This Policy Review presents the International Myeloma Working Group's clinical practice recommendations for the treatment of relapsed and refractory multiple myeloma. Based on the results of phase 2 and phase 3 trials, these recommendations are proposed for the treatment of patients with relapsed and refractory disease who have received one previous line of therapy, and for patients with relapsed and refractory multiple myeloma who have received two or more previous lines of therapy. These recommendations integrate the issue of drug access in both low-income and middle-income countries and in high-income countries to help guide real-world practice and thus improve patient outcomes.

• MeSH
• antitumorózní látky terapeutické užití   MeSH
• chemorezistence účinky léků   MeSH
• lidé MeSH
• lokální recidiva nádoru farmakoterapie   patologie   MeSH
• mnohočetný myelom farmakoterapie   patologie   MeSH
• směrnice pro lékařskou praxi jako téma normy   MeSH
• záchranná terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

In this review, two types of soft-tissue involvement in multiple myeloma are defined: (i) extramedullary (EMD) with haematogenous spread involving only soft tissues and (ii) paraskeletal (PS) with tumour masses arising from skeletal lesions. The incidence of EMD and PS plasmacytomas at diagnosis ranges from 1·7% to 4·5% and 7% to 34·4% respectively. EMD disease is often associated with high-risk cytogenetics, resistance to therapy and worse prognosis than in PS involvement. In patients with PS involvement a proteasome inhibitor-based regimen may be the best option followed by autologous stem cell transplantation (ASCT) in transplant eligible patients. In patients with EMD disease who are not eligible for ASCT, a proteasome inhibitor-based regimen such as lenalidomide-bortezomib-dexamethasone (RVD) may be the best option, while for those eligible for high-dose therapy a myeloma/lymphoma-like regimen such as bortezomib, thalidomide and dexamethasone (VTD)-RVD/cisplatin, doxorubicin, cyclophosphamide and etoposide (PACE) followed by SCT should be considered. In both EMD and PS disease at relapse many strategies have been tried, but this remains a high-unmet need population.

• MeSH
• autologní transplantace MeSH
• bortezomib terapeutické užití   MeSH
• cisplatina terapeutické užití   MeSH
• cyklofosfamid terapeutické užití   MeSH
• dexamethason terapeutické užití   MeSH
• doxorubicin terapeutické užití   MeSH
• etoposid terapeutické užití   MeSH
• lenalidomid terapeutické užití   MeSH
• lidé MeSH
• management nemoci MeSH
• mnohočetný myelom komplikace   diagnóza   patologie   terapie   MeSH
• plazmocytom komplikace   diagnóza   patologie   terapie   MeSH
• prognóza MeSH
• protokoly antitumorózní kombinované chemoterapie terapeutické užití   MeSH
• transplantace hematopoetických kmenových buněk MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH