Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
Hematology Am Soc Hematol Educ Program. 2009:578-86. doi: 10.1182/asheducation-2009.1.578.
Treatment of myeloma relapse needs to be individualized to reflect the effectiveness and toxicities of prior therapies, with consideration given to pragmatic issues such as the tempo of relapse, age of the patient, access to drugs and patient preference. In general, combination therapies have been associated with higher response rates and improved progression-free survival and may be preferable when a rapid response is required. Nevertheless, in a slower-tempo relapse it is unclear at this juncture whether sequencing of drugs or multi-agent combinations offer superior overall survival results. Fortunately, active novel agents that offer further possibilities for some myeloma patients have become available in clinical trials. In this review we will describe the various classes of novel drugs being tested and the pros and cons of preclinical testing, and will particularly focus on two agents with single-agent activity in myeloma: carfilzomib, a proteasome inhibitor, and pomalidomide, a member of the immunomodulatory class of drugs.
骨髓瘤复发的治疗需要个体化，以反映既往治疗的有效性和毒性，同时考虑到复发的节奏、患者年龄、药物可及性和患者偏好等实际问题。一般来说，联合治疗与更高的缓解率和改善的无进展生存期相关，当需要快速缓解时可能更可取。然而，在复发节奏较慢的情况下，目前尚不清楚药物排序或多药物联合治疗是否能提供更好的总生存期结果。幸运的是，一些新的活性药物在临床试验中为一些骨髓瘤患者提供了进一步的可能性。在这篇综述中，我们将描述正在测试的各种新型药物类别，以及临床前测试的优缺点，并特别关注两种在骨髓瘤中有单药活性的药物：蛋白酶体抑制剂卡非佐米和免疫调节类药物来那度胺。
