Treatment algorithms for multiple myeloma in Japan.

Recent progress in the development of novel therapeutic agents has remarkably improved the treatment outcome for multiple myeloma (MM). Proteasome inhibitors such as bortezomib, carfilzomib, and ixazomib; immunomodulatory drugs (IMiDs) such as thalidomide, lenalidomide, and pomalidomide; the histone deacetylase (HDAC) inhibitor panobinostat; and the monoclonal antibody, elotuzumab, have all been approved in Japan, although only bortezomib and lenalidomide have been approved for initial therapy. Accordingly, the Japanese Society of Hematology has released updated treatment guidelines for MM. Initial treatments with bortezomib-based 2-3 drug regimens and lenalidomide＋dexamethasone are recommended for patients eligible for autologous stem cell transplantation (ASCT), while bortezomib＋melphalan＋prednisolone and lenalidomide＋dexamethasone are recommended for patients who are not eligible for ASCT. These novel agents provide us with wider therapeutic options for relapsed or refractory patients. Consequently, treatment paradigms for MM continue to rapidly evolve, and it is important to select the optimal treatment strategy for each patient.