Different induction regimens for myeloma patients eligible for high-dose chemotherapy followed by autologous stem cell transplantations and Polish Myeloma Group current recommendations

Abstract

Despite significant progress in the treatment of multiple myeloma, it still remains an incurable disease. The introduction of new drugs has contributed to the increased overall survival of patients diagnosed with multiple myeloma and significantly improved their quality of life. Proteasome inhibitors, immunomodulators and monoclonal antibodies are often used in combination with chemotherapeutic agents. Despite the indisputable role of the new drugs for the treatment of myeloma, high-dose chemotherapy with autologous stem cell transplantation is still the method of choice in a group of younger patients without significant comorbidities. Induction treatment in myeloma patients eligible for autologous stem cell transplantation is particularly important, because the results of the first-line therapy impact further outcome of patients. The quality of the response to first-line treatment determines the progression-free survival. The choice of bortezomib, thalidomide, dexamethasone regimen as induction therapy, recommended by the Polish Myeloma Group, is in line with the recommendations of international experts. The results of the randomized clinical trials have demonstrated that the triple therapy, based on proteasom inhibitors, immunomodulators and steroids, is more effective than regimens involving two drugs only (proteasom inhibitors and steroids or immunomodulators and steroids). Sometimes, due to the clinical situation of the patient and/or unusual features of the disease, it is necessary to individualize induction therapy. The following article provides an overview of different induction regimens for myeloma patients in Poland and suggestions for modifications in justified cases.