Tratamento do mieloma múltiplo recidivado

Abstract

Multiple myeloma still remains an incurable disease. Despite the new treatment approaches, almost all patients face the risk of an eventual relapse. The pattern of relapse is very heterogeneous and can be indolent or more aggressive. The treatment of relapsed disease depends on a number of factors: duration of response, relapse on or off maintenance therapy, prior therapy and specially prior autologous stem cell transplantation, performance status, hematopoietic reserve. If relapse occurs more than 6 months after therapy ended, the initial chemotherapy regimen should be reinstituted. Autologous stem cell transplantation can be proposed as consolidation therapy in chemosensitive relapses or as salvage therapy if stem cells have been collected earlier. Thalidomide has been tested in relapsed multiple myeloma and is now considered as standard treatment for patients relapsing after conventional chemotherapy or after autologous stem cell transplantation. Thalidomide alone can induce objective responses in at least one-third of heavily pretreated patients and, combined with chemotherapy, objective responses can be achieved by two-thirds of the patients. Bortezomib is indicated, alone or in combination with other agents, for relapsed patients and can produce an overall response rate of 43% to 76%. The most appropriate management must be individualized depending on the age, bone marrow function, prior therapy and the timing of the relapse.