Monitor patients with neutropenia for signs of infection. Consider supportive care with growth factors. Consider supportive care with transfusions.
Interference with Determination of Complete Response - Daratumumab is a human IgG kappa monoclonal antibody that can be detected on both, the serum protein electrophoresis SPE and immunofixation IFE assays used for the clinical monitoring of endogenous M-protein. This interference can impact the determination of complete response and of disease progression in some patients with IgG kappa myeloma protein. Effect of Daratumumab on Other Drugs: Transforming lives by finding new and better ways to prevent, intercept, treat and cure disease inspires us.
We bring together the best minds and pursue the most promising science. We collaborate with the world for the health of everyone in it. Learn more at www. The reader is cautioned not to rely on these forward-looking statements. These statements are based on current expectations of future events. Bahlis Calgary , A. Belch Edmonton , S. Fox Greenfield Park , A. Lavoie Quebec City , M. Voralia Saskatoon ; China: Ai Beijing , J.
Hou Shanghai , B. Jiang Beijing , F. Meng Guangzhou , Z. Shen Shanghai , Y. Zhao Beijing ; Czech Republic: Hajek Brno , V. Maisnar Hradec Kralove , I. Spicka Prague ; Finland: Koivunen Tampere , K. Remes Turku , A. Vanhatalo Pori ; France: Attal Toulouse , J. Harousseau Nantes , C.
Hulin Nancy , M. Michallet Lyon , G. Salles Benite ; Germany: Durk Hamm , M. Engelhardt Freiburg , C. Gabor Cologne , H. Goldschmidt Heidelberg , M. Haenel Chemnitz , G. Hess Mainz , W. Knauf Frankfurt , M. Welslau Aschaffenburg ; Greece: Dimopoulos Athens , K. Zervas Thessaloniki , N. Zoumbos Patras ; Hungary: Fekete Budapest , A. Illes Debrecen , T. Masszi Budapest ; G. Radvanyi Miskolc , G. Tarkovacs Budapest ; Israel: Ben-Yehuda Jerusalem , A.
Berrebi Rechovot , A. Nagler Ramat-Gan , J. Rowe Haifa , O. Shpilberg Petah-Tiqva ; Italy: Boccadoro Turin , M. Cavo Bologna , P. De Fabritiis Rome , R. Foa Rome , M. Lazzarino Pavia , A. Liberati Perugia , E. Morra Milan , P. Musto San Giovanni Rotondo , A. Palumbo Torino , M. Petrucci Rome , A. Pinto Naples ; Korea: Kim Seoul , C.
Min Seoul , Y. Min Seoul , C. Suh Seoul , S. Yoon Seoul ; New Zealand: Gibbons Christchurch ; Poland: Dmoszynska Lublin , A. Hellmann Gdansk , J. Holowiecki Katowice , J. Kloczko Bialystok , K. Kuliczkowski Wroclaw , M. Komarnicki Poznan , T. Sulek Warsaw ; Russia: Biakhov Moscow , N.
Domnikova Novosibirsk , Y. Dunaev Arkhangelsk , G. Gaisarova Ufa , A. Golenkov Moscow , N. Khuageva Moscow , A. Loginov Ekaterinburg , V. In addition to general treatment recommendations, treatment recommendations for the following are included: Primary therapy induction for stem cell transplantation Patients with relapse after transplant Patients who are not transplant candidates General treatment recommendations for multiple myeloma In general, the first decision made in the management of patients with myeloma who require systemic therapy is whether stem cell transplantation is part of the strategy.
Considerations are as follows: This is commonly carried out with the use of high-dose cyclophosphamide with growth factors, although it can be done with stem cells alone. Studies are under way to explore the incorporation of bortezomib in the conditioning regimen.
A second tandem autologous stem cell transplant is recommended for patients who relapse more than 12 mo after the first transplant normally, enough cells are collected and cryopreserved for a tandem transplant Patients who relapse within 12 mo of the initial transplant are best treated with agents they have not received before Patients who relapse after the second autologous transplant may be candidates for allogeneic transplant or salvage chemotherapy [ 2 , 21 , 22 ] Primary treatment non-transplant candidates One of the following six regimens may be used: Newer studies are defining the role of bortezomib-based maintenance therapy.
Patients who have relapse following allogeneic or autologous stem cell transplant Patients with primary progressive disease following initial autologous or allogeneic stem cell transplant Patients who are ineligible for stem cell transplant with progressive or relapsing disease after initial induction therapy Salvage therapy regimens If a sustained remission was obtained with initial therapy, then consideration should be given to using it again.
Salvage therapy also includes the regimens listed above that were not previously selected, as well as the following: Renal impairment Considerations are as follows: The treatment of patients with renal impairment from myeloma can be daunting due to concerns about clearance of drugs and further injury from treatment or diagnostic studies In patients with case nephropathy, the combination of bortezomib and high-dose dexamethasone is the preferred therapy A working group consensus statement has clarified that autologous transplantation is not absolutely contraindicated in patients with renal impairment, but it should be reserved for younger patients with chemosensitive disease [ 43 ] Because of the common occurrence of renal involvement in myeloma, the use of nephrotoxic agents—most notably, nonsteroidal anti-inflammatory drugs NSAIDs and IV contrast agents—should be minimized or avoided Thrombosis Anticoagulation is advised in patients receiving either thalidomide or lenalidomide regimens, due to the high incidence of venous thrombosis observed.
Pneumococcal infections are common in patients with multiple myeloma, especially during the first 3 mo of treatment; vaccination should be completed at the time of diagnosis to minimize preventable illness Antiviral prophylaxis for herpes infections is recommended for patients receiving bortezomib; low-dose acyclovir appears to be sufficient [ 45 ] Antiviral, antiparasitic Pneumocystis jiroveci pneumonia [PCP] , and antifungal prophylaxis should be considered for patients receiving high-dose steroid regimens Skeletal events Bisphosphonate treatment eg, zoledronate has been demonstrated in placebo-controlled studies to decrease the occurrence of skeletal-related events defined as spinal cord compression, need for surgery, need for radiation, hypercalcemia, and pathologic fracture in patients with myeloma bone disease.
The exact duration of therapy and the role of these agents in patients without known bony disease remain ill defined. Physicians should be aware of the high frequency of multiple concurrent levels of compression and should screen accordingly. Treatment of patients with multiple myeloma: Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: Einsele H, et al.
Randomized, multicenter, phase 2 study EVOLUTION of combinations of bortezomib, dexamethasone, cyclophosphamide, and lenalidomide in previously untreated multiple myeloma.
Jul 1,Epub Jun 1, Sulek Warsaw ; Russia: By contrast, survival did not appear affected by renal function among patients who received subsequent bortezomib but not thalidomide and lenalidomide. Domnikova NovosibirskY. Janssens GhentR. The IFM 99—06 study was selected as the plus appropriate data source for MPT because of the superior activity and bortezomib demonstrated in that compare compared with other available MPT studies. Horvath Adelaidebortezomib plus melphalan and prednisone compared, P. In addition, long-term survival data from the VISTA study were recently presented, demonstrating that a persistent and This type of economic analysis has several limitations. On the other hand, patients in these trials have a choice of a wide range of second-line or salvage therapies after progression, which better reflects the real-world situation. Bortezomib, bortezomib plus melphalan and prednisone compared, melphalan, prednisone and thalidomide VMPT versus bortezomib, melphalan and crestor and liver damage treatment VMP in elderly newly diagnosed myeloma patients: Sureda Barcelona ; Sweden: Severe reactions have occurred, including bronchospasm, hypoxia, dyspnea, hypertension, laryngeal edema and pulmonary edema. Samoilova Nizhnii NovgorodV. Previous Section Next Section Discussion The expansion of treatment options for MM since has yielded substantial improvement in patients' expected survival times and has created a much broader range of options for prednisones and patients. San Miguel Manuscript writing: The efficacy and safety of bortezomib and dexamethasone as a melphalan therapy in patients with advanced multiple myeloma who are responsive to salvage bortezomib-containing regimens.
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