Treatment approaches for relapsing and refractory multiple myeloma

Relapsing patients with multiple myeloma show a response rate higher than 50% with the resumption of the initial chemotherapy. However, since the duration of second responses are short, HDT/autotransplantation is recommended in patients with sensitive relapse. In patients with primary refractory myeloma the best treatment approach seems to be early HDT/autotransplantation. It is crucial to recognize a subset of patients who do not respond to the initial chemotherapy but who have non-progressive disease in order to avoid the administration of salvage regimens until clinical disease progression occurs. The treatment of patients with refractory relapse is disappointing. The most promising agent in this situation is thalidomide. Patients with late relapse after autologous transplantation can benefit from a second autologous transplant. The results of the allogeneic transplantation after autotransplantation are disappointing. In heavily pretreated resistant patients a conservative approach with alternate day prednisone (30 to 50 mg) along with pulse cyclophosphamide (800 to 1,200 mg every 2 to 3 weeks) is recommended.