PURPOSE: To provide an update on recent advances in the management of patients with multiple myeloma who are not eligible for autologous stem-cell transplantation. METHODS: A comprehensive review of the literature on diagnostic criteria is provided, and treatment options and management of adverse events are summarized. RESULTS: Patients with symptomatic disease and organ damage (ie, hypercalcemia, renal failure, anemia, or bone lesions) require immediate treatment. The International Staging System and chromosomal abnormalities identify high- and standard-risk patients. Proteasome inhibitors, immunomodulatory drugs, corticosteroids, and alkylating agents are the most active agents. The presence of concomitant diseases, frailty, or disability should be assessed and, if present, treated with reduced-dose approaches. Bone disease, renal damage, hematologic toxicities, infections, thromboembolism, and peripheral neuropathy are the most frequent disabling events requiring prompt and active supportive care. CONCLUSION: These recommendations will help clinicians ensure the most appropriate care for patients with myeloma in everyday clinical practice.

Antonio Palumbo and Alessandra Larocca University of Torino Torino; Michele Cavo Seràgnoli Institute of Hematology Bologna University School of Medicine Bologna Italy; S Vincent Rajkumar Mayo Clinic Rochester MN; Jesus F San Miguel University Hospital of Salamanca Salamanca Spain; Ruben Niesvizky Weill Cornell Medical College New York NY; Gareth Morgan Royal Marsden Hospital London United Kingdom; Ola Landgren National Cancer Institute Bethesda MD; Roman Hajek University of Ostrava School of Medicine and University Hospital Ostrava Ostrava Czech Republic; Hermann Einsele University of Wurzburg Wurzburg Germany; Kenneth C Anderson and Paul G Richardson Dana Farber Cancer Institute Boston MA; Meletios A Dimopoulos University of Athens School of Medicine Athens Greece; Andrew Spencer Alfred Hospital Melbourne Victoria Australia; A Keith Stewart Mayo Clinic Scottsdale AZ; Kazuyuki Shimizu Aichi Gakuin Hospital Nagoya Japan; Sagar Lonial Emory University Atlanta GA; Pieter Sonneveld Erasmus Medical Centre Rotterdam the Netherlands; Brian G M Durie Cedars Sinai Comprehensive Cancer Center Los Angeles CA; Philippe Moreau University Hospital Nantes France; and Robert Z Orlowski MD Anderson Cancer Center Houston TX

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