Therapy concepts in younger patients with multiple myeloma

The treatment results in patients with multiple myeloma could be gradually improved over the last 20 years. This article presents the current developments in treatment concepts for younger patients with multiple myeloma. This article gives a selection, presentation, assessment and discussion of practice relevant large clinical trials on the primary treatment of multiple myeloma. The results of the various transplantation procedures were compared. High-dose therapy with autologous transplantation is widely used both nationally and internationally. A tandem transplantation can improve and consolidate the effect of an initial high-dose therapy resulting in a favorable progression-free survival and overall. Novel agents, such as bortezomib and lenalidomide administered during induction (before high-dose therapy) and also as consolidation or maintenance treatment (after high-dose therapy) can increase the remission rate, progression-free survival and partly also overall survival of patients. Allogeneic transplantation is an option for patients with a good performance status and cytogenetic or clinical high-risk features and should preferably be performed within the framework of clinical studies. Cytogenetic aberrations, such as translocation t(4;14) or 17p deletion are associated with a worse prognosis which can partly be overcome by novel treatment approaches. High-dose therapy with autologous blood stem cell transplantation remains the standard treatment for younger patients with multiple myeloma. The overall treatment results can be improved by the additional and combined use of novel agents. The consequences for overall survival, however, cannot be clearly determined so far. The increasing availability of further novel pharmaceuticals suggests further improvements and possibly a chance for a cure in the future.