TY - CHAP M1 - Book, Section TI - Multiple Myeloma A1 - Rao, Kamakshi V. A1 - Pick, Amy M. A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael PY - 2017 T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - KEY CONCEPTS Multiple myeloma (MM) is a cancer that develops in plasma cells, leading to excessive production of a monoclonal immunoglobulin. Most patients have skeletal involvement at the time of diagnosis with associated bone pain and fractures. Anemia, hypercalcemia, and renal failure may also be present. A bone marrow biopsy with 10% or more plasma cells and a M-protein spike on plasma or urine electrophoresis confirms the diagnosis. Cytogenetics may play an important role when selecting the appropriate initial therapy for patients with a new MM diagnosis and tools such as the Mayo Stratification for Myeloma and Risk-adapted Therapy (mSMART) approach are available. Induction treatment is based on patients’ eligibility for autologous stem cell transplantation. Novel agents such as thalidomide, lenalidomide, pomalidomide, bortezomib, and carfilzomib have gained popularity over traditional chemotherapy because of higher response rates and survival. The increased response rate is at the expense of significant grade 3 and 4 toxicity, which can include myelosuppression, venous thromboembolism (VTE), and neuropathy depending on the regimen used. Thalidomide, lenalidomide, and pomalidomide are immunomodulatory agents that have antiangiogenic and anti-inflammatory activity. Thalidomide’s dose limiting toxicity is neuropathy. Lenalidomide is less neurotoxic, but can cause significant myelosuppression. Pomalidomide, the newest of this class, is currently only used in relapsed/refractory MM. The proteasome inhibitors, bortezomib and carfilzomib, are highly active in the treatment of MM, particularly those with high-risk cytogenetics. Autologous hematopoietic stem cell transplantation (HSCT) is used after induction in patients with reasonably good performance status to maximize complete remissions and prolong survival. Combining autologous HSCT with allogeneic HSCT is investigational and should be performed within a clinical trial. Maintenance therapies may be used in both transplant-eligible and ineligible patients. Current regimens typically include lenalidomide or bortezomib with the intent of increasing response rates and progression-free survival. Bisphosphonates are used to treat bone disease associated with MM, which results in decreased pain and skeletal-related events and improved quality of life. Salvage therapy for patients with relapsed or refractory MM can include any of the prior listed therapies and depends on patient’s performance status, risk category, and prior treatments used for induction. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1145215012 ER -