Nevertheless, further studies are required to investigate the benefits of using thalidomide and lenalidomide as maintenance treatments on large cohorts of patients and for a longer duration to help establish clear guidelines for disease maintenance

Nevertheless, further studies are required to investigate the benefits of using thalidomide and lenalidomide as maintenance treatments on large cohorts of patients and for a longer duration to help establish clear guidelines for disease maintenance. 5. posttransplant. This retrospective study was performed on a group of 105 hospitalized patients in the Hematology Department of the Timisoara Municipal Emergency Clinical Hospital between January 2016 and December 2021. Data was collected from the paper records of patients with MM who were under-followed. The treatment regimens used as induction therapy were either VCD or VTD if cyclophosphamide was contraindicated. Of the 105 patients, 27 became eligible for bone marrow transplantation. Furthermore, they received maintenance therapy which was based on either lenalidomide with dexamethasone or thalidomide with dexamethasone. Of the 62 patients treated with VTD, 17.7% were in complete remission before stem cell transplantation. Of the 43 β-Secretase Inhibitor IV patients treated with VCD, 37.2% were in complete remission. The 5-year mean progression-free survival (PFS) in the entire cohort was better in the group treated with the VTD regimen (31.6 vs. 27.2 months). However, in the 27 patients undergoing maintenance after ASCT, the PFS with thalidomide was 35.5 months (95% CI = 27C42), while the PFS rate in those receiving maintenance treatment with lenalidomide was 46.1 months (95% CI = 20C73). VCD proved to be superior to VTD in inducing complete pretransplant responses. Regarding maintenance therapy, patients from the lenalidomide group had superior responses compared with those under thalidomide. Keywords: multiple myeloma, stem cell transplantation, bortezomib, thalidomide, cyclophosphamide, dexamethasone, lenalidomide 1. Introduction Multiple myeloma (MM), the second most prevalent form of hematologic cancer, after leukemias and lymphomas, is characterized MMP3 by the uncontrolled proliferation of clonal plasma cells [1,2,3]. Researchers have β-Secretase Inhibitor IV shown that the monoclonal gammopathy of uncertain significance precursor stage is present in almost all instances of multiple myeloma [4]. The secreted plasma cells are hyperproliferative differentiated B-lymphocytes that are capable of secreting a range of immunoglobulins [5]. In most cases, the aberrant plasma cells will proliferate in the bone marrow, and β-Secretase Inhibitor IV only a small percentage of patients will present with an extramedullary development at the time of diagnosis or acquire extramedullary disease later on in the course of the disease [6,7]. Anemia, renal failure, hypercalcemia, and lytic bone lesions are some of the most common clinical symptoms associated with excessive monoclonal immunoglobulins released from clonal plasma cells, which is the cause of organ damage [8,9]. The overall survival of multiple myeloma has improved significantly in the last ten years, depending on the type and factors of aggressivity [10,11,12]. Patients who are eligible for a transplant have the highest survival rate at five years, which reaches about 80% with modern therapy, in contrast to elderly patients non-eligible for transplantation, whose survival rate is only about 20% at five years [13,14]. However, the prognosis continues to be higher compared with other more aggressive hematologic cancers and much higher than some solid tumors, considerably depending on a variety of prognostic factors [15,16,17]. Despite aggressive therapy that incorporates almost all available drugs and treatment options [18,19,20], strategies to overcome the side effects must be identified in high-risk patients and improve survival in this patient population. Multiple myeloma is typically sensitive to a variety of cytotoxic drugs, both as an initial treatment and as a treatment for recurrent disease, although the treatments effects are transitory, and the MM is not considered curable with current approaches [21]. However, MM treatment has evolved rapidly due to the introduction of new drugs, such as carfilzomib, daratumumab, and pomalidomide [22,23,24]. When deciding on a treatment for multiple myeloma (MM), it is important to take into account a number of criteria that pertain to both the patient and the illness. Age, fragility, and performance status are three. β-Secretase Inhibitor IV