University of Maryland, Greenebaum Cancer Center, Bone Marrow Transplant Program, Baltimore, Maryland 21201, USA.
J Natl Compr Canc Netw. 2010 Feb;8 Suppl 1:S21-7. doi: 10.6004/jnccn.2010.0113.
Maintenance therapy in multiple myeloma has been under investigation for more than 3 decades, without evidence of clear benefit until recently. Chemotherapy maintenance offers no benefit after conventional or high-dose treatment. Interferon-based maintenance is associated with minimal improvements in clinical outcomes, but is poorly tolerated. Results of corticosteroid maintenance studies have been conflicting; at least one randomized trial showed improved survival with prednisone maintenance after conventional chemotherapy. The role of the novel agents thalidomide, lenalidomide, and bortezomib as maintenance is emerging. Most reported maintenance studies have evaluated thalidomide, alone or in combination with a corticosteroid. Several of these studies suggest that thalidomide-based maintenance prolongs overall survival after autologous stem cell transplantation. Important questions that have not yet been resolved include the optimal dose and duration of thalidomide, whether clinical benefit depends on response to induction therapy and risk for relapse, and whether reported benefits are caused by cytoreduction or eradication of minimal residual disease, especially with bortezomib maintenance. Ongoing randomized trials are evaluating lenalidomide and bortezomib maintenance therapies to better define the role of these drugs as maintenance in multiple myeloma.
多发性骨髓瘤的维持治疗已经研究了 30 多年，但直到最近才发现其明确的益处。在常规或高剂量治疗后，化疗维持治疗没有益处。基于干扰素的维持治疗与临床结局的微小改善相关，但耐受性差。皮质类固醇维持研究的结果存在矛盾；至少有一项随机试验显示，在常规化疗后使用泼尼松维持治疗可改善生存。新型药物沙利度胺、来那度胺和硼替佐米作为维持治疗的作用正在显现。大多数报告的维持治疗研究都评估了沙利度胺单独使用或与皮质类固醇联合使用。其中一些研究表明，沙利度胺维持治疗可延长自体干细胞移植后的总生存期。尚未解决的重要问题包括沙利度胺的最佳剂量和持续时间、临床获益是否取决于诱导治疗的反应和复发风险，以及报告的获益是否是由于细胞减少或微小残留病的消除引起的，特别是硼替佐米维持治疗。正在进行的随机试验正在评估来那度胺和硼替佐米维持治疗，以更好地确定这些药物作为多发性骨髓瘤维持治疗的作用。
