TY - JOUR
T1 - Addressing the questions of tomorrow
T2 - Melphalan and new combinations as conditioning regimens before autologous hematopoietic progenitor cell transplantation in multiple myeloma
AU - Martino, Massimo
AU - Olivieri, Attilio
AU - Offidani, Massimo
AU - Vigna, Ernesto
AU - Moscato, Tiziana
AU - Fedele, Roberta
AU - Montanari, Mauro
AU - Console, Giuseppe
AU - Gentile, Massimo
AU - Messina, Giuseppe
AU - Irrera, Giuseppe
AU - Morabito, Fortunato
PY - 2013/5
Y1 - 2013/5
N2 - Introduction: The role of high-dose chemotherapy (HDC) followed by autologous-progenitor cell transplantation (auto-HPCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. Administration of high-dose melphalan (HDM) is considered the standard conditioning regimen. Nevertheless, several attempts have recently been made to improve the conditioning phase of the HDC procedure. Areas covered: We reviewed all the reported experiences and illustrated current knowledge in the field of conditioning regimens. Expert opinion: For fit MM patients, HDC followed by auto-HPCT remains the standard of care. The available data confirm that melphalan (MEL) 200 mg/mshould continue to be considered the gold standard conditioning regimen, with dose reduction based on age and renal function. Targeting exposure to MEL by using area under the curve is a particularly appealing approach that could be explored to maximize efficacy and minimize toxicity of this drug. Other strategies are currently being evaluated in different trials, and the most interesting areas of research involve the incorporation of newer agents like bortezomib (BOR) into conditioning regimens. Moreover, intravenous busulfan has become available and this formulation may reduce toxicity and result in greater efficacy in association with MEL-based conditioning.
AB - Introduction: The role of high-dose chemotherapy (HDC) followed by autologous-progenitor cell transplantation (auto-HPCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. Administration of high-dose melphalan (HDM) is considered the standard conditioning regimen. Nevertheless, several attempts have recently been made to improve the conditioning phase of the HDC procedure. Areas covered: We reviewed all the reported experiences and illustrated current knowledge in the field of conditioning regimens. Expert opinion: For fit MM patients, HDC followed by auto-HPCT remains the standard of care. The available data confirm that melphalan (MEL) 200 mg/mshould continue to be considered the gold standard conditioning regimen, with dose reduction based on age and renal function. Targeting exposure to MEL by using area under the curve is a particularly appealing approach that could be explored to maximize efficacy and minimize toxicity of this drug. Other strategies are currently being evaluated in different trials, and the most interesting areas of research involve the incorporation of newer agents like bortezomib (BOR) into conditioning regimens. Moreover, intravenous busulfan has become available and this formulation may reduce toxicity and result in greater efficacy in association with MEL-based conditioning.
KW - Autologous hematopoietic progenitor cell transplantation
KW - Conditioning regiments
KW - High-dose chemotherapy
KW - Multiple myeloma
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U2 - 10.1517/13543784.2013.788643
DO - 10.1517/13543784.2013.788643
M3 - Article
C2 - 23550793
AN - SCOPUS:84876230870
VL - 22
SP - 619
EP - 634
JO - Expert Opinion on Investigational Drugs
JF - Expert Opinion on Investigational Drugs
SN - 1354-3784
IS - 5
ER -