Advertisement
Review Article| Volume 21, ISSUE 6, P1247-1273, December 2007

Complications of Myeloma Therapy

      The advent of new therapies for multiple myeloma brings new hope for patients but also new side effects. Emerging information about the risks of supportive care therapies, including long-term, high-intensity bisphosphonate use and erythropoiesis-stimulating agents, is examined. As the number of drugs in the myeloma armamentarium grows, so does the list of possible side effects and interactions. With current progress, not only are there more complications to consider but patients are also living longer and the risk for delayed complications is becoming more relevant. The author provides perspective about the risks for the most active and commonly used single-agent and combination myeloma therapies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Hematology/Oncology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berenson J.R.
        • Lichtenstein A.
        • Porter L.
        • et al.
        Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Myeloma Aredia Study Group.
        N Engl J Med. 1996; 334: 488-493
        • Berenson J.R.
        • Lichtenstein A.
        • Porter L.
        • et al.
        Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. Myeloma Aredia Study Group.
        J Clin Oncol. 1998; 16: 593-602
        • Berenson J.R.
        • Rosen L.S.
        • Howell A.
        • et al.
        Zoledronic acid reduces skeletal-related events in patients with osteolytic metastases.
        Cancer. 2001; 91: 1191-1200
        • Rosen L.S.
        • Gordon D.
        • Antonio B.S.
        • et al.
        Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial.
        Cancer J. 2001; 7: 377-387
        • Berenson J.R.
        • Hillner B.E.
        • Kyle R.A.
        • et al.
        American Society of Clinical Oncology clinical practice guidelines: the role of bisphosphonates in multiple myeloma.
        J Clin Oncol. 2002; 20: 3719-3736
        • Abe M.
        • Hiura K.
        • Wilde J.
        • et al.
        Osteoclasts enhance myeloma cell growth and survival via cell-cell contact: a vicious cycle between bone destruction and myeloma expansion.
        Blood. 2004; 104: 2484-2491
        • Yaccoby S.
        • Wezeman M.J.
        • Zangari M.
        • et al.
        Inhibitory effects of osteoblasts and increased bone formation on myeloma in novel culture systems and a myelomatous mouse model.
        Haematologica. 2006; 91: 192-199
        • Stewart J.P.
        • Shaughnessy Jr., J.D.
        Role of osteoblast suppression in multiple myeloma.
        J Cell Biochem. 2006; 98: 1-13
        • Terpos E.
        • Politou M.
        • Szydlo R.
        • et al.
        Serum levels of macrophage inflammatory protein-1 alpha (MIP-1alpha) correlate with the extent of bone disease and survival in patients with multiple myeloma.
        Br J Haematol. 2003; 123: 106-109
        • Silvestris F.
        • Lombardi L.
        • De Matteo M.
        • et al.
        Myeloma bone disease: pathogenetic mechanisms and clinical assessment.
        Leuk Res. 2007; 31: 129-138
        • Marx R.E.
        Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic.
        J Oral Maxillofac Surg. 2003; 61: 1115-1117
        • Carter G.D.
        • Goss A.N.
        Bisphosphonates and avascular necrosis of the jaws.
        Aust Dent J. 2003; 48: 268
        • Lugassy G.
        • Shaham R.
        • Nemets A.
        • et al.
        Severe osteomyelitis of the jaw in long-term survivors of multiple myeloma: a new clinical entity.
        Am J Med. 2004; 117: 440-441
        • Migliorati C.A.
        Bisphosphanates and oral cavity avascular bone necrosis.
        J Clin Oncol. 2003; 21: 4253-4254
        • Tarassoff P.
        • Csermak K.
        Avascular necrosis of the jaws: risk factors in metastatic cancer patients.
        J Oral Maxillofac Surg. 2003; 61: 1238-1239
        • Ruggiero S.L.
        • Mehrotra B.
        • Rosenberg T.J.
        • et al.
        Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases.
        J Oral Maxillofac Surg. 2004; 62: 527-534
        • Bagan J.V.
        • Murillo J.
        • Jimenez Y.
        • et al.
        Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases.
        J Oral Pathol Med. 2005; 34: 120-123
        • Bamias A.
        • Kastritis E.
        • Bamia C.
        • et al.
        Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors.
        J Clin Oncol. 2005; 23: 8580-8587
        • Durie B.G.
        • Katz M.
        • Crowley J.
        Osteonecrosis of the jaw and bisphosphonates.
        N Engl J Med. 2005; 353 ([discussion: 199–102]): 99-102
        • Marx R.E.
        • Sawatari Y.
        • Fortin M.
        • et al.
        Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment.
        J Oral Maxillofac Surg. 2005; 63: 1567-1575
        • Badros A.
        • Weikel D.
        • Salama A.
        • et al.
        Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors.
        J Clin Oncol. 2006; 24: 945-952
        • Kanat O.
        • Ozet A.
        • Arpaci F.
        • et al.
        Bisphosphonate-associated osteonecrosis of the jaws: case reports and analysis of 184 cases.
        J Clin Oncol [Meeting abstracts]. 2006; 24: 18595
        • Migliorati C.A.
        • Casiglia J.
        • Epstein J.
        • et al.
        Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper.
        J Am Dent Assoc. 2005; 136: 1658-1668
        • Lacy M.Q.
        • Dispenzieri A.
        • Gertz M.A.
        • et al.
        Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma.
        Mayo Clin Proc. 2006; 81: 1047-1053
        • Kyle R.A.
        • Yee G.C.
        • Somerfield M.R.
        • et al.
        American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma.
        J Clin Oncol. 2007; 27: 2464-2472
        • Melton 3rd, L.J.
        • Kyle R.A.
        • Achenbach S.J.
        • et al.
        Fracture risk with multiple myeloma: a population-based study.
        J Bone Miner Res. 2005; 20: 487-493
        • Attal M.
        • Harousseau J.L.
        • Leyvraz S.
        • et al.
        Maintenance therapy with thalidomide improves survival in patients with multiple myeloma.
        Blood. 2006; 108: 3289-3294
        • Rosen L.S.
        • Gordon D.
        • Tchekmedyian S.
        • et al.
        Zoledronic acid versus placebo in the treatment of skeletal metastases in patients with lung cancer and other solid tumors: a phase III, double-blind, randomized trial—the Zoledronic Acid Lung Cancer and Other Solid Tumors Study Group.
        J Clin Oncol. 2003; 21: 3150-3157
        • Guarneri V.
        • Donati S.
        • Nicolini M.
        • et al.
        Renal safety and efficacy of i.v. bisphosphonates in patients with skeletal metastases treated for up to 10 Years.
        Oncologist. 2005; 10: 842-848
        • Nickolas T.L.
        • Chen L.
        • Markowitz G.
        • et al.
        Renal toxicity associated with zoledronic acid and pamidronate in multiple myeloma patients: a retrospective study.
        J Clin Oncol [Meeting abstracts]. 2006; 24: 17515
        • Markowitz G.S.
        • Appel G.B.
        • Fine P.L.
        • et al.
        Collapsing focal segmental glomerulosclerosis following treatment with high-dose pamidronate.
        J Am Soc Nephrol. 2001; 12: 1164-1172
        • Markowitz G.S.
        • Fine P.L.
        • Stack J.I.
        • et al.
        Toxic acute tubular necrosis following treatment with zoledronate (Zometa).
        Kidney Int. 2003; 64: 281-289
        • Dijkman H.B.
        • Weening J.J.
        • Smeets B.
        • et al.
        Proliferating cells in HIV and pamidronate-associated collapsing focal segmental glomerulosclerosis are parietal epithelial cells.
        Kidney Int. 2006; 70: 338-344
        • Sauter M.
        • Julg B.
        • Porubsky S.
        • et al.
        Nephrotic-range proteinuria following pamidronate therapy in a patient with metastatic breast cancer: mitochondrial toxicity as a pathogenetic concept?.
        Am J Kidney Dis. 2006; 47: 1075-1080
        • Kunin M.
        • Kopolovic J.
        • Avigdor A.
        • et al.
        Collapsing glomerulopathy induced by long-term treatment with standard-dose pamidronate in a myeloma patient.
        Nephrol Dial Transplant. 2004; 19: 723-726
        • Barri Y.M.
        • Munshi N.C.
        • Sukumalchantra S.
        • et al.
        Podocyte injury associated glomerulopathies induced by pamidronate.
        Kidney Int. 2004; 65: 634-641
        • Banerjee D.
        • Asif A.
        • Striker L.
        • et al.
        Short-term, high-dose pamidronate-induced acute tubular necrosis: the postulated mechanisms of bisphosphonate nephrotoxicity.
        Am J Kidney Dis. 2003; 41: E18
        • Kyle R.A.
        Multiple myeloma: review of 869 cases.
        Mayo Clin Proc. 1975; 50: 29-40
        • Riccardi A.
        • Gobbi P.G.
        • Ucci G.
        • et al.
        Changing clinical presentation of multiple myeloma.
        Eur J Cancer. 1991; 27: 1401-1405
        • Kyle R.A.
        • Gertz M.A.
        • Witzig T.E.
        • et al.
        Review of 1027 patients with newly diagnosed multiple myeloma.
        Mayo Clin Proc. 2003; 78: 21-33
        • Desai J.
        • Demetri G.D.
        Recombinant human erythropoietin in cancer-related anemia: an evidence-based review.
        Best Pract Res Clin Haematol. 2005; 18: 389-406
        • Garton J.P.
        • Gertz M.A.
        • Witzig T.E.
        • et al.
        Epoetin alfa for the treatment of the anemia of multiple myeloma. A prospective, randomized, placebo-controlled, double-blind trial.
        Arch Intern Med. 1995; 155: 2069-2074
        • Dammacco F.
        • Castoldi G.
        • Rodjer S.
        Efficacy of epoetin alfa in the treatment of anaemia of multiple myeloma.
        Br J Haematol. 2001; 113: 172-179
        • Osterborg A.
        • Boogaerts M.A.
        • Cimino R.
        • et al.
        Recombinant human erythropoietin in transfusion-dependent anemic patients with multiple myeloma and non-Hodgkin's lymphoma—a randomized multicenter study. The European Study Group of Erythropoietin (Epoetin Beta) Treatment in Multiple Myeloma and Non-Hodgkin's Lymphoma.
        Blood. 1996; 87: 2675-2682
        • Singh A.K.
        • Szczech L.
        • Tang K.L.
        • et al.
        Correction of anemia with epoetin alfa in chronic kidney disease.
        N Engl J Med. 2006; 355: 2085-2098
        • Drueke T.B.
        • Locatelli F.
        • Clyne N.
        • et al.
        Normalization of hemoglobin level in patients with chronic kidney disease and anemia.
        N Engl J Med. 2006; 355: 2071-2084
        • Rajkumar S.V.
        • Blood E.
        • Vesole D.
        • et al.
        Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group.
        J Clin Oncol. 2006; 24: 431-436
        • Rajkumar S.V.
        • Hayman S.R.
        • Lacy M.Q.
        • et al.
        Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma.
        Blood. 2005; 106: 4050-4053
        • Zangari M.
        • Barlogie B.
        • Anaissie E.
        • et al.
        Deep vein thrombosis in patients with multiple myeloma treated with thalidomide and chemotherapy: effects of prophylactic and therapeutic anticoagulation.
        Br J Haematol. 2004; 126: 715-721
        • Baz R.
        • Li L.
        • Kottke-Marchant K.
        • et al.
        The role of aspirin in the prevention of thrombotic complications of thalidomide and anthracycline-based chemotherapy for multiple myeloma.
        Mayo Clin Proc. 2005; 80: 1568-1574
        • Rajkumar S.V.
        • Blood E.
        Lenalidomide and venous thrombosis in multiple myeloma.
        N Engl J Med. 2006; 354: 2079-2080
        • Knight R.
        • DeLap R.J.
        • Zeldis J.B.
        Lenalidomide and venous thrombosis in multiple myeloma.
        N Engl J Med. 2006; 354: 2079-2080
        • Remuzzi G.
        • Ingelfinger J.R.
        Correction of anemia—payoffs and problems.
        N Engl J Med. 2006; 355: 2144-2146
        • Leyland-Jones B.
        Breast cancer trial with erythropoietin terminated unexpectedly.
        Lancet Oncol. 2003; 4: 459-460
        • Nordenson N.
        Myelomatosis: a clinical review of 310 cases.
        Acta Med Scand. 1966; 445: 178-186
        • Osserman E.F.
        • Takatsuki K.
        • Talal N.
        The pathogenesis of “amyloidosis”.
        Semin Hematol. 1964; 1: 3-85
        • Edwards G.A.
        • Zawadzki Z.A.
        Extraosseous lesions in plasma cell myeloma: a report of six cases.
        Am J Med. 1967; 43: 194-205
        • Kyle R.A.
        • Pierre R.V.
        • Bayrd E.D.
        Multiple myeloma and acute myelomonocytic leukemia.
        N Engl J Med. 1970; 283: 1121-1125
        • Facon T.
        • Mary J.Y.
        • Pegourie B.
        • et al.
        Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy.
        Blood. 2006; 107: 1292-1298
      1. Acute leukaemia and other secondary neoplasms in patients treated with conventional chemotherapy for multiple myeloma: a Finnish Leukaemia Group study.
        Eur J Haematol. 2000; 65: 123-127
        • Cuzick J.
        • Erskine S.
        • Edelman D.
        • et al.
        A comparison of the incidence of the myelodysplastic syndrome and acute myeloid leukaemia following melphalan and cyclophosphamide treatment for myelomatosis. A report to the Medical Research Council's working party on leukaemia in adults.
        Br J Cancer. 1987; 55: 523-529
        • Bergsagel D.E.
        Chemotherapy of myeloma: drug combinations versus single agents, an overview, and comments on acute leukemia in myeloma.
        Hematol Oncol. 1988; 6: 159-166
        • Oken M.M.
        • Harrington D.P.
        • Abramson N.
        • et al.
        Comparison of melphalan and prednisone with vincristine, carmustine, melphalan, cyclophosphamide, and prednisone in the treatment of multiple myeloma: results of Eastern Cooperative Oncology Group Study E2479.
        Cancer. 1997; 79: 1561-1567
        • Gonzalez F.
        • Trujillo J.M.
        • Alexanian R.
        Acute leukemia in multiple myeloma.
        Ann Intern Med. 1977; 86: 440-443
        • Bergsagel D.E.
        • Bailey A.J.
        • Langley G.R.
        • et al.
        The chemotherapy on plasma-cell myeloma and the incidence of acute leukemia.
        N Engl J Med. 1979; 301: 743-748
        • West W.O.
        Acute erythroid leukemia after cyclophosphamide therapy for multiple myeloma: report of two cases.
        South Med J. 1976; 69: 1331-1332
        • Greene M.H.
        • Harris E.L.
        • Gershenson D.M.
        • et al.
        Melphalan may be a more potent leukemogen than cyclophosphamide.
        Ann Intern Med. 1986; 105: 360-367
        • Govindarajan R.
        • Jagannath S.
        • Flick J.T.
        • et al.
        Preceding standard therapy is the likely cause of MDS after autotransplants for multiple myeloma.
        Br J Haematol. 1996; 95: 349-353
        • Tricot G.
        • Reiner M.
        • Sawyer J.
        • et al.
        Low frequency of treatment-related myelodysplastic syndromes (t-MDS) after autotransplants (AT) for multiple myeloma (MM), especially if at is applied early during treatment.
        Blood. 2005; 106: 706
        • Rajkumar S.V.
        Current status of thalidomide in the treatment of cancer.
        Oncology. 2001; : 867-874
        • Yakoub-Agha I.
        • Doyen C.
        • Hulin C.
        • et al.
        A multicenter prospective randomized study testing non-inferiority of thalidomide 100 mg/day as compared with 400 mg/day in patients with refractory/relapsed multiple myeloma: Results of the final analysis of the IFM 01-02 study.
        J Clin Oncol [Meeting abstracts]. 2006; 24: 7520
        • Singhal S.
        • Mehta J.
        • Desikan R.
        • et al.
        Antitumor activity of thalidomide in refractory multiple myeloma.
        N Engl J Med. 1999; 341: 1565-1571
        • Durie B.G.M.
        • Stephan D.E.
        Efficacy of low dose thalidomide in multiple myeloma.
        Blood. 1999; 96 ([abstract]): 168a
        • Pini M.
        • Baraldi A.
        • Pietrasanta D.
        • et al.
        Low-dose of thalidomide in the treatment of refractory myeloma.
        Haematologica. 2000; 85: 1111-1112
        • Palumbo A.
        • Giaccone L.
        • Bertola A.
        • et al.
        Low-dose thalidomide plus dexamethasone is an effective salvage therapy for advanced myeloma.
        Haematologica. 2001; 86: 399-403
        • Coleman M.
        • Leonard J.
        • Lyons L.
        • et al.
        BLT-D (clarithromycin [Biaxin], low-dose thalidomide, and dexamethasone) for the treatment of myeloma and Waldenstrom's macroglobulinemia.
        Leuk Lymphoma. 2002; 43: 1777-1782
        • Rajkumar S.V.
        • Gertz M.A.
        • Lacy M.Q.
        • et al.
        Thalidomide as initial therapy for early-stage myeloma.
        Leukemia. 2003; 17: 775-779
        • Rajkumar S.V.
        • Gertz M.A.
        • Witzig T.E.
        Life-threatening toxic epidermal necrolysis with thalidomide therapy for myeloma.
        N Engl J Med. 2000; 343: 972-973
        • Fowler R.
        • Imrie K.
        Thalidomide-associated hepatitis: a case report.
        Am J Hematol. 2001; 66: 300-302
        • Zangari M.
        • Anaissie E.
        • Barlogie B.
        • et al.
        Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy.
        Blood. 2001; 98: 1614-1615
        • Osman K.
        • Comenzo R.
        • Rajkumar S.V.
        Deep venous thrombosis and thalidomide therapy for multiple myeloma.
        N Engl J Med. 2001; 344: 1951-1952
        • Camba L.
        • Peccatori J.
        • Pescarollo A.
        • et al.
        Thalidomide and thrombosis in patients with multiple myeloma.
        Haematologica. 2001; 86: 1108-1109
        • Mileshkin L.R.
        • Stark R.
        • Day B.
        • et al.
        Development of neuropathy in patients (pts) with multiple myeloma (MM) treated with thalidomide (thal)—patterns of occurrence and the role of electrophysiologic monitoring.
        J Clin Oncol [Meeting abstracts]. 2006; 24: 7618
        • Richardson P.G.
        • Schlossman R.L.
        • Weller E.
        • et al.
        Immunomodulatory drug CC-5013 overcomes drug resistance and is well tolerated in patients with relapsed multiple myeloma.
        Blood. 2002; 100: 3063-3067
        • Richardson P.G.
        • Blood E.
        • Mitsiades C.S.
        • et al.
        A randomized phase 2 study of lenalidomide therapy for patients with relapsed or relapsed and refractory multiple myeloma.
        Blood. 2006; 108: 3458-3464
        • Palumbo A.
        • Bringhen S.
        • Caravita T.
        • et al.
        Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial.
        Lancet. 2006; 367: 825-831
        • Palumbo A.
        • Falco P.
        • Benevolo G.
        • et al.
        Oral lenalidomide plus melphalan and prednisone (R-MP) for newly diagnosed multiple myeloma.
        J Clin Oncol [Meeting abstracts]. 2006; 24: 7518
        • Jimenez V.H.
        • Dominguez V.
        • Reynoso E.
        • et al.
        Thromboprophylaxis with aspirin for newly diagnosed multiple myeloma treated with thalidomide plus dexamethasone: a preliminary report.
        Blood. 2006; 108: 5091
        • Hideshima T.
        • Mitsiades C.
        • Akiyama M.
        • et al.
        Molecular mechanisms mediating antimyeloma activity of proteasome inhibitor PS-341.
        Blood. 2003; 101: 1530-1534
        • Richardson P.G.
        • Sonneveld P.
        • Schuster M.W.
        • et al.
        Bortezomib or high-dose dexamethasone for relapsed multiple myeloma.
        N Engl J Med. 2005; 352: 2487-2498
        • Jagannath S.
        • Durie B.G.
        • Wolf J.
        • et al.
        Bortezomib therapy alone and in combination with dexamethasone for previously untreated symptomatic multiple myeloma.
        Br J Haematol. 2005; 129: 776-783
        • Richardson P.G.
        • Briemberg H.
        • Jagannath S.
        • et al.
        Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib.
        J Clin Oncol. 2006; 24: 3113-3120
        • Miyakoshi S.
        • Kami M.
        • Yuji K.
        • et al.
        Severe pulmonary complications in Japanese patients after bortezomib treatment for refractory multiple myeloma.
        Blood. 2006; 107: 3492-3494
        • Jagannath S.
        • Barlogie B.
        • Berenson J.
        • et al.
        A phase 2 study of two doses of bortezomib in relapsed or refractory myeloma.
        Br J Haematol. 2004; 127: 165-172
        • Berenson J.R.
        • Jagannath S.
        • Barlogie B.
        • et al.
        Safety of prolonged therapy with bortezomib in relapsed or refractory multiple myeloma.
        Cancer. 2005; 104: 2141-2148
        • Thorn G.W.
        • Forsham P.H.
        • Frawley R.F.
        • et al.
        The clinical usefulness of ACTH and cortisone.
        N Engl J Med. 1950; 242: 824
        • Feinman R.
        • Koury J.
        • Thames M.
        • et al.
        Role of NF-kappaB in the rescue of multiple myeloma cells from glucocorticoid-induced apoptosis by bcl-2.
        Blood. 1999; 93: 3044-3052
        • Karadag A.
        • Oyajobi B.O.
        • Apperley J.F.
        • et al.
        Human myeloma cells promote the production of interleukin 6 by primary human osteoblasts.
        Br J Haematol. 2000; 108: 383-390
        • De Bosscher K.
        • Vanden Berghe W.
        • Vermeulen L.
        • et al.
        Glucocorticoids repress NF-kappaB-driven genes by disturbing the interaction of p65 with the basal transcription machinery, irrespective of coactivator levels in the cell.
        Proc Natl Acad Sci U S A. 2000; 97: 3919-3924
        • Kawano M.
        • Tanaka H.
        • Ishikawa H.
        • et al.
        Interleukin-1 accelerates autocrine growth of myeloma cells through interleukin-6 in human myeloma.
        Blood. 1989; 73: 2145-2148
        • Alexanian R.
        • Yap B.S.
        • Bodey G.P.
        Prednisone pulse therapy for refractory myeloma.
        Blood. 1983; 62: 572-577
        • Alexanian R.
        • Barlogie B.
        • Dixon D.
        High-dose glucocorticoid treatment of resistant myeloma.
        Ann Intern Med. 1986; 105: 8-11
        • Gertz M.A.
        • Garton J.P.
        • Greipp P.R.
        • et al.
        A phase II study of high-dose methylprednisolone in refractory or relapsed multiple myeloma.
        Leukemia. 1995; 9: 2115-2118
        • Weber D.
        • Rankin K.
        • Gavino M.
        • et al.
        Thalidomide alone or with dexamethasone for previously untreated multiple myeloma.
        J Clin Oncol. 2003; 21: 16-19
        • Jagannath S.
        • Richardson P.G.
        • Barlogie B.
        • et al.
        Bortezomib in combination with dexamethasone for the treatment of patients with relapsed and/or refractory multiple myeloma with less than optimal response to bortezomib alone.
        Haematologica. 2006; 91: 929-934
        • Mass R.E.
        A comparison of the effect of prednisone and a placebo in the treatment of multiple myeloma.
        Cancer Chemother Rep. 1962; 16: 257-259
        • Palva I.P.
        • Ala-Harja K.
        • Almqvist A.
        • et al.
        Corticosteroid is not beneficial in multiple-drug combination chemotherapy for multiple myeloma. Finnish Leukaemia Group.
        Eur J Haematol. 1993; 51: 98-101
        • Rajkumar S.V.
        • Jacobus S.
        • Callander N.
        • et al.
        A randomized phase III trial of lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone in newly diagnosed multiple myeloma (e4a03): a Trial Coordinated by the Eastern Cooperative Oncology Group.
        Blood. 2006; 108 ([abstract]): 799
        • Bennett J.M.
        • Silber R.
        • Ezdinli E.
        • et al.
        Phase II study of Adriamycin and bleomycin in patients with multiple myeloma.
        Cancer Treat Rep. 1978; 62: 1367-1369
        • Alberts D.S.
        • Salmon S.E.
        Adriamycin (NSC-123127) in the treatment of alkylator-resistant multiple myeloma: a pilot study.
        Cancer Chemother Rep. 1975; 59: 345-350
        • Takemura G.
        • Fujiwara H.
        Doxorubicin-induced cardiomyopathy from the cardiotoxic mechanisms to management.
        Prog Cardiovasc Dis. 2007; 49: 330-352
        • Lefrak E.A.
        • Pitha J.
        • Rosenheim S.
        • et al.
        A clinicopathologic analysis of Adriamycin cardiotoxicity.
        Cancer. 1973; 32: 302-314
        • Aviles A.
        • Neri N.
        • Nambo J.M.
        • et al.
        Late cardiac toxicity secondary to treatment in Hodgkin's disease. A study comparing doxorubicin, epirubicin and mitoxantrone in combined therapy.
        Leuk Lymphoma. 2005; 46: 1023-1028
        • Elbl L.
        • Hrstkova H.
        • Tomaskova I.
        • et al.
        Late anthracycline cardiotoxicity protection by dexraxane (ICRF-187) in pediatric patients: echocardiographic follow-up.
        Support Care Cancer. 2006; 14: 128-136
        • Ma M.H.
        • Yang H.H.
        • Parker K.
        • et al.
        The proteasome inhibitor PS-341 markedly enhances sensitivity of multiple myeloma tumor cells to chemotherapeutic agents.
        Clin Cancer Res. 2003; 9: 1136-1144
        • Rifkin R.M.
        • Gregory S.A.
        • Mohrbacher A.
        • et al.
        Pegylated liposomal doxorubicin, vincristine, and dexamethasone provide significant reduction in toxicity compared with doxorubicin, vincristine, and dexamethasone in patients with newly diagnosed multiple myeloma: a Phase III multicenter randomized trial.
        Cancer. 2006; 106: 848-858
        • Orlowski R.Z.
        • Voorhees P.M.
        • Garcia R.A.
        • et al.
        Phase 1 trial of the proteasome inhibitor bortezomib and pegylated liposomal doxorubicin in patients with advanced hematologic malignancies.
        Blood. 2005; 105: 3058-3065
        • Jackson D.V.
        • Case L.D.
        • Pope E.K.
        • et al.
        Single agent vincristine by infusion in refractory multiple myeloma.
        J Clin Oncol. 1985; 3: 1508-1512
        • Salmon S.E.
        Immunoglobulin synthesis and tumor kinetics of multiple myeloma.
        Semin Hematol. 1973; 10: 135-144
        • Alexanian R.
        • Salmon S.
        • Bonnet J.
        • et al.
        Combination therapy for multiple myeloma.
        Cancer. 1977; 40: 2765-2771
        • Alexanian R.
        • Dreicer R.
        Chemotherapy for multiple myeloma.
        Cancer. 1984; 53: 583-588
        • Cornwell 3rd, G.G.
        • Pajak T.F.
        • Kochwa S.
        • et al.
        Comparison of oral melphalan, CCNU, and BCNU with and without vincristine and prednisone in the treatment of multiple myeloma. Cancer and Leukemia Group B experience.
        Cancer. 1982; 50: 1669-1675
        • Hansen O.P.
        • Clausen N.A.
        • Drivsholm A.
        • et al.
        Phase III study of intermittent 5-drug regimen (VBCMP) versus intermittent 3-drug regimen (VMP) versus intermittent melphalan and prednisone (MP) in myelomatosis.
        Scand J Haematol. 1985; 35: 518-524
        • MacLennan I.C.
        • Cusick J.
        Objective evaluation of the role of vincristine in induction and maintenance therapy for myelomatosis. Medical Research Council Working Party on Leukaemia in Adults.
        Br J Cancer. 1985; 52: 153-158
        • Tribalto M.
        • Amadori S.
        • Cantonetti M.
        • et al.
        Treatment of multiple myeloma: a randomized study of three different regimens.
        Leuk Res. 1985; 9: 1043-1049
        • Rousselot P.
        • Labaume S.
        • Marolleau J.P.
        • et al.
        Arsenic trioxide and melarsoprol induce apoptosis in plasma cell lines and in plasma cells from myeloma patients.
        Cancer Res. 1999; 59: 1041-1048
        • Kalmadi S.R.
        • Hussein M.A.
        The emerging role of arsenic trioxide as an immunomodulatory agent in the management of multiple myeloma.
        Acta Haematol. 2006; 116: 1-7
        • Munshi N.C.
        • Tricot G.
        • Desikan R.
        • et al.
        Clinical activity of arsenic trioxide for the treatment of multiple myeloma.
        Leukemia. 2002; 16: 1835-1837
        • Hussein M.A.
        • Saleh M.
        • Ravandi F.
        • et al.
        Phase 2 study of arsenic trioxide in patients with relapsed or refractory multiple myeloma.
        Br J Haematol. 2004; 125: 470-476
        • Abou-Jawde R.M.
        • Reed J.
        • Kelly M.
        • et al.
        Efficacy and safety results with the combination therapy of arsenic trioxide, dexamethasone, and ascorbic acid in multiple myeloma patients: a phase 2 trial.
        Med Oncol. 2006; 23: 263-272
        • Zervas K.
        • Dimopoulos M.A.
        • Hatzicharissi E.
        • et al.
        Primary treatment of multiple myeloma with thalidomide, vincristine, liposomal doxorubicin and dexamethasone (T-VAD Doxil): a phase II multicenter study.
        Ann Oncol. 2004; 15: 134-138
        • Hussein M.A.
        • Wood L.
        • Hsi E.
        • et al.
        A Phase II trial of pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone combination therapy in newly diagnosed multiple myeloma patients.
        Cancer. 2002; 95: 2160-2168
        • Ciolli S.
        • Leoni F.
        • Gigli F.
        • et al.
        Low dose Velcade, thalidomide and dexamethasone (LD-VTD): an effective regimen for relapsed and refractory multiple myeloma patients.
        Leuk Lymphoma. 2006; 47: 171-173
        • Zangari M.
        • Barlogi B.
        • Jacobson J.
        • et al.
        VTD regimen comprising Velcade (V) + thalidomide (T) and added DEX (D) for non-responders to V + T effects a 57% PR Rate among 56 patients with myeloma (M) relapsing after autologous transplant.
        Blood. 2003; 102: 830a
        • Wang M.
        • Delasalle K.
        • Giralt S.
        • et al.
        Rapid control of previously untreated multiple myeloma with bortezomib-thalidomide-dexamethasone followed by early intensive therapy.
        Blood. 2005; ([784])
        • Oakervee H.E.
        • Popat R.
        • Curry N.
        • et al.
        PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma.
        Br J Haematol. 2005; 129: 755-762
        • Orlowski R.Z.
        • Peterson B.L.
        • Sanford B.
        • et al.
        Bortezomib and pegylated liposomal doxorubicin as induction therapy for adult patients with symptomatic multiple myeloma: Cancer and Leukemia Group B Study 10301.
        Blood. 2006; 108: 797
        • Orlowski R.Z.
        • Zhuang S.H.
        • Parekh T.
        • et al.
        • the DOXIL-MMY-3001 Study Investigators
        The combination of pegylated liposomal doxorubicin and bortezomib significantly improves time to progression of patients with relapsed/refractory multiple myeloma compared with bortezomib alone: results from a planned interim analysis of a randomized phase III study.
        Blood. 2006; 108: 404
        • Facon T.
        • Mary J.
        • Harousseau J.
        • et al.
        Superiority of melphalan-prednisone (MP) + thalidomide (THAL) over MP and autologous stem cell transplantation in the treatment of newly diagnosed elderly patients with multiple myeloma.
        J Clin Oncol [Meeting abstracts]. 2006; 24: 1
        • Harousseau J.L.
        • Attal M.
        • Leleu X.
        • et al.
        Bortezomib plus dexamethasone as induction treatment prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma: results of an IFM phase II study.
        Haematologica. 2006; 91: 1498-1505
        • Augustson B.M.
        • Begum G.
        • Dunn J.A.
        • et al.
        Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom medical research council trials between 1980 and 2002—Medical Research Council Adult Leukaemia Working Party.
        J Clin Oncol. 2005; 23: 9219-9226
        • Dispenzieri A.
        • Rajkumar S.V.
        • Gertz M.A.
        • et al.
        Treatment of newly diagnosed multiple myeloma based on Mayo stratification of myeloma and risk-adapted therapy (mSMART): consensus statement.
        Mayo Clin Proc. 2007; 82: 323-341