The combnatoof these agents wth dexamethasone partcularhas showmpressve actvty relapsed or refractory MM and adds Dabrafenib structure to your wde array of therapeutc optons avaable.45 Other optons nclude conventonal chemotherapy, melphalaplus prednsone, dexamethasone alone superior rsk patents and, patents wth early stem cellharvest, autologous SCT could possibly be consdered as salvage therapy.27 Accordng to NCCgudelnes, patents who relapse right after additional thasx months might beneft from reductowth the prmary nductotherapy.27 Conventonal dose salvage therapy combnatowth novel agents cabe consdered patents wth progressve dsease followng allogenec or autologous SCT, patents wth prmary progressve dsease followng ntal allogenec or autologous SCT, and patents who’re not canddates for transplantatowth progressve or relapsng dsease.
Possble salvage therapes wth group one evdence or 2A are summarzed Fgure one, collectively wth suggested optons for nductoand mantenance therapes.27 As aexample, lenaldomde combned wth dexamethasonehas receved US Meals and Drug Admnstratoapproval, primarily based otwo studes of 692 patents, for use MM patents wth PS-341 Velcade at least a single pror remedy and so s assgned a category one recommedaton.46 The NCCrecommends antcoagulatotherapy patents taken care of wth lenaldomde plus dexamethasone wth lenaldomde monotherapy as a group 2A recommendaton.27 Thaldomde Like a salvage treatment for patents wth relapsed or refractory MM, thaldomdehas beenvestgated as monotherapy, combnatowth dexamethasone, wth bortezomb and dexamethasone, and combnatowth dexamethasone, csplatn, doxorubcn, cyclophosphamde, and etoposde.
47 49 As being a sngle agent therapy, thaldomdehas demonstrated aoverall response fee approachng
30%, wth a relatvely reduced CR fee of 1.6%, and ancdence of venous thromboembolsm of 3%, and also a price of dscontnuatodue to ntolerance of 15%.50 The combnatoof thaldomde and dexamethasone presents sgnfcantly greater actvty tharespectve sngle agent therapes, wth a charge of PR or considerably better the buy of 55% 59%, and a medasurvval of 13 26 months relapsed or refractory dsease.51 53 Lower dose thaldomdehas beenvestgated combnatowth cyclophosphamde and dexamethasone,eldng aORR one review of 79%, ncludng a CR rate of 17%.54 Twoear OS and EFS were 73% and 34%, respectvely.Bortezomb Bortezomb was frst studed the settng of relapsed or refractory MM, and showed aoverall response rate of 28% ncludng 10% CR nCR heavy pretreated patents,25 leadng to ts accelerated approval through the FDA 2003.a latest systematc analyss, sngle agent bortezomb was compared wth sngle agent thaldomde patents wth relapsed or refractory MM.