Initial treatment of nontransplant patients with multiple myeloma

During the last two decades, many steps forward have been made in the treatment of multiple myeloma (MM) thanks to the introduction of the novel agents thalidomide, lenalidomide, and bortezomib. Despite this, MM remains an incurable disease. Elderly patients (≥65 years) represent the majority of subjects. Differently from younger (<65 years) and fit patients, elderly patients are usually not eligible for transplantation. Gentler approaches with novel agents plus conventional chemotherapy with melphalan-prednisone are commonly adopted in this setting. Data show that a sequential approach including induction followed by consolidation/maintenance therapy is an optimal strategy to improve patient outcome. In addition, second-generation novel agents are currently under investigation and may represent valuable alternative treatment options in the future.