What are the chemotherapy regimens for multiple myeloma?

Chemotherapy is usually used for multiple myeloma. There are many options for treatment using chemotherapy. What chemotherapy method to use should depend on the patient's physical condition and the doctor's advice should be followed.

For high-risk patients, it is still recommended to use a regimen based on Velcade, as other regimens are less effective. The so-called high risk refers to the presence of p53, t(4; 14), t(14;

16) Any of the following: extramedullary lesions, multiple appearances of plasma cells in peripheral blood, or combined with acute renal failure; the above situations usually have a poor prognosis, and even if the general regimen is initially effective, it is easy to relapse and progress in a short period of time. However, such patients only account for a small part of the entire group, so it is recommended that patients must complete chromosome, FISH, and imaging evaluations before the initial treatment to guide clinical treatment.

Any chromosomal abnormality detected by standard cytogenetic analysis is associated with a worse patient outcome compared with the outcome of patients with a normal karyotype. Specific translocations in the immunoglobulin heavy chain region (IgH) detected by FISH, such as t(4;14), 17p13 deletion, and chromosome 1 abnormalities, are also associated with a poor prognosis. Recently, gene expression profiles and gene copy number alterations have shown a promising predictive role that needs to be validated in larger studies. High-risk disease and a poor prognosis can be determined by the presence of 1 of each of the following categories: hypodiploidy, t(4;14), or 17p13 deletion; high levels of serum β2-microglobulin or lactate dehydrogenase; and International Staging System stage III. Standard-risk disease is defined by the presence of hyperdiploidy or t(11;14), normal levels of serum β2-microglobulin or lactate dehydrogenase, and International Staging System stage I.

Symptomatic (active) disease should be treated promptly, whereas asymptomatic (smoldering) myeloma requires only clinical observation because early treatment with conventional chemotherapy has no benefit. Investigational trials are currently evaluating the ability of immunomodulatory drugs to delay the progression from asymptomatic to symptomatic myeloma. Treatment strategies are mainly related to age. For patients who are < 65 years of age and do not have severe cardiac, pulmonary, renal, or hepatic dysfunction, current data support starting induction therapy with thalidomide, lenalidomide, or bortezomib plus hematopoietic stem cell transplantation. For older patients or those with comorbidities, autologous stem cell transplantation with reduced conditioning intensity should be considered. In patients aged > 65 years, conventional treatment should be given in combination with thalidomide, lenalidomide, or bortezomib. In patients >75 years of age, or in younger patients with comorbidities, less intensive approaches should be considered that limit toxic effects or avoid treatment interruptions that would reduce the desired efficacy. Treatment selection and drug dosage should be determined based on biological age (as opposed to chronological age) and the presence of comorbidities.