Sandbox: treatment: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months. Whereas patients with active (symptomatic) multiple myeloma are treated with a combination of | Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and undergoing follow up tests every 3 to 6 months. Whereas patients with active (symptomatic) multiple myeloma are treated with a combination of steroid therapy, immune modulator therapy and chemotherapy. The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation. Patients who are candidates for bone marrow transplantation are treated by a combination of dexamethasone and lenalidomide/bortezomib in advance to their transplantation. [[Alkylating antineoplastic agents|Alkylating agents]] are not recommended among transplant eligible patients, as the toxicity of such agents makes the harvest of bone marrow stem cell difficult later in the course. Other pharmacological regimes used to treat active multiple myeloma patients eligible for bone marrow transplant may include either [[thalidomide]], carfilzomib, cyclophosphamide, vincristine, or doxorubicin. In addition to the aforementioned agents, pharmacological regimes used for treatment of active multiple myeloma patients who are '''not''' eligible for bone marrow transplantation may include either melphalan or prednisone. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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===Smoldering multiple myeloma=== | ===Smoldering multiple myeloma=== | ||
*Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months. | *Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months. | ||
*Follow up studies | *Follow up studies of asymptomatic multiple myeloma patients include: | ||
* | **Laboratory studies such as complete blood count, blood chemistry, 24 hour urine collection, electrophoresis, and quantitative immunoglobulin analysis | ||
**Imaging studies such as skeletal survey, MRI, and PET scan | |||
Treatment | **Flow cytometry as needed | ||
**Bone marrow aspiration and biopsy as needed | |||
*Treatment should be differed until such patients develop symptoms. | |||
Revision as of 20:14, 22 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and undergoing follow up tests every 3 to 6 months. Whereas patients with active (symptomatic) multiple myeloma are treated with a combination of steroid therapy, immune modulator therapy and chemotherapy. The optimal therapy for active multiple myeloma depends on whether or not a patient is eligible for bone marrow transplantation. Patients who are candidates for bone marrow transplantation are treated by a combination of dexamethasone and lenalidomide/bortezomib in advance to their transplantation. Alkylating agents are not recommended among transplant eligible patients, as the toxicity of such agents makes the harvest of bone marrow stem cell difficult later in the course. Other pharmacological regimes used to treat active multiple myeloma patients eligible for bone marrow transplant may include either thalidomide, carfilzomib, cyclophosphamide, vincristine, or doxorubicin. In addition to the aforementioned agents, pharmacological regimes used for treatment of active multiple myeloma patients who are not eligible for bone marrow transplantation may include either melphalan or prednisone.
Medical Therapy
Smoldering multiple myeloma
- Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and follow up tests every 3 to 6 months.
- Follow up studies of asymptomatic multiple myeloma patients include:
- Laboratory studies such as complete blood count, blood chemistry, 24 hour urine collection, electrophoresis, and quantitative immunoglobulin analysis
- Imaging studies such as skeletal survey, MRI, and PET scan
- Flow cytometry as needed
- Bone marrow aspiration and biopsy as needed
- Treatment should be differed until such patients develop symptoms.