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How I treat a refractory myeloma patient who is not eligible for a clinical trial.

Abstract

Myeloma patients not eligible for clinical trials have many treatment options. Choosing the next best therapy starts with careful assessment of the biology and dynamics of the disease at relapse, as well as the condition and situation of the patient. Fit patients should be considered for triplet regimens, whereas intermediate and frail patients warrant dose-reduced triplets or doublets. An indolent serologic relapse may be treated with dose intensification, especially in a maintenance situation, whereas a rapid relapse requires a more aggressive approach with drug class change or a second-generation immunomodulatory drug (IMID) or proteasome inhibitor (PI). Monoclonal antibodies, in combination with PIs and IMIDs, have proven highly efficacious in early and late relapse. Key elements of supportive care include infection prevention, bone health, thromboprophylaxis, and management of active symptoms, such as pain and distress.

Authors+Show Affiliations

Columbia University Vagelos College of Physicians and Surgeons, New York, NY.Columbia University Vagelos College of Physicians and Surgeons, New York, NY.Columbia University Vagelos College of Physicians and Surgeons, New York, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31808850

Citation

Leng, Siyang, et al. "How I Treat a Refractory Myeloma Patient Who Is Not Eligible for a Clinical Trial." Hematology. American Society of Hematology. Education Program, vol. 2019, no. 1, 2019, pp. 125-136.
Leng S, Bhutani D, Lentzsch S. How I treat a refractory myeloma patient who is not eligible for a clinical trial. Hematology Am Soc Hematol Educ Program. 2019;2019(1):125-136.
Leng, S., Bhutani, D., & Lentzsch, S. (2019). How I treat a refractory myeloma patient who is not eligible for a clinical trial. Hematology. American Society of Hematology. Education Program, 2019(1), pp. 125-136. doi:10.1182/hematology.2019000016.
Leng S, Bhutani D, Lentzsch S. How I Treat a Refractory Myeloma Patient Who Is Not Eligible for a Clinical Trial. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):125-136. PubMed PMID: 31808850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How I treat a refractory myeloma patient who is not eligible for a clinical trial. AU - Leng,Siyang, AU - Bhutani,Divaya, AU - Lentzsch,Suzanne, PY - 2020/12/06/pmc-release PY - 2019/12/7/entrez PY - 2019/12/7/pubmed PY - 2019/12/7/medline SP - 125 EP - 136 JF - Hematology. American Society of Hematology. Education Program JO - Hematology Am Soc Hematol Educ Program VL - 2019 IS - 1 N2 - Myeloma patients not eligible for clinical trials have many treatment options. Choosing the next best therapy starts with careful assessment of the biology and dynamics of the disease at relapse, as well as the condition and situation of the patient. Fit patients should be considered for triplet regimens, whereas intermediate and frail patients warrant dose-reduced triplets or doublets. An indolent serologic relapse may be treated with dose intensification, especially in a maintenance situation, whereas a rapid relapse requires a more aggressive approach with drug class change or a second-generation immunomodulatory drug (IMID) or proteasome inhibitor (PI). Monoclonal antibodies, in combination with PIs and IMIDs, have proven highly efficacious in early and late relapse. Key elements of supportive care include infection prevention, bone health, thromboprophylaxis, and management of active symptoms, such as pain and distress. SN - 1520-4383 UR - https://www.unboundmedicine.com/medline/citation/31808850/How_I_treat_a_refractory_myeloma_patient_who_is_not_eligible_for_a_clinical_trial L2 - https://ashpublications.org/hematology/article-lookup/doi/10.1182/hematology.2019000016 DB - PRIME DP - Unbound Medicine ER -