Dr. Martin on Choosing Treatments for Multiple Myeloma

Thomas G. Martin, MD, clinical professor of medicine, Adult Leukemia and Bone Marrow Transplantation Program, and associate director, Myeloma Program, University of California, San Francisco; co-leader, Hematopoietic Malignancies Program, Helen Diller Family Comprehensive Cancer Center, discusses choosing treatments for patients with multiple myeloma.

There have been many advancements in the treatment of patients with multiple myeloma, however, patients still relapse, explains Martin. There are patient- and disease-related factors to relapse. According to Martin, when choosing a treatment, considerations include age, performance status, and other toxicities, such as kidney, liver or cardiac toxicities. Lenalidomide (Revlimid) is excreted in the kidneys so there is more toxicity in patients that have renal insufficiency, particularly if the dose is not reduced.

In early 2017, the FDA approved lenalidomide as a maintenance therapy for patients with multiple myeloma following autologous hematopoietic stem cell transplant.

The disease-related factors depend on whether it is the first relapse, second relapse, or refractory relapse. Patients can also have a biochemical relapse. Those patients generally need a more aggressive initial therapy, says Martin.