Past and current treatment algorithms for patients with multiple myeloma.

The recent standard treatment algorithm for patients who are not candidates for stem cell transplantation included MP as the standard of care, though other regimens could be used as well, including dexamethasone alone, thalidomide and dexamethasone, and infusional vincristine, doxorubicin, and dexamethasone, or its equivalent with pegylated liposomal doxorubicin. Results from two randomized phase III studies now indicate that MPT provides a survival advantage over MP, suggesting that this should be the current standard of care for patients who can tolerate this therapy.

Abbreviations: MP, melphalan and prednisone; MPT, melphalan and prednisone with thalidomide; R-MP, melphalan and prednisone with lenalidomide; ThaDD, thalidomide with pegylated liposomal doxorubicin and dexamethasone; thal/dex, thalidomide with dexamethasone; VAD/DVD dexamethasone, vincristine, adriamycin; DVd-T, pegylated liposomal doxorubicin/vincristine/reduced-dose dexamethasone, thalidomide