Few Clues on Myeloma treatment

Some of the Key points in Myeloma Treatment
1. After the diagnosis of Myeloma, determination of presence of Del 17, and t(4:14) is the first step to treatment.  You may be "liable" if Velcade is not included in the first line treatment in patient with  del 17.
2. CYBORD is a good induction option
3. Use of Triplets always better than Doublets
4.In clinical practice, Bortezomib Sub Q is now adopted widely despite lack of clinical trial showing equivalency to IV route (in up front treatment) because it leads to  somewhat less Neuropathy and thrombocytopenia.
5. Dexamethasone is still a corner stone of Myeloma treatment.  Add it even to the newest drug for their full effect to be unleashed (even Pomalidomide has 3 times the effect when Dexamethasone is added!
6.Almost everybody is treating until progression or maintenance therapy is the alternative.  As if now are assuming that the driver of the disease are continuously present!`
Now for Maintenance therapy, not only Revlimid, but also Velcade can be given with Dex in Maintenance setting.
7."In myeloma, a CR (or complete response) is a CR no matter how you got there" meaning any CR give the same benefit to the patient in terms of progression frr survival.
8. The idea of Maintenance therapy was further re-enforced by the VPMT forwed by Maintenance MT in cases treated without transplant!
9.Remember Carfilzomib and Pomalidomide are 3rd live as approved by FDA.  Meaning 2 treatment have to fail before you can prescribe these meds!
10. With Carfilzomid  (approved in July 2012)watch the kidney and cardiac parameters (concerns here)
less Neuropathy noted.
11. With more drugs available, 2 new combination triplets
  Carfilzomib/Pom/Dex
 Velcade/Pom /Dex meds
12 New drugs to be incorporated "  Daratuzumab, Aratuzumab, ARRY520
new combination Len/Carfil/Dex
13 New salvage TD-PACE,  VTD-PACE
14. one trial Cytoxan/Carfilzomid?Dex, surprising Cytoxan an option in Renal failure patients!

IN MYELOMA ANY OPTION IS GOOD BUT WATCH FOR DEL 17 PRESENCE! (pom AND velcade ARE THEN SOME OF THE OPTIONS)