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  • Author: Sundar Jagannath x
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Sundar Jagannath

Hematologists/oncologists and other physicians can expect to encounter an increasing number of patients with multiple myeloma (MM) in the coming years. Between 1997 and 2006, the incidence rate of myeloma declined in the United States, but the burden (number of incident cases) increased. 1 An analysis of population-based cancer registries in 9 countries detected modest increases in the incidence of MM in most between 1973 and 1992, with further increases projected by 2007. 2 MM remains the second most common hematologic malignancy in the United States after non-Hodgkin's lymphoma. 3 Historically, MM has been a difficult and frustrating disease for patients and physicians. Since the reintroduction of thalidomide and development of lenalidomide and bortezomib, outcomes have improved considerably, particularly when these newer agents are combined with conventional chemotherapeutic agents or each other. Using the first-line regimens common in 1983, typical 2-year survival rates were 48% to 66%. In trials of triple combination therapy reported in 2008, the 2-year survival rates ranged from 83% to 90%. 4 In the United States, the 5-year survival rate improved from 26% in 1975 to 1977 to 34% in 1996 to 2003, a statistically significant difference. 5 Obviously, it is vitally important for today's physicians to understand the newer agents, but this is a challenge because the drugs have multiple functions (e.g., antiangiogenesis, immunomodulation, proteasome inhibition), have different toxicity profiles, and can be used in myriad combinations and sequences. Hematologists/oncologists have indicated a need to know more about choosing first-, second-, and third-line therapies; side effects of the new agents;...