Optimising patient outcomes in myeloma

Multiple myeloma (MM) is an incurable disease, and the goal of therapy is to prolong survival. Newer therapies (thalidomide, lenalidomide, and bortezomib) have contributed to the recent improvements in survival. Optimal integration of these newer therapies into standard practice may be aided by better methods of risk stratification. Supplementation of existing risk stratification methods with new prognostic information, such as cytogenetic data and gene expression profiles, may improve prognostication and help to identify appropriate treatment. The advent of newer therapies has also prompted a reassessment of traditional endpoints and goals of therapy, such as complete response. While complete response correlates with survival in some cases, the correlation is not consistent across all treatment regimens and patient groups, and is therefore not always the most appropriate goal of therapy. With the aim of prolonging survival, trials are currently evaluating newer therapies as long-term maintenance therapy or as prevention therapy for patients with smouldering myeloma. Given that these patients are often asymptomatic and free of clinically active disease, success in this setting depends highly on long-term tolerability of these agents. The available evidence suggests that their adverse event profiles are distinct, predictable, and manageable with careful monitoring and intervention as appropriate. Treatment of MM should therefore be tailored to the individual patient based on the goals of therapy, patient condition, expected adverse events, and patient preference.