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ASCO Educational Book; 2008
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Controversies Surrounding the Initial Treatment of Multiple Myeloma

S. Vincent Rajkumar, MD, and Suzanne R. Hayman, MD

From the Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN

Authors' disclosures of potential conflicts of interest are found at the end of this article.

Supported in part by Grants CA62242, CA85818, CA93842, and CA100080 from the National Cancer Institute, Bethesda, MD.

Address reprint requests to S. Vincent Rajkumar, MD, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail: rajkumar.vincent{at}mayo.edu

Overview: The treatment of multiple myeloma has changed dramatically with the introduction of thalidomide, bortezomib, and lenalidomide. With the arrival of novel agents and combinations, there is significant controversy involving the treatment of newly diagnosed disease. The four main areas of debate include choice of regimen, dose of concomitant corticosteroids, goal of therapy, and duration of therapy. This article addresses these four issues in a strict evidence-based manner. This article also discusses the evidence supporting available regimens, and the pros and cons of each treatment option.