Multiple myeloma: Chemotherapy or transplantation in the era of new drugs

Antonio Palumbo, S. Vincent Rajkumar

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Objective: To review the current results of studies incorporating novel agents in multiple myeloma (MM) and discuss the role of autologous stem-cell transplantation (ASCT) in the era of new active drugs for the treatment of this disease. The outlook for patients with symptomatic MM is changing with the introduction of bortezomib, thalidomide, and lenalidomide into the repertoire of available chemotherapeutic agents. Compared with standard chemotherapy, a survival benefit has been reported for the first time in 30 yrs. Methods: Articles published in English between 1969 and 2008 were identified by searching PubMed for 'myeloma', 'diagnosis', 'thalidomide', 'bortezomib', 'lenalidomide', 'dexamethasone', 'prednisone', 'doxorubicin', 'cyclophosphamide', 'melphalan', 'combination chemotherapy', and 'autologous transplantation'. Results: In randomized studies, bortezomib, thalidomide, and lenalidomide have each been combined with dexamethasone, alkylating agents, or doxorubicin, and such combinations resulted in significant improvement in progression-free survival. Conclusions: The incorporation of new drugs as induction therapy along with ASCT appears to produce very good partial response rates, slightly superior to those achieved by conventional chemotherapy with new drugs. How to best optimize induction, consolidation, and maintenance therapy and how to best select and prepare patients for ASCT are still to be determined. Randomized trials are needed to directly compare the current best chemotherapeutic approach with best ASCT strategies and to guide clinical practice for patients with MM.

Original languageEnglish (US)
Pages (from-to)379-390
Number of pages12
JournalEuropean Journal of Haematology
Issue number5
StatePublished - May 2010


  • Autologous stem-cell transplantation
  • Chemotherapeutic agents
  • Induction therapy
  • Lenalidomide
  • Multiple myeloma
  • Response rates

ASJC Scopus subject areas

  • Hematology


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