الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Responses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months.
Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.
The development of novel therapies targeting disease biology and tumor microenvironment has significantly improved the outlook for patients with relapsed and refractory disease, with bortezomib (Velcade), a first-in-class proteasome inhibitor, and the immunomodulatory agents thalidomide (Thalomid) and lenalidomide (Revlimid) constituting “backbone” agents in this setting.
More recent approaches for treating relapsed and refractory myeloma that are recommended by the National Comprehensive Cancer Network, (NCCN), include single-agent bortezomib, single-agent lenalidomide, bortezomib / dexamethasone, bortezomib plus pegylated liposomal doxorubicin, lenalidomide / dexamethasone, and lenalidomide / bortezomib / dexamethasone.
Individualized treatment of progressive myeloma should take into account the time to progression and/or the type of prior therapy.
The potential to improve responses and survival in patients with relapsed and refractory MM has increased with the introduction of novel therapies.
Ongoing research into drug resistance, side-effect management, and optimal sequencing of available therapies should inform decisions about future treatment choices for individual patients with relapsed and refractory MM.
In this context, a number of new approaches—such as inhibiting heat shock protein 90, histone deacetylase, AkT, and mammalian target of rapamycin, as well as using monoclonal antibodies—show great promise.
Our Study shows that the DVd-R regimen is safe, well tolerated, and effective in patients with refractory & relapsed Multiple Myeloma. The addition of Lenalidomide to the DVd regimen improves the response rate and quality of responses.