More than thirty years, the combination melphalan-prednisone (MP) has been considered the standard treatment for the transplant-ineligible multiple myeloma patients. In the last decade, the emergence of novel agents, such as thalidomide, lenalidomide and bortezomib, has increased the treatment options. In VISTA trial, MP pulse bortezomib (MPB) was correlated with an increase in both TTP and OS compared with MP. From the six randomized controlled trials compared MP and MP pulse thalidomide (MPT), the meta-analysis has demonstrated that MPT result in improved PFS and OS. MPB and MPT currently appear to be the new standards of care, but other combination of lenalidomide and dexamethasone could provide good options. And recently, FDA has approved carfilzomib and pomalidomide. These new drugs are also very effective for the multiple myeloma patients. Farther more, a lot of phase II and phase III trials have demonstrated the efficacy of novel agents combinations, and based on these results new standard frontline regimens are being challenged.
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