Management of relapsed multiple myeloma: Recommendations of the International Myeloma Working Group
Open accessAbstract
The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity. In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research. This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics. In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant. Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM.
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Those undergoing HCT typically receive a triplet regimen for 3-4 months prior to stem cell collection in order to reduce tumor cell numbers in the bone marrow.
“Those undergoing HCT typically receive a triplet regimen for 3–4 months prior to stem cell collection in order to reduce tumor cell numbers in the bone marrow.”
From Epidemiology, Staging, and Management of Multiple Myeloma (2021) · cites this paper as [34]
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The role of second autografts in the management of myeloma at first relapse.
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Autologous Stem Cell Transplantation: An Effective Salvage Therapy in Multiple Myeloma
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Self-citationReduced-intensity conditioning allogeneic SCT as salvage treatment for relapsed multiple myeloma
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Self-citationAutologous retransplantation for patients with recurrent multiple myeloma
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D(T) PACE as salvage therapy for aggressive or refractory multiple myeloma
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An Observational, Retrospective Analysis of Retreatment with Bortezomib for Multiple Myeloma
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First thalidomide clinical trial in multiple myeloma: a decade
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Lenalidomide, melphalan, prednisone and thalidomide (RMPT) for relapsed/refractory multiple myeloma
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Self-citationThe adverse effects of thalidomide in relapsed and refractory patients of multiple myeloma
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Self-citationReduced-Intensity Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed Multiple Myeloma
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New insights into the treatment of multiple myeloma with histone deacetylase inhibitors.
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New Insights into the Treatment of Multiple Myeloma with Histone Deacetylase Inhibitors
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Thalidomide plus oral melphalan compared with thalidomide alone for advanced multiple myeloma
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Self-citationDiscordant Response or Progression in Patients with Myeloma Treated with Thalidomide-based Regimens
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Self-citationVDTPACE As Salvage Therapy For Heavily Pretreated MM Patients
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Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Moreau, P., Miguel, J. F. S., Sonneveld, P., Mateos, M., Zamagni, E., Avet‐Loiseau, H., Hájek, R., Dimopoulos, M. A., Ludwig, H., Einsele, H., et al. (2017) · Annals of Oncology · doi:10.1093/annonc/mdx096 · Cited by 882 · see citing works
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Self-citationMultiple myeloma current treatment algorithms
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Self-citationEpidemiology, Staging, and Management of Multiple Myeloma
Padala, S. A., Barsouk, A., Barsouk, A., Rawla, P., Vakiti, A., Kolhe, R., Kota, V., & Ajebo, G. H. (2021) · Medical Sciences · doi:10.3390/medsci9010003 · Cited by 332 · see citing works
“Lastly, immunomodulators like lenalidomide, pomalidomide, and thalidomide are frequently used in triplet or quadruplet induction regimens and maintenance regimens [33,34].”
BackgroundThe multiple myelomas — current concepts in cytogenetic classification and therapy
Kumar, S. K., & Rajkumar, S. V. (2018) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-018-0018-y · Cited by 302 · see citing works
Self-citationMoreau, P., Kumar, S. K., Miguel, J. F. S., Davies, F. E., Zamagni, E., Bahlis, N. J., Ludwig, H., Mikhael, J. R., Terpos, E., Schjesvold, F. H., et al. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(20)30756-7 · Cited by 280 · see citing works
Self-citationCAR T cell therapies for patients with multiple myeloma
Mikkilineni, L., & Kochenderfer, J. N. (2020) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-020-0427-6 · Cited by 270 · see citing works
Shah, N. D., Li, L., McCarty, J. M., Kaur, I., Yvon, E. S., Shaim, H., Müftüoğlu, M., Liu, E., Orlowski, R. Z., Cooper, L. J. N., et al. (2017) · British Journal of Haematology · doi:10.1111/bjh.14570 · Cited by 218 · see citing works
Self-citationChimeric antigen receptor T-cell therapies for multiple myeloma
Mikkilineni, L., & Kochenderfer, J. N. (2017) · Blood · doi:10.1182/blood-2017-06-793869 · Cited by 213 · see citing works
Multiple myeloma in the marrow: pathogenesis and treatments
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Current and New Therapeutic Strategies for Relapsed and Refractory Multiple Myeloma: An Update
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Bortezomib for the Treatment of Hematologic Malignancies: 15 Years Later
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Kararoudi, M. N., Nagai, Y., Elmas, E., Pereira, M. D. S. F., Ali, S. A., Imus, P. H., Wethington, D., Borrello, I., Lee, D. A., & Ghiaur, G. (2020) · Blood · doi:10.1182/blood.2020006200 · Cited by 131 · see citing works
Management of multiple myeloma in the relapsed/refractory patient
Sonneveld, P. (2017) · Hematology · doi:10.1182/asheducation-2017.1.508 · Cited by 108 · see citing works
Gherardin, N. A., Loh, L., Admojo, L., Davenport, A. J., Richardson, K., Rogers, A. J., Darcy, P. K., Jenkins, M. R., Prince, H. M., Harrison, S. J., et al. (2018) · Scientific Reports · doi:10.1038/s41598-018-22130-1 · Cited by 106 · see citing works
Dimopoulos, M. A., Bringhen, S., Anttila, P., Capra, M., Cavo, M., Cole, C. E., Gasparetto, C., Hungria, V., Jenner, M. W., Vorobyev, V. I., et al. (2020) · Blood · doi:10.1182/blood.2020008209 · Cited by 84 · see citing works
Self-citationNext-generation multiple myeloma treatment: a pharmacoeconomic perspective
Rajkumar, S. V., & Harousseau, J. L. (2016) · Blood · doi:10.1182/blood-2016-09-692947 · Cited by 80 · see citing works
How I treat myeloma with new agents
Moreau, P. (2017) · Blood · doi:10.1182/blood-2017-05-743203 · Cited by 81 · see citing works
Self-citationNavigating the treatment landscape in multiple myeloma: which combinations to use and when?
Goldschmidt, H., Ashcroft, J., Szabó, Z. R., & Garderet, L. (2018) · Annals of Hematology · doi:10.1007/s00277-018-3546-8 · Cited by 80 · see citing works
Self-citationSafety of proteasome inhibitors for treatment of multiple myeloma
Schlafer, D., Shah, K. S., Panjic, E. H., & Lonial, S. (2016) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2017.1259310 · Cited by 71 · see citing works
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- Authors
- Laubach, J., Garderet, L., Mahindra, A., Gahrton, G., Caers, J., Sezer, O., Voorhees, P., Leleu, X., Johnsen, H. E., Streetly, M., Jurczyszyn, A., Ludwig, H., Mellqvist, U.-H., Chng, W.-J., Pilarski, L., Einsele, H., Hou, J., Turesson, I., Zamagni, E., Chim, C. S., Mazumder, A., Westin, J., Lu, J., Reiman, T., Kristinsson, S., Joshua, D., Roussel, M., O'Gorman, P., Terpos, E., McCarthy, P., Dimopoulos, M., Moreau, P., Orlowski, R. Z., Miguel, J. S., Anderson, K. C., Palumbo, A., Kumar, S., Rajkumar, V, Durie, B., & Richardson, P. G.
- Affiliations
- Dana-Farber Cancer Institute (US)
- Hôpital Saint-Antoine (FR)
- University of California, San Francisco (US)
- Karolinska University Hospital (SE)
- Centre Hospitalier Universitaire de Liège (BE)
- Istanbul Memorial Hospital (TR)
- University of North Carolina at Chapel Hill (US)
- Centre Hospitalier Universitaire de Lille (FR)
- Aalborg University Hospital (DK)
- King's College Hospital (GB)
- Jagiellonian University (PL)
- Wilhelminen Hospital (AT)
- Sahlgrenska University Hospital (SE)
- National University of Singapore (SG)
- University of Alberta (CA)
- Universitätsklinikum Würzburg (DE)
- Second Military Medical University (CN)
- Skåne University Hospital (SE)
- University of Bologna (IT)
- Queen Mary Hospital (CN)
- NYU Langone Health (US)
- Peking University People's Hospital (CN)
- Dalhousie University (CA)
- Royal Prince Alfred Hospital (AU)
- Hôpital Purpan (FR)
- National and Kapodistrian University of Athens (GR)
- Roswell Park Comprehensive Cancer Center (US)
- Nantes Université (FR)
- The University of Texas MD Anderson Cancer Center (US)
- University of Turin (IT)
- Mayo Clinic (US)
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Richardson, P G
- ORCID
- Laubach, J
- Garderet, L
- Caers, J
- Sezer, O
- Voorhees, P
- Leleu, X
- Johnsen, H E
- Streetly, M
- Jurczyszyn, A
- Ludwig, H
- Einsele, H
- Hou, J
- Turesson, I
- Zamagni, E
- Chim, C S
- Mazumder, A
- Reiman, T
- Kristinsson, S
- Roussel, M
- Terpos, E
- McCarthy, P
- Dimopoulos, M
- Moreau, P
- Orlowski, R Z
- Anderson, K C
- Palumbo, A
- Kumar, S
- Durie, B
- Richardson, P G
- Venue
- Leukemia
- Published
- 2015-12-29
- Volume
- 30
- Issue
- 5
- Pages
- 1005-1017
- ISSN
- 0887-6924 (ISSN-L)
- 1476-5551
- OpenAlex
- W2216303864
- Cited by
- 258
- References
- 133
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 10 · 2023: 33 · 2022: 24 · 2021: 25 · 2020: 35 · 2019: 29 · 2018: 32 · 2017: 38 · 2016: 10
- FWCI
- 3.99
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Leukemia (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, other-oa)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- ORBi (University of Liège) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Health Sciences › Medicine › Genetics › Chronic Lymphocytic Leukemia Research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Keywords
- relapsed multiple myeloma, relapsed/refractory multiple myeloma, second relapse, autologous stem cell transplantation, allogeneic stem cell transplantation, conventional-dose chemotherapy, diagnostic assessment, treatment selection
- MeSH terms
- Antineoplastic Agents, Humans, Multiple Myeloma, Recurrence, Salvage Therapy, Practice Guidelines as Topic, Hematopoietic Stem Cell Transplantation, Disease Management
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