Treatment of relapsed and refractory myeloma

Treatment options for patients with relapsed and refractory myeloma have dramatically changed as a result of the approval of bortezomib, thalidomide, lenalidomide, and bortezomib/liposomal doxorubicin by the US Food and Drug Administration. These changes have resulted in improved responses to salvage therapy and, in many cases, improved overall survival. The challenge for clinicians is choosing which agent to use and deciding whether a single agent or combination therapy is the optimal treatment option for each patient. This article outlines some of the data underpinning the use of bortezomib, thalidomide, lenalidomide, or combinations of these agents in the setting of relapsed myeloma, as well as a number of potential future agents or combinations that may improve outcomes for patients with relapsed and refractory disease.