Newly diagnosed XXXX .

@entity1 @entity632 @entity66 @entity229 @entity2816 @entity1582 @entity619 @entity177 @entity1891 @entity9865
Melphalan combined with @entity229 (MP) has been accepted as the standard therapy for previously untreated @entity1582 ( @entity1582 ) because most studies demonstrate only a modest survival benefit of combination chemotherapy regimens when compared with MP. There have been modest gains with more intensive myeloablative regimens in combination with blood stem cell support, particularly for @entity1 with early primary @entity66 who subsequently achieve partial remission, and for the approximately 25% to 35% of @entity1 achieving complete remission. To preserve the ability to adequately collect stem cells, the use of alkylating agents, such as melphalan, should be limited in the previously untreated @entity1 with @entity1582 (including those older than 65 years of age) who is a candidate for myeloablative therapy. Pulse @entity619 -containing regimens provide rapid responses and may be considered the first regimens of choice. Although @entity1891 / @entity632 / @entity619 (VAD) produces responses in approximately 50% to 70% of @entity1 with previously untreated @entity1582 , use early in the disease has not improved survival. Outside of a specific study protocol, this regimen may be best reserved for @entity1 with refractory (particularly relapsing) disease. Notable exceptions include @entity1 with @entity177 or @entity9865 in whom the rapid responses provided by VAD may avoid potentially permanent, serious complications. Recently, new agents with novel mechanisms of action (ie, @entity2816 , immunomodulatory drugs, proteosome inhibitors) have demonstrated activity in resistant @entity1582 . Because these agents are likely to show activity alone or in combination, newly diagnosed @entity1 and previously untreated @entity1 should be considered for clinical trials. @entity2816 / @entity619 has already produced response rates of 65% to 75% in previously untreated @entity1 . Its ease of administration along with stem cell preservation are likely to make this, followed by myeloablative therapy with stem cell support, the treatment of choice for untreated @entity1582 as confirmatory studies are completed.
