Initial treatment strategy for patients newly diagnosed with multiple myeloma

In Japan, the latest trends in induction therapy for patients newly diagnosed with multiple myeloma are multi-drug combinations, including bortezomib, lenalidomide, and thalidomide. Patients <65 years old and those <70 years old who have normal cardiac and lung functions without any serious complications are good candidates for high-dose L-PAM with autologous stem cell transplantation. For successful stem cell collection, anti-cancer drugs that have a negative impact on stem cell mobilization are usually excluded from induction therapies. It has been reported that bortezomib and thalidomide do not affect mobilization of stem cells; however, extended exposure to lenalidomide may have a potential risk of poor mobilization. Under these circumstances, PAD, VTD, VCD, and RVD are recommended as first induction therapies for transplant-eligible patients. On the other hand, two- or three-drug combinations are effective as induction therapies for transplant-ineligible patients >65-70 years old and <65 years old with serious complications or insufficiencies of cardiac or lung functions as well as for any patients who refuse transplantation strategy. For these patients, VMP, MPT, and Rd are usually recommended. For elderly patients >75 years old, it is important that the dosage of each drug be properly reduced according to the frailty of the patient.