Kyle RA

Language: Spanish
References: 61
Page: 30-39
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ABSTRACT

Multiple myeloma is a plasma cell neoplasm that accounts for slightly more than 10% of hematologic malignancies. The diagnosis requires the presence of monoclonal bone marrow plasma cells, serum and/or urinary M protein and evidence of end organ damage (CRAB - hypercalcemia, renal disease, anemia or lytic bone lesions). Multiple myeloma may be divided into high-risk or standard-risk disease based upon fluorescence in situ hybridization (FISH), metaphase cytogenetics and the plasma cell labeling index. The physician must determine initially if the patient is eligible for an autologous stem cell transplant. If the patient is eligible, alkylating agents should be avoided because they may damage the hematopoietic stem cells. We prefer lenalidomide plus dexamethasone weekly but bortezomib or thalidomide both with dexamethasone are reasonable regimens. Autologous stem cell transplant may be performed immediately after induction therapy or delayed until relapse. Patients deemed ineligible for an autologous stem cell transplant may be given melphalan, prednisone and thalidomide (MPT). Lenalidomide and bortezomib are other options. The novel agents (thalidomide, bortezomib and lenalidomide have improved the survival of patients with multiple myeloma). Management of the complications which include skeletal disease, renal insufficiency, anemia, hypercalcemia, recurrent infections, spinal cord compression and thromboembolic phenomena must be managed appropriately.

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