Recent advances in myeloma treatment.

The novel agents including thalidomide, bortezomib and lenalidomide have been incorporated into combination regimens which are moving from the advanced/refractory setting to first-line treatment. For the majority of elderly patients, the following regimens are considered standard: melphalan+prednisone in combination with bortezomib or thalidomide and the combination of lenalidomide+low-dose dex. For transplant-eligible patients novel agents are included in the induction phase before and in the consolidation/maintenance phase after transplant. In the relapsed/refractory setting, combinations of novel agents generate the best results but cumulative toxicity is limiting. Several newer agents such as carfilzomib, pomalidomide and deacetylase inhibitors are entering phase II and III clinical trials. The place of allogeneic stem cell transplantation in the treatment of myeloma remains controversial.