Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Cancer J. 2009 Nov-Dec;15(6):465-72. doi: 10.1097/PPO.0b013e3181c51cd4.
Outcomes for patients with multiple myeloma have dramatically improved during the past 20 years as a result of improved therapeutic options and a better understanding of malignant plasma cell biology. Until the past 10 years, the major limitations on improving outcomes were related to the minimal efficacy of existing agents and balancing the toxicity of therapy in an older patient population. However, despite these limitations, there have been advances that have resulted in improvements in progression-free survival and overall survival (OS). High-dose therapy and autologous transplant were the first among therapies to demonstrate an improvement in OS; but more recent analyses have demonstrated that there can be improvement in OS, which is also associated with improvement in the complete response (CR) rate, even among nontransplant patients as well. Thus, achieving CR has been associated with improved OS and has become a therapeutic goal. In the current era of new agents, such as thalidomide, bortezomib, and lenalidomide, the fraction of patients who achieve a CR is now greater than before, and the data regarding the importance of achieving this benchmark of response have never been more benefit.
在过去的 20 年中，由于治疗选择的改进和对恶性浆细胞生物学的更好理解，多发性骨髓瘤患者的预后得到了显著改善。在过去的 10 年中，改善预后的主要限制因素与现有药物的疗效有限以及平衡老年患者群体的治疗毒性有关。然而，尽管存在这些限制，仍取得了一些进展，导致无进展生存期和总生存期（OS）的改善。大剂量化疗和自体移植是第一批在 OS 中显示出改善的治疗方法；但最近的分析表明，即使在非移植患者中，也可以改善 OS，并且与完全缓解（CR）率的提高相关。因此，实现 CR 与改善 OS 相关，并已成为治疗目标。在当前新型药物的时代，如沙利度胺、硼替佐米和来那度胺，实现 CR 的患者比例现在高于以往，关于实现这一反应基准的重要性的数据从未如此受益。
