TY - CHAP M1 - Book, Section TI - Multiple Myeloma A1 - Pick, Amy M. A1 - Rao, Kamakshi V. A2 - DiPiro, Joseph T. A2 - Yee, Gary C. A2 - Posey, L. Michael A2 - Haines, Stuart T. A2 - Nolin, Thomas D. A2 - Ellingrod, Vicki PY - 2020 T2 - Pharmacotherapy: A Pathophysiologic Approach, 11e AB - KEY CONCEPTSMultiple 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.Initial therapy for patients with newly diagnosed MM should be personalized based on cytogenetics and tools such as the Mayo Stratification for Myeloma and Risk-Adapted Therapy (mSMART). Primary treatment selection is based on the patient’s eligibility for an autologous hematopoietic stem cell transplantation. Immunomodulatory agents and proteasome inhibitors are used 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 may include myelosuppression, venous thromboembolism (VTE), and neuropathy depending on the regimen used.Thalidomide, lenalidomide, and pomalidomide are immunomodulatory agents with antiangiogenic and anti-inflammatory activity. Lenalidomide is widely utilized compared to thalidomide due to increased potency and less adverse effects. Pomalidomide is currently only used in relapsed/refractory MM.The proteasome inhibitors, bortezomib, carfilzomib, and ixazomib, are highly active in the treatment of MM, particularly in 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 usually include lenalidomide or bortezomib with the intent of increasing 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 therapies and depends on the 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=1182476481 ER -