Multiple Myeloma Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. The American Cancer Society estimates that 20,580 new cases of MM will occur in the United States in 2009, including 11,680 in men and 8900 in women, with an estimated 10,580 deaths.1 The mean age of affected individuals is 62 years for men (75% > 70 years) and 61 years for women (79% > 70 years). The treatment of MM has dramatically improved over the past decade. The 5-year survival rate reported in the Surveillance Epidemiology and End Results database has increased from 25% in 1975 to 34% in 2003 because of the availability of newer and more effective treatment options.2,3 MM is typically sensitive to various cytotoxic drugs, both as initial treatment...
  • 1

    Jemal A, Siegel R, Ward E. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225249.

  • 2

    Brenner H, Gondos A, Pulte D. Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 2008;111:25212526.

    • Search Google Scholar
    • Export Citation
  • 3

    Kumar SK, Rajkumar SV, Dispenzieri A. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008;111:25162520.

  • 4

    Hideshima T, Anderson KC. Molecular mechanisms of novel therapeutic approaches for multiple myeloma. Nat Rev Cancer 2002;2:927937.

  • 5

    Kyle RA, Gertz MA, Witzig TE. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003;78:2133.

  • 6

    Fonseca R, Barlogie B, Bataille R. Genetics and cytogenetics of multiple myeloma: a Workshop Report. Cancer Res 2004;64:15461558.

  • 7

    Dewald GW, Therneau T, Larson D. Relationship of patient survival and chromosome anomalies detected in metaphase and/or interphase cells at diagnosis of myeloma. Blood 2005;106:35533558.

    • Search Google Scholar
    • Export Citation
  • 8

    Moulopoulos LA, Dimopoulos MA, Weber D. Magnetic resonance imaging in the staging of solitary plasmacytoma of bone. J Clin Oncol 1993;11:13111315.

    • Search Google Scholar
    • Export Citation
  • 9

    Durie BG, Waxman AD, D’Agnolo A, Williams CM. Whole-body (18)F-FDG PET identifies high-risk myeloma. J Nucl Med 2002;43:14571463.

  • 10

    Schirrmeister H, Bommer M, Buck AK. Initial results in the assessment of multiple myeloma using 18F-FDG PET. Eur J Nucl Med Mol Imaging 2002;29:361366.

    • Search Google Scholar
    • Export Citation
  • 11

    Dispenzieri A, Kyle R, Merlini G. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009;23:215224.

    • Search Google Scholar
    • Export Citation
  • 12

    Tate JR, Gill D, Cobcroft R, Hickman PE. Practical considerations for the measurement of free light chains in serum. Clin Chem 2003;49:12521257.

    • Search Google Scholar
    • Export Citation
  • 13

    Bradwell AR, Carr-Smith HD, Mead GP. Serum test for assessment of patients with Bence Jones myeloma. Lancet 2003;361:489491.

  • 14

    Greipp P, Lust J, O’Fallon M. Plasma cell labeling index and B2-microglobulin predict survival independent of thymidine kinase and C-reactive protein in multiple myeloma. Blood 1993;81:33823387.

    • Search Google Scholar
    • Export Citation
  • 15

    Greipp P, San Miquel J, Durie B. International staging system for multiple myeloma. J Clin Oncol 2005;23:34123420.

  • 16

    Knowling MA, Harwood AR, Bergsagel DE. Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumors of bone. J Clin Oncol 1983;1:255262.

    • Search Google Scholar
    • Export Citation
  • 17

    Dimopoulos MA, Goldstein J, Fuller L. Curability of solitary bone plasmacytoma. J Clin Oncol 1992;10:587590.

  • 18

    Hu K, Yahalom J. Radiotherapy in the management of plasma cell tumors. Oncology 2000;14:101111.

  • 19

    Kato T, Tsukamoto E, Nishioka T. Early detection of bone marrow involvement in extramedullary plasmacytoma by whole-body F-18 FDG positron emission tomography. Clin Nucl Med 2000;25:870873.

    • Search Google Scholar
    • Export Citation
  • 20

    Schirrmeister H, Bommer M, Buck AK. Initial results in the assessment of multiple myeloma using 18F-FDG PET. Eur J Nucl Med Mol Imaging 2002;29:361366.

    • Search Google Scholar
    • Export Citation
  • 21

    Jadvar H, Conti PS. Diagnostic utility of FDG PET in multiple myeloma. Skeletal Radiol 2002;31:690694.

  • 22

    Orchard K, Barrington S, Buscombe J. Fluoro-deoxyglucose positron emission tomography imaging for the detection of occult disease in multiple myeloma. Br J Haematol 2002;117:133135.

    • Search Google Scholar
    • Export Citation
  • 23

    Schirrmeister H, Buck AK, Bergmann L. Positron emission tomography (PET) for staging of solitary plasmacytoma. Cancer Biother Radiopharm 2003;8:841845.

    • Search Google Scholar
    • Export Citation
  • 24

    Bredella MA, Steinbach L, Caputo G. Value of FDG PET in the assessment of patients with multiple myeloma. Am J Roentgenol 2005;184:11991204.

    • Search Google Scholar
    • Export Citation
  • 25

    Harousseau JL, Mathiot C, Attal M. Bortezomib/dexamethasone versus VAD as induction prior to autologous stem cell transplantation (ASCT) in previously untreated multiple myeloma (MM): updated data from IFM 2005/01 trial [abstract]. J Clin Oncol 2008;26(Suppl 15):Abstract 8505.

    • Search Google Scholar
    • Export Citation
  • 26

    Sonneveld P, van der Holt B, Schmidt-Wolf IGH. First analysis of HOVON-65/GMMG-HD4 randomized phase III trial comparing bortezomib, adriamycin, dexamethasone (PAD) vs VAD as induction treatment prior to high dose melphalan (HDM) in patients with newly diagnosed multiple myeloma (MM) [abstract]. Blood 2008;112:243a. Abstract 653.

    • Search Google Scholar
    • Export Citation
  • 27

    Cavo M, Tacchetti P, Patriarca F. Superior complete response rate and progression-free survival after autologous transplantation with up-front Velcade-thalidomide-dexamethasone compared with thalidomide-dexamethasone in newly diagnosed multiple myeloma [abstract]. Blood 2008;112:Abstract 158.

    • Search Google Scholar
    • Export Citation
  • 28

    Richardson P, Jagannath S, Raje N. Lenalidomide, bortezomib, and dexamethasone (Rev/Vel/Dex) as front-line therapy for patients with multiple myeloma (MM): preliminary results of a phase II study [abstract]. Blood 2007;110:Abstract 187.

    • Search Google Scholar
    • Export Citation
  • 29

    Richardson P, Lonial S, Jakubowiak A. Lenalidomide, bortezomib, and dexamethasone in patients with newly diagnosed multiple myeloma: encouraging efficacy in high risk groups with updated results of a phase I/II study [abstract]. Blood 2008;112:Abstract 92.

    • Search Google Scholar
    • Export Citation
  • 30

    Richardson PG, Sonneveld P, Schuster MW. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005;352:24872498.

    • Search Google Scholar
    • Export Citation
  • 31

    Mateos MV, Hernandez JM, Hernandez MT. Bortezomib plus melphalan and prednisone in elderly untreated patients with multiple myeloma: results of a multicenter phase 1/2 trial. Blood 2006;108:21652172.

    • Search Google Scholar
    • Export Citation
  • 32

    Zonder AJ, Crowley J, Hussein M. Superiority of lenalidomide (Len) plus high-dose Dexamethasone (HD) compared to HD alone as treatment of newly-diagnosed multiple myeloma (NDMM): results of the randomized, double-blinded, placebo-controlled SWOG trial S0232 [abstract]. Blood 2007;110:Abstract 77.

    • Search Google Scholar
    • Export Citation
  • 33

    Rajkumar SV, Jacobus S, Callander N. A randomized phase III trial of lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone in newly diagnosed multiple myeloma (E4A03): a trial coordinated by the Eastern Cooperative Oncology Group [abstract]. Blood 2006;108:Abstract 799.

    • Search Google Scholar
    • Export Citation
  • 34

    Rajkumar SV, Jacobus S, Callander N. Randomized trial of lenalidomide plus high-dose dexamethasone (RD) versus lenalidomide plus low-dose dexamethasone (Rd) in newly diagnosed multiple myeloma (E4A03): a trial coordinated by the Eastern Cooperative Oncology Group [abstract]. Blood 2007;110:Abstract 74.

    • Search Google Scholar
    • Export Citation
  • 35

    Paripati H, Stewart AK, Cabou S. Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma. Leukemia 2008;22:12821284.

    • Search Google Scholar
    • Export Citation
  • 36

    Kumar S, Dispenzieri A, Lacy MQ. Impact of lenalidomide therapy on stem cell mobilization and engraftment post-peripheral blood stem cell transplantation in patients with newly diagnosed myeloma. Leukemia 2007;21:20352042.

    • Search Google Scholar
    • Export Citation
  • 37

    Mazumder A, Kaufman J, Niesvizky R. Effect of lenalidomide therapy on mobilization of peripheral blood stem cells in previously untreated multiple myeloma patients. Leukemia 2008;22:12801281.

    • Search Google Scholar
    • Export Citation
  • 38

    Palumbo A, Rajkumar SV, Dimopoulos MA. Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 2008;22:414423.

    • Search Google Scholar
    • Export Citation
  • 39

    Rajkumar SV, Blood E, Vesole D. Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 2006;24:431436.

    • Search Google Scholar
    • Export Citation
  • 40

    Rifkin RM, Gregory SA, Mohrbacher A, Hussein MA. Pegylated liposomal doxorubicin, vincristine, and dexamethasone provide significant reduction in toxicity compared with doxorubicin, vincristine, and dexamethasone in patients with newly diagnosed multiple myeloma: a phase III multicenter randomized trial. Cancer 2006;106:848858.

    • Search Google Scholar
    • Export Citation
  • 41

    Gregory WM, Richards MA, Malpas JS. Combination chemotherapy vs. melphalan and prednisolone in the treatment of multiple myeloma: an overview of published trials. J Clin Oncol 1992;10:334342.

    • Search Google Scholar
    • Export Citation
  • 42

    Palumbo A, Bringhen S, Caravita T. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006;367:825831.

    • Search Google Scholar
    • Export Citation
  • 43

    Facon T, Mary JY, Hulin C. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet 2007;370:12091218.

    • Search Google Scholar
    • Export Citation
  • 44

    Hulin C, Facon T, Rodon P. Melphalan- prednisone-thalidomide (MP-T) demonstrates a significant survival advantage in elderly patients 75 years with multiple myeloma compared with melphalan-prednisone (MP) in a randomized, double-blind, placebo-controlled trial, IFM 01/01 [abstract]. Blood 2007;110:Abstract 75

    • Search Google Scholar
    • Export Citation
  • 45

    Waage A, Gimsing P, Juliusson G. Melphalan-prednisone-thalidomide to newly diagnosed patients with multiple myeloma: a placebo controlled randomised phase III trial [abstract]. Blood 2007;110: Abstract 78.

    • Search Google Scholar
    • Export Citation
  • 46

    Palumbo A, Bringhen S, Liberati AM. Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized controlled trial. Blood 2008;112:31073114.

    • Search Google Scholar
    • Export Citation
  • 47

    Wijermans P, Schaafsma M, van Norden Y. Melphalan + prednisone versus melphalan + prednisone + thalidomide induction therapy for multiple myeloma in elderly patients: first interim results of the Dutch cooperative group HOVON [abstract]. Haematologica 2008;93:Abstract 178.

    • Search Google Scholar
    • Export Citation
  • 48

    San Miguel JF, Schlag R, Khuageva NK. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008;359:906917.

    • Search Google Scholar
    • Export Citation
  • 49

    Miguel JFS, Schlag R, Khuageva NK. Updated follow-up and results of subsequent therapy in the phase III VISTA trial: bortezomib plus melphalan-prednisone versus melphalan-prednisone in newly diagnosed multiple myeloma [abstract]. Blood 2008;112:Abstract 650.

    • Search Google Scholar
    • Export Citation
  • 50

    Badros A, Barlogie B, Morris C. High response rate in refractory and poor-risk multiple myeloma after allotransplantation using a nonmyeloablative conditioning regimen and donor lymphocyte infusions. Blood 2001;97:25742579.

    • Search Google Scholar
    • Export Citation
  • 51

    Kroger N, Schwerdtfeger R, Kiehl M. Autologous stem cell transplantation followed by a dose-reduced allograft induces high complete remission rate in multiple myeloma. Blood 2002;100:755760.

    • Search Google Scholar
    • Export Citation
  • 52

    Maloney D, Sahebi F, Stockerl-Goldstein KE. Combining an allogenic graft versus myeloma effect with high dose autologous stem cell rescue in the treatment of multiple myeloma [abstract]. Blood 2001;98:Abstract 434a.

    • Search Google Scholar
    • Export Citation
  • 53

    Moreau P, Facon T, Attal M. Intergroupe Francophone du Myelome. Comparison of 200 mg/m(2) melphalan and 8 Gy total body irradiation plus 140 mg/m(2) melphalan as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the Intergroupe Francophone du Myelome 9502 randomized trial. Blood 2002;99:731735.

    • Search Google Scholar
    • Export Citation
  • 54

    Attal M, Harousseau JL, Stoppa AM. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996;335:9197.

    • Search Google Scholar
    • Export Citation
  • 55

    Child JA, Morgan GJ, Davies FE. Medical Research Council Adult Leukaemia Working Party. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003;348:18751883.

    • Search Google Scholar
    • Export Citation
  • 56

    Barlogie B, Kyle RA, Anderson KC. Standard chemotherapy compared with high dose chemoradiotherapy for multiple myeloma. Final results of phase III US Intergroup Trial S9321. J Clin Oncol 2006;24:929936.

    • Search Google Scholar
    • Export Citation
  • 57

    Fermand JP, Katsahian S, Divine M. High dose therapy and autologous blood stem cell transplantation compared with conventional treatment in myeloma patients aged 55 to 65 years: long term results of a randomized control trial from the Group Myelome-Autogreffe. J Clin Oncol 2005;23:92279233.

    • Search Google Scholar
    • Export Citation
  • 58

    Corradini P, Cavo M, Lokhorst H. Molecular remission after myeloablative allogeneic stem cell transplantation predicts a better relapse-free survival in patients with multiple myeloma Blood 2003;102:19271929.

    • Search Google Scholar
    • Export Citation
  • 59

    Kumar S, Lacy MQ, Dispenzieri A. High-dose therapy and autologous stem cell transplantation for multiple myeloma poorly responsive to initial therapy. Bone Marrow Transplant 2004;34:161167.

    • Search Google Scholar
    • Export Citation
  • 60

    Hahn T, Wingard JR, Anderson KC. The role of cytotoxic therapy with haematopoietic stem cell transplantation in the therapy of multiple myeloma: an evidenced based review. Biol Blood Marrow Transplant 2003;9:437.

    • Search Google Scholar
    • Export Citation
  • 61

    Attal M, Harousseau JL, Facon T. Single versus double autologous stem cell transplantation for multiple myeloma. N Engl J Med 2003;349:24952502.

    • Search Google Scholar
    • Export Citation
  • 62

    Stadtmauer EA. Multiple myeloma 2004—one or two transplants? N Engl J Med 2003;349:25512553.

  • 63

    Fermand JP, Katsahian S, Devine M. High-dose therapy and autologous blood stem-cell transplantation compared with conventional treatment in myeloma patients aged 55 to 65 years: long-term results of a randomized control trial from the Group Myelome-Autogreffe. J Clin Oncol 2005;23:92279233.

    • Search Google Scholar
    • Export Citation
  • 64

    Goldschmidt H. Single vs double high-dose therapy in multiple myeloma: second analysis of the GMMG-HD2 trial [abstract]. Haematologica 2005;90(Suppl 1):Abstract 38.

    • Search Google Scholar
    • Export Citation
  • 65

    Sonneveld P, van der Holt B, Segeren C. Intensive versus double intensive therapy in untreated multiple myeloma: updated analysis of the randomized phase III study HOVON 24 MM [abstract]. Blood 2004;104:Abstract 948.

    • Search Google Scholar
    • Export Citation
  • 66

    Cavo M, Tosi P, Zamagni E. Prospective, randomized study of single compared with double autologous stem-cell transplantation for multiple myeloma: Bologna 96 Clinical Study. J Clin Oncol 2007;25:24342441.

    • Search Google Scholar
    • Export Citation
  • 67

    Kyle RA. High dose therapy in multiple myeloma and primary amyloidosis: an overview. Semin Oncol 1999;26:7483.

  • 68

    Kumar A, Loughran T, Alsina M. Management of multiple myeloma: a systematic review and critical appraisal of published studies. Lancet Oncol 2003;4:293304.

    • Search Google Scholar
    • Export Citation
  • 69

    Bruno B, Rotta M, Patriarca F. A comparison of allografting with autografting for newly diagnosed myeloma. N Engl J Med 2007;356:11101120.

  • 70

    Garban F, Attal M, Michallet M. Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft (IFM99-03 trial) with tandem autologous stem cell transplantation (IFM99-04 trial) in high-risk de novo multiple myeloma. Blood 2006;107:34743480.

    • Search Google Scholar
    • Export Citation
  • 71

    Maloney DG, Molina AJ, Sahebi F. Allografting with nonmyeloablative conditioning following cytoreductive autograft for the treatment of patients with multiple myeloma. Blood 2003;102:34473454.

    • Search Google Scholar
    • Export Citation
  • 72

    Crawley C, Lalancette M, Szydlo R. Outcome for reduced intensity allogeneic transplantation for multiple myeloma: an analysis of prognostic factors from the Chronic Leukemia Working Party of the EBMT. Blood 2005;105:45324539.

    • Search Google Scholar
    • Export Citation
  • 73

    Zeiser R, Bertz H, Spyridonidis A. Donor lymphocyte infusions for multiple myeloma: clinical results and novel perspectives. Bone Marrow Transplant 2004;34:923928.

    • Search Google Scholar
    • Export Citation
  • 74

    Browman GP, Bergsagel D, Sicheri D. Randomized trial of interferon maintenance in multiple myeloma: a study of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1995;13:23542360.

    • Search Google Scholar
    • Export Citation
  • 75

    Shustik C, Belch A, Robinson S. Dexamethasone (dex) maintenance versus observation (obs) in patients with previously untreated multiple myeloma: a National Cancer Institute of Canada Clinical Trials Group Study: MY.7 [abstract]. J Clin Oncol 2004;22(Suppl 14):Abstract 6510.

    • Search Google Scholar
    • Export Citation
  • 76

    Fritz E, Ludwig H. Interferon-alpha treatment in multiple myeloma: meta-analysis of 30 randomized trials among 3948 patients. Ann Oncol 2000;11:14271436.

    • Search Google Scholar
    • Export Citation
  • 77

    Brinker BT, Waller EK, Leong T. Maintenance therapy with thalidomide improves overall survival after autologous hematopoietic progenitor cell transplantation for multiple myeloma. Cancer 2006;106:21712180.

    • Search Google Scholar
    • Export Citation
  • 78

    Attal M, Harousseau JL, Leyvraz S. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006;108:32893294.

    • Search Google Scholar
    • Export Citation
  • 79

    Spencer A, Prince M, Roberts AW. First analysis of the Australian leukaemia and lymphoma group (ALLG) trial of thalidomide and alternate day prednisone following autologous stem cell transplantation (ASCT) for patients with multiple myeloma (ALLGMM6) [abstract]. Blood 2006;108:Abstract 58.

    • Search Google Scholar
    • Export Citation
  • 80

    Barlogie B, Kyle RA, Anderson KC. Standard chemotherapy compared with high-dose chemoradiotherapy for multiple myeloma: final results of phase III US Intergroup trial S9321. J Clin Oncol 2006;24:929936.

    • Search Google Scholar
    • Export Citation
  • 81

    Barlogie B, Tricot G, Anaissie E. Thalidomide and hematopoietic cell transplantation for multiple myeloma. N Eng J Med 2006;354:10211030.

  • 82

    Richardson P, Sonneveld P, Schuster M. Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trial. Blood 2007;110:35573560.

    • Search Google Scholar
    • Export Citation
  • 83

    Jagannath S, Richardson PG, Sonneveld P. Bortezomib appears to overcome the poor prognosis conferred by chromosome 13 deletion in phase 2 and 3 trials. Leukemia 2007;21:151157.

    • Search Google Scholar
    • Export Citation
  • 84

    Orlowski RZ, Nagler A, Sonneveld P. Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma: combination therapy improves time to progression. J Clin Oncol 2007;25:38923901.

    • Search Google Scholar
    • Export Citation
  • 85

    Weber DM, Chen C, Niesvizky R. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med 2007;357:21332142.

    • Search Google Scholar
    • Export Citation
  • 86

    Dimopoulos M, Spencer A, Attal M. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma N Engl J Med 2007;357:21232132.

    • Search Google Scholar
    • Export Citation
  • 87

    Richardson P, Jagannath S, Hussein M. A muticenter, single arm, open label study to evaluate the efficacy and safety of single agent lenalidomide in patients with relapsed and refractory multiple myeloma [abstract]. Blood 2005;106:Abstract 2550.

    • Search Google Scholar
    • Export Citation
  • 88

    Rajkumar SV, Fonseca R, Dispenzieri A. Thalidomide in the treatment of relapsed multiple myeloma. Mayo Clin Proc 2000;75:897901.

  • 89

    Lee CK, Barlogie B, Munshi N. DTPACE: an effective, novel combination chemotherapy with thalidomide for previously treated patients with myeloma. J Clin Oncol 2003;21:27322739.

    • Search Google Scholar
    • Export Citation
  • 90

    Singhal S, Mehta J, Desikan R. Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med 1999;341:15651571.

  • 91

    Waage A, Gimsing P, Juliusson G. Early response predicts thalidomide efficiency in patients with advanced multiple myeloma. Br J Haematology 2004;125:149155.

    • Search Google Scholar
    • Export Citation
  • 92

    Mohty M, Attal M, Marit G. Thalidomide salvage therapy following allogeneic stem cell transplantation for multiple myeloma: a retrospective study from the Intergroupe Francophone du Myelome (IFM) and the Society Francaise de Greffe de Moelle et Therapie Cellulairs (SFGM-TC). Bone Marrow Transplant 2005;35:165169.

    • Search Google Scholar
    • Export Citation
  • 93

    Knop S, Straka C, Haen M. The efficacy and toxicity of bendamustine in recurrent multiple myeloma after high-dose chemotherapy. Haematologica 2005;90:12871288.

    • Search Google Scholar
    • Export Citation
  • 94

    Richardson P, Jagannath S, Avigan DE. Lenalidomide plus bortezomib (Rev-Vel) in relapsed and/or refractory multiple myeloma (MM): final results of a multicenter phase 1 trial [abstract]. Blood 2006;108:Abstract 405.

    • Search Google Scholar
    • Export Citation
  • 95

    Anderson KC, Jagannath S, Jakubowiak A. Phase II study of lenalidomide (Len), bortezomib (Bz), and dexamethasone (Dex) in patients (pts) with relapsed or relapsed and refractory multiple myeloma (MM) [abstract]. J Clin Oncol 2008;26(Suppl 15):Abstract 8545.

    • Search Google Scholar
    • Export Citation
  • 96

    Ikhlaque N, Seshadri V, Kathula S, Baumann MA. Efficacy of prophylactic warfarin for prevention of thalidomide-related deep venous thrombosis. Am J Hematol 2006;81:420422.

    • Search Google Scholar
    • Export Citation
  • 97

    Baz R, Li L, Kottke-Marchant K. The role of aspirin in the prevention of thrombotic complications of thalidomide and anthracycline-based chemotherapy for multiple myeloma. Mayo Clin Proc 2005;80:15681574.

    • Search Google Scholar
    • Export Citation
  • 98

    Berenson JR, Lichtenstein A, Porter L. Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. N Engl J Med 1996;334:488493.

    • Search Google Scholar
    • Export Citation
  • 99

    Berenson JR, Lichtenstein A, Porter L. Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. J Clin Oncol 1998;16:593602.

    • Search Google Scholar
    • Export Citation
  • 100

    Major P, Lortholary A, Hon J. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol 2001;19:558567.

    • Search Google Scholar
    • Export Citation
  • 101

    Bloomfield DJ. Should bisphosphonates be part of the standard therapy of patients with multiple myeloma or bone metastases from other cancers? An evidence-based review. J Clin Oncol 1998;16:12181225.

    • Search Google Scholar
    • Export Citation
  • 102

    Kyle RA, Yee GC, Somerfield MR. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol 2007;25:24642472.

    • Search Google Scholar
    • Export Citation
  • 103

    Zervas K, Verrou E, Teleioudis Z. Incidence, risk factors and management of osteonecrosis of the jaw in patients with multiple myeloma: a single-centre experience in 303 patients. Br J Haematol 2006;134:620623.

    • Search Google Scholar
    • Export Citation
  • 104

    Lindsley H, Teller D, Noonan B. Hyperviscosity syndrome in multiple myeloma. A reversible, concentration-dependent aggregation of the myeloma protein. Am J Med 1973;54:682688.

    • Search Google Scholar
    • Export Citation
  • 105

    Ludwig H, Fritz E, Kotzmann H. Erythropoietin treatment of anemia associated with multiple myeloma. N Engl J Med 1990;322:16931699.

  • 106

    Osterborg A, Boogaerts MA, Cimino R. Recombinant human erythropoietin in transfusion-dependent anemic patients with multiple myeloma and non-Hodgkin’s lymphoma—a randomized multicenter study. Blood 1996;87:2675682.

    • Search Google Scholar
    • Export Citation
  • 107

    Chanan-Khan A, Sonneveld P, Schuster MW. Analysis of herpes zoster events among bortezomib-treated patients in the phase III APEX study. J Clin Oncol 2008;26:47844790.

    • Search Google Scholar
    • Export Citation
  • 108

    Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses: current approaches to diagnosis and treatment. N Engl J Med 1997;337:898909.

  • 109

    Skinner M, Sanchorawala V, Seldin DC. High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study. Ann Intern Med 2004;140:8593.

    • Search Google Scholar
    • Export Citation
  • 110

    Dispenzieri A, Kyle RA, Lacy MQ. Superior survival in primary systemic amyloidosis patients undergoing peripheral blood stem cell transplant: a case control study. Blood 2004;103:39603963.

    • Search Google Scholar
    • Export Citation
  • 111

    Gertz MA, Lacy MQ, Dispenzieri A. Therapy for immunoglobulin light chain amyloidosis: the new and the old. Blood Rev 2004;18:1737.

  • 112

    Palladini G, Perfetti V, Obici L. Association of melphalan and high-dose dexamethasone is effective and well tolerated in patients with AL (primary) amyloidosis who are ineligible for stem cell transplantation. Blood 2004;103:29362938.

    • Search Google Scholar
    • Export Citation
  • 113

    Comenzo RL, Gertz MA. Autologous stem cell transplantation for primary systemic amyloidosis. Blood 2002;99:42764282.

  • 114

    Dhodapkar MV, Hussein MA, Rasmussen E. Clinical efficacy of high-dose dexamethasone with maintenance dexamethasone/alpha interferon in patients with primary systemic amyloidosis: results of United States Intergroup Trial Southwest Oncology Group (SWOG) S9628. Blood 2004;104:35203526.

    • Search Google Scholar
    • Export Citation
  • 115

    Dispenzieri A, Lacy MQ, Zeldenrust SR. The activity of lenalidomide with or without dexamethasone in patients with primary systemic amyloidosis. Blood 2007;109:465470.

    • Search Google Scholar
    • Export Citation
  • 116

    Sanchorawala V, Wright DG, Rosenzweig M. Lenalidomide and dexamethasone in the treatment of AL amyloidosis: results of a phase 2 trial. Blood 2007;109:492496.

    • Search Google Scholar
    • Export Citation
  • 117

    Wechalekar AD, Lachmann HJ, Offer M. Efficacy of bortezomib in systemic AL amyloidosis with relapsed/refractory clonal disease. Haematologica 2008;93:295298.

    • Search Google Scholar
    • Export Citation
  • 118

    Dimopoulos MA, Alexanian R. Waldenström’s macroglobulinemia. Blood 1994;83:14521459.

  • 119

    Ghobrial IM, Gertz MA, Fonseca R. Waldenström macroglobulinaemia. Lancet Oncol 2003;4:679685.

  • 120

    McIntyre OR. Laboratory investigation of myeloma. In: Malpas JS, Bergsagel DE, Kyle RA., eds. Myeloma: Biology and Management. Oxford: Oxford University Press; 1998:217.

    • Search Google Scholar
    • Export Citation
  • 121

    Dimopoulos MA, Kantarjian H, Estey E. Treatment of Waldenström’s macroglobulinemia with 2-chlorodeoxyadenosine. Ann Intern Med 1993;118:195198.

    • Search Google Scholar
    • Export Citation
  • 122

    Dimopoulos MA, Zervas C, Zomas A. Treatment of Waldenstrom’s macroglobulinemia with rituximab. J Clin Oncol 2002;20:23272333.

  • 123

    Dimopoulos MA, Zomas A, Viniou NA. Treatment of Waldenstrom’s macroglobulinemia with thalidomide. J Clin Oncol 2001;19:35963601.

  • 124

    Chen CI, Kouroukis CT, White D. Bortezomib is active in patients with untreated or relapsed Waldenstrom’s macroglobulinemia: a phase II study of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2007;25:15701575.

    • Search Google Scholar
    • Export Citation
  • 125

    Gertz MA, Anagnostopoulos A, Anderson KC. Treatment recommendations in Waldenström’s macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenström’s Macroglobulinemia. Semin Oncol 2003;30:121126.

    • Search Google Scholar
    • Export Citation
  • 126

    Gertz MA. Waldenström’s macroglobulinemia: a review of therapy. Leuk Lymphoma 2002;43:15171526.

  • 127

    Dimopoulos MA, Gertz MA, Kastritis E. Update on treatment recommendations from the Fourth International Workshop on Waldenstrom’s Macroglobulinemia. J Clin Oncol 2009;27:120126.

    • Search Google Scholar
    • Export Citation
  • 128

    Dimopoulos MA, Kantarjian H, Weber D. Primary therapy of Waldenström’s macroglobulinemia with 2-chlorodeoxyadenosine. J Clin Oncol 1994;2:26942698.

    • Search Google Scholar
    • Export Citation
  • 129

    Foran JM, Rohatiner AZ, Coiffier B. Multicenter phase II study of fludarabine phosphate for patients with newly diagnosed lymphoplasmacytoid lymphoma, Waldenstrom’s macroglobulinemia, and mantle-cell lymphoma. J Clin Oncol 1999;17:546553.

    • Search Google Scholar
    • Export Citation
  • 130

    Dimopoulos MA, O’Brien S, Kantarjian H. Treatment of Waldenstrom’s macroglobulinemia with nucleoside analogues. Leuk Lymphoma 1993;11(Suppl 2):105108.

    • Search Google Scholar
    • Export Citation
  • 131

    Treon SP, Agus DB, Link B. CD20-directed antibody-mediated immunotherapy induces responses and facilitates hematologic recovery in patients with Waldenström’s macroglobulinemia. J Immunotherapy 2001;24:272279.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 369 293 76
PDF Downloads 183 160 46
EPUB Downloads 0 0 0