Initial Therapy of Multiple Myeloma (MM)

Abstract

Multiple myeloma is a plasma cell neoplasm that accounts for approximately 1-1.8% of cancer cases. It constitutes 10% of malignant blood diseases and is the 2nd most common hematopoietic tumor. In Spain, between 2,500 and 3,000 new cases are diagnosed per year with a median age at diagnosis of 69 years. A great effort has been made to try to improve MM survival, which has ranged from 3 years in the 1990s, to 5 years in the 2000s, and is currently of around 8-9 years. This improvement is due to a better definition of diagnostic, prognostic, and response to treatment criteria and to the successive introduction of new drugs: proteasome inhibitors, immunomodulators, and monoclonal antibodies. Differences have also been established in the therapeutic strategy for multiple myeloma depending on whether the patients are eligible for autologous transplantation of peripheral blood hematopoietic progenitors (TASPE) or ineligible patients. In the first case, the current standard treatment consists of the combination Daraturumab, Velcade, Thalidomide and Dexamethasone (DVTD) – a regime approved by the EMA (European Medicines Agency) – followed by the practice of TASPE and subsequent maintenance therapy with Lenalidomide with or without post-transplant consolidation. For patients who are not candidates for transplantation, current recommendations support the combination of Daraturumab, Revlimid, Dexamethasone (DRD) as the first therapeutic option, while other alternatives are the combination Daraturumab, Velcade, Melphalan, Prednisone (DVMP) or Velcade, Revlimid, Dexamethasone (VRD).