imaging, molecular pathogenesis, and therapy of myeloma. This book describes these advances in a single, practical volume, placing them in the context of daily clinical practice. Different myeloma subtypes are discussed in individual chapters, integrating etiology, pathogenesis, molecular pathology, histology, and therapy in a single place for each condition. The book begins by discussing epidemiology, imaging techniques, pathogenesis, and other general considerations. Conditions covered in detail include multiple myeloma, POEMS syndrome, Castleman's syndrome, Waldenstrom's macroglobulinemia, amyloidosis and MGUS. Featuring color illustrations, and written and edited by leading authorities in the field, Myeloma provides readers with the information they need to diagnose and manage these complex disorders.