Recent trends in the management of newly diagnosed multiple myeloma.

PURPOSE OF REVIEW: Many recent trials have been undertaken that incorporate novel agents into the treatment of newly diagnosed multiple myeloma patients. This review highlights the current status of different approaches to initial therapy in the era of novel drugs. RECENT FINDINGS: The therapy of newly diagnosed patients with multiple myeloma is still usually based on age and eligibility for autologous stem cell transplantation (ASCT). In older patients, several randomized trials have evaluated the addition of a novel agent to oral melphalan and prednisone, while novel agents have been incorporated before, during and after ASCT in younger individuals. Newer investigational approaches that are not age-dependent include continuous myeloma suppression with dexamethasone plus an immunomodulatory derivative, or the use of multiple cycles of combination regimens followed by a treatment break or maintenance therapy. Updated information is now also available regarding the use of nonmyeloablative allogeneic transplantation. The biologic heterogeneity of myeloma is most easily measured in the clinic by fluorescence in-situ hybridization (FISH) cytogenetics, and the detection of adverse cytogenetics is beginning to influence treatment decisions. SUMMARY: Clinical trials have established the superiority of regimens containing novel agents in the initial management of myeloma, although a number of questions remain about the optimal strategy.