The combnatoof these agents wth dexamethasone partcularhas showmpressve actvty relapsed or refractory MM and adds inhibitor DOT1L inhibitors to the wde selection of therapeutc optons avaable.45 Other optons nclude conventonal chemotherapy, melphalaplus prednsone, dexamethasone alone really good rsk patents and, patents wth early stem cellharvest, autologous SCT could possibly be consdered as salvage therapy.27 Accordng to NCCgudelnes, patents who relapse following a lot more thasx months might beneft from reductowth the prmary nductotherapy.27 Conventonal dose salvage treatment combnatowth novel agents cabe consdered patents wth progressve dsease followng allogenec or autologous SCT, patents wth prmary progressve dsease followng ntal allogenec or autologous SCT, and patents that are not canddates for transplantatowth progressve or relapsng dsease.
Possble salvage therapes wth group one evdence or 2A are summarzed Fgure 1, together wth encouraged optons for nductoand mantenance therapes.27 As aexample, lenaldomde combned wth dexamethasonehas receved US Food and Drug Admnstratoapproval, based otwo studes of 692 patents, for use MM patents wth recommended site at the least a single pror treatment and so s assgned a class 1 recommedaton.46 The NCCrecommends antcoagulatotherapy patents taken care of wth lenaldomde plus dexamethasone wth lenaldomde monotherapy as being a group 2A recommendaton.27 Thaldomde Being a salvage therapy for patents wth relapsed or refractory MM, thaldomdehas beenvestgated as monotherapy, combnatowth dexamethasone, wth bortezomb and dexamethasone, and combnatowth dexamethasone, csplatn, doxorubcn, cyclophosphamde, and etoposde.
47 49 As a sngle agent therapy, thaldomdehas demonstrated aoverall response rate approachng
30%, wth a relatvely lower CR rate of 1.6%, and ancdence of venous thromboembolsm of 3%, along with a charge of dscontnuatodue to ntolerance of 15%.50 The combnatoof thaldomde and dexamethasone delivers sgnfcantly better actvty tharespectve sngle agent therapes, wth a price of PR or considerably better the buy of 55% 59%, plus a medasurvval of 13 26 months relapsed or refractory dsease.51 53 Very low dose thaldomdehas beenvestgated combnatowth cyclophosphamde and dexamethasone,eldng aORR one research of 79%, ncludng a CR fee of 17%.54 Twoear OS and EFS had been 73% and 34%, respectvely.Bortezomb Bortezomb was frst studed the settng of relapsed or refractory MM, and showed aoverall response fee of 28% ncludng 10% CR nCR heavy pretreated patents,25 leadng to ts accelerated approval by the FDA 2003.a latest systematc analyss, sngle agent bortezomb was in contrast wth sngle agent thaldomde patents wth relapsed or refractory MM.