Multiple myeloma

Authors: I. Špička;  M. Klánová
Authors‘ workplace: I. interní klinika –  klinika hematologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MU Dr. Marek Trněný, CSc.
Published in: Vnitř Lék 2013; 59(7): 627-630


Multiple myeloma is one of the most common hematological malignancies with increasing prevalence. Not until the introduction of 1 or 2 cycles of high‑dose therapy with the support of hematopoietic cells meant a certain progress in the prognosis of patients. The radical change in the therapy efficiency was not made possible until the so‑ called new or targeting drugs –  thalidomide, bortezomib and lenalidomide. The 2 latter preparations have particularly changed the approach to the disease itself from one of the least prognostically favourable hematological tumours to a long‑term controllable malignancy with a potential to treat at least some of the patients. Currently, 3 ways of further progress towards more efficient treatment methods are under investigation: a) maintenance or consolidation treatment aimed at further intensification of therapeutic response, b) combination of targeting drugs and c) efficiency of the “second generation” targeting drugs.

Key words:
multiple myeloma –  bortezomib –  lenalidomide –  carfilzomib


1. Malpas JS, Bergsagel DE, Kyle RA. Myeloma, bio­logy and management. Oxford: Oxford Medical Publications 1995.

2. Konečný M, Geryk E, Kubíček P et al. Prevalence nádorů v České republice. Brno: PřF MU 2008.

3. Mitsiades CS, Mitsiades NS, Munshi NC et al. The role of the bone microenvironment in the pathophysiology and therapeutic management of multiple myeloma: interplay of growth factors, their receptors and stromal interactions. Eur J Cancer 2006; 42: 1564– 1573.

4. Facon T, Mary JY, Pégourie B et al. Dexamethasone‑based regimens versus melphalan‑ prednisone for elderly multiple myeloma patients ineligible for high‑dose therapy. Blood 2006; 107: 1292– 1298.

5. Boyle P, Ferlay J. Cancer incidence and mortality in Europe 2004. Ann Oncol 2005; 16: 481– 488.

6. Attal M, Harousseau JL, Stoppa AM et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med 1996; 335: 91– 97.

7. Moreau P, Misbahi R, Milpied N et al. Long‑term results (12 years) of high‑dose therapy in 127 patients with de novo multiple myeloma. Leukemia 2002; 16: 1838– 1843.

8. Koren J, Spicka I, Straub J et al. Retrospective analysis of the results of high‑dose chemotherapy with the support of autologous blood stem cells in patients with multiple myeloma. The experience of a single centre. Prague Med Rep 2010; 111: 207– 218.

9. Rajkumar SV. Treatment of myeloma: cure vs control. Mayo Clin Proc 2008; 83: 1142– 1145.

10. San Miguel JF, Schlag R, Khuageva NK et al. VISTA Trial Investigators. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008; 359: 906– 917.

11. Spicka I, Mateos MV, Redman K et al. An overview of the VISTA trial: newly dia­gnosed, untreated patients with multiple myeloma ineligible for stem cell transplantation. Immunotherapy 2011; 3: 1033– 1040.

12. Palumbo A, Bringhen S, Caravita T et al. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006; 367: 825– 831.

13. Davies FE, Wu P, Jenner M et al. The combination of cyclophosphamide, velcade and dexamethasone induces high response rates with comparable toxicity to velcade alone and velcade plus dexamethasone. Haematologica 2007; 92: 1149– 1150.

14. Richardson PG, Lonial S, Jakubowiak A et al. Lenalidomide, bortezomib, and dexamethasone in patients with newly dia­gnosed multiple myeloma: Encouraging efficacy in high risk groups with updated results of a phase I/ II study. Blood 2008; 112: 41. Abstract 92.

15. Ludwig H, Beksac M, Bladé J et al. Multiple myeloma treatment strategies with novel agents in 2011: a European perspective. Oncologist 2011; 16: 388– 403.

16. Palumbo A, Falco P, Corradini P et al. Melphalan, prednisone, and lenalidomide treatment for newly dia­gnosed myeloma: a report from the GIMEMA –  Italian Multiple Myeloma Network. J Clin Oncol 2007; 25: 4459– 4465.

17. Attal M, Lauwers V, Marit G et al. Maintenance treatment with lenalidomide after transplantation for myeloma: final analysis of the IFM 2005– 02. Blood 2010; 116. Abstract 310.

18. McCarthy PL, Owzar K, Anderson KC et al. Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous hematopoietic stem cell transplantation (ahsct) for multiple myeloma: CALGB 100104. Blood 2010; 116. Abstract 37.

19. Mitsiades CS, Davies FE, Laubach JP et al. Future directions of next‑ generation novel therapies, combination approaches, and the development of personalized medicine in myeloma. J Clin Oncol 2011; 29: 1916– 1923.

20. Kumar SK, Rajkumar SV, Dispenzieri A et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516–2520.

21. Bladé J, Samson D, Reeece D et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high‑dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998; 102: 1115– 1123.

22. Durie BG, Harousseau JL, Miguel JS et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467– 1473.

23. Palumbo A, Hajek R, Delforge M et al. Continuous lenalidomide treatmedn for newly dia­gnosted multiple myeloma. N Engl J Med 2012; 366: 1759– 1769.

24. Palumbo A et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 2012; 367: 285.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account