Hussein Mohamad A
Cleveland Clinic Multiple Myeloma Research Center, Cleveland, OH 44195, USA.
Semin Hematol. 2004 Oct;41(4 Suppl 7):2-8. doi: 10.1053/j.seminhematol.2004.09.002.
Multiple myeloma remains an incurable disease despite aggressive, high-dose therapy and intensive supportive care. Newer therapies with good safety profiles are needed for patients with multiple myeloma to improve the quality of responses and prolong survival. Novel treatment strategies for multiple myeloma include replacing conventional doxorubicin with pegylated liposomal doxorubicin and reducing the dexamethasone dose (DVd) in the widely accepted VAD (vincristine, conventional doxorubicin, dexamethasone) regimen to improve the safety profile. Because of its antiangiogenic and immunomodulatory effects, thalidomide has also been explored for use in the treatment of multiple myeloma and has demonstrated increased response rates when used in combination with dexamethasone. These findings subsequently led to the evaluation of the role of thalidomide in combination with pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone (the DVd-T regimen). This regimen was associated with response rates greater than 80% in patients with both newly diagnosed and relapsed/refractory multiple myeloma. Future applications of this and similar regimens for the treatment of multiple myeloma are currently being explored.
尽管采用了积极的大剂量疗法和强化支持治疗，多发性骨髓瘤仍然是一种无法治愈的疾病。对于多发性骨髓瘤患者而言，需要安全性良好的新型疗法来提高缓解质量并延长生存期。多发性骨髓瘤的新型治疗策略包括用聚乙二醇化脂质体阿霉素替代传统阿霉素，并在广泛应用的VAD（长春新碱、传统阿霉素、地塞米松）方案中降低地塞米松剂量（DVd）以改善安全性。由于沙利度胺具有抗血管生成和免疫调节作用，它也被用于探索治疗多发性骨髓瘤，并且已证明与地塞米松联合使用时缓解率会提高。这些发现随后促使人们评估沙利度胺与聚乙二醇化脂质体阿霉素、长春新碱和低剂量地塞米松联合使用（DVd-T方案）的作用。该方案在新诊断和复发/难治性多发性骨髓瘤患者中的缓解率均超过80%。目前正在探索该方案及类似方案在治疗多发性骨髓瘤方面的未来应用。
