Review Article

Sequencing of Treatment and Integration of Clinical Trials

Beth Faiman,(1) PhD, MSN, APRN-BC, AOCN®, Charise Gleason,(2) MSN, NP-BC, AOCNP®, Kathleen Colson,(3) RN, BSN, BS, Ann McNeill,(4) RN, MSN, APN, and Donna Catamero,(5) ANP-BC, OCN®, CCRC, on behalf of the International Myeloma Foundation Nurse Leadership Board

1Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio; 2Emory University, Atlanta, Georgia; 3Dana-Farber Cancer Institute, Boston, Massachusetts; 4Hackensack University Medical Center, Hackensack, New Jersey; 5Mount Sinai Medical Center, New York, New York

Beth Faiman, PhD, MSN, APRN-BC, AOCN®, Cleveland Clinic Taussig Cancer Institute, Multiple Myeloma Program, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail:

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

J Adv Pract Oncol 2016;7:17–29 | doi: 10.6004/jadpro.2016.7.2.11 | © 2016 Harborside Press®




This article provides an overview of current approaches for the treatment of newly diagnosed multiple myeloma using approved agents, including bortezomib and lenalidomide. Clinical development of drugs for multiple myeloma, and the overall clinical trial process, are reviewed. Because optimal therapy for newly diagnosed patients remains controversial, existing treatment guidelines and recommendations are discussed, including data from recent clinical trials. Special considerations should be given to patients considering hematopoietic stem cell transplant since some treatments may decrease the ability to effectively harvest stem cells. Since many patients are refractory to treatment or subsequently relapse, treatment regimens for relapsed/refractory multiple myeloma as well as chemotherapy-based salvage therapy are also discussed. The use of biomarkers in multiple myeloma, such as kappa/lambda serum free light chain (FLC) and gene expression profiling (GEP), are becoming standard for risk prognosis and monitoring of response to therapy. Clinical trial results using the histone deacetylase (HDAC) inhibitor panobinostat and the proteasome inhibitor carfilzomib for treatment of relapsed/refractory disease are presented. Familiarity with risk-stratification tools such as mSMART and treatment guidelines will help advanced practitioners understand the rationale for patient assessment and selection of treatment options. Advanced practitioners can offer patients the opportunity to enroll in ongoing clinical trials, based on their risk status and eligibility for transplant.

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