University Hospital of Salamanca, Salamanca, Spain.
Hematology Am Soc Hematol Educ Program. 2009:555-65. doi: 10.1182/asheducation-2009.1.555.
Survival rates of young patients with myeloma have increased markedly in the last decade, mainly due to the use of autologous stem cell transplantation (ASCT) and new, highly efficient rescue treatments. In order to improve the survival of newly diagnosed young patients further, the next steps need to focus on increasing the activity of upfront or debulking regimens, improving the efficacy of ASCT, mainly through the conditioning regimen, and increasing the duration of responses through more effective maintenance or consolidation therapies. Nevertheless, this approach is being challenged by the favorable results obtained with long-term treatment with novel agents and the possibility of reserving the ASCT until relapse. Allogeneic transplantation in newly diagnosed patients should be considered as an investigational procedure and used only in well-designed clinical trials. This review covers the new strategies that are currently under investigation with the aim of optimizing the outcome for newly diagnosed young patients with myeloma.
过去十年中，年轻骨髓瘤患者的生存率显著提高，主要归功于自体干细胞移植（ASCT）和新型、高效的挽救治疗的应用。为了进一步提高新诊断的年轻患者的生存率，下一步需要关注提高起始或减瘤方案的活性，通过改善预处理方案来提高 ASCT 的疗效，并通过更有效的维持或巩固治疗来延长缓解持续时间。然而，新型药物的长期治疗所取得的良好结果以及将 ASCT 保留至复发时再使用的可能性，对这种方法提出了挑战。异基因移植在新诊断患者中应被视为一种试验性治疗，仅在精心设计的临床试验中使用。这篇综述涵盖了目前正在研究的新策略，旨在优化新诊断的年轻骨髓瘤患者的治疗效果。
