Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3053, Australia.
Leukemia. 2010 Jan;24(1):22-32. doi: 10.1038/leu.2009.236. Epub 2009 Nov 12.
Immunomodulatory drugs (IMiDs) are thalidomide analogues, which possess pleiotropic anti-myeloma properties including immune-modulation, anti-angiogenic, anti-inflammatory and anti-proliferative effects. Their development was facilitated by an improved understanding in myeloma (MM) biology and initiated a profound shift in the therapeutic approach towards MM. Despite the diverse effects of IMiDs in vitro, the relative contribution of each effect towards their ultimate anti-MM activity is still unclear. Based on in vitro data, it appears that anti-proliferative effects and downregulation of crucial cytokines are their most important anti-MM attributes. Although the co-stimulatory effects on T and NK cells have been heralded as a unique and important property of IMiDs towards enhancing anti-MM immune activity, these in vitro effects have yet to be firmly corroborated in vivo. Much is yet to be elucidated regarding the complex interplay of immunomodulatory cytokines that occurs in vivo, which ultimately dictates the net effects of IMiDs in MM-the understanding of which is necessary to facilitate optimal manipulation of these drugs in future MM management.
免疫调节药物（IMiDs）是沙利度胺类似物，具有多种抗骨髓瘤特性，包括免疫调节、抗血管生成、抗炎和抗增殖作用。它们的发展得益于对骨髓瘤（MM）生物学的更好理解，并引发了治疗 MM 的方法的深刻转变。尽管 IMiDs 在体外具有多种作用，但每种作用对其最终抗 MM 活性的相对贡献仍不清楚。根据体外数据，抗增殖作用和关键细胞因子的下调似乎是它们最重要的抗 MM 属性。尽管对 T 和 NK 细胞的共刺激作用被认为是 IMiDs 增强抗 MM 免疫活性的独特和重要特性，但这些体外作用尚未在体内得到充分证实。关于体内发生的免疫调节细胞因子的复杂相互作用还有很多需要阐明，这最终决定了 IMiDs 在 MM 中的净效应——为了在未来的 MM 管理中促进这些药物的最佳应用，理解这一点是必要的。
