René Gauducheau Cancer Center, Nantes/Saint Herblain, France.
Oncology (Williston Park). 2010 Oct;24(11):992-8.
Until recently, standard treatment of multiple myeloma (MM) in elderly patients who were not candidates for autologous stem cell transplantation was with the combination of melphalan plus prednisone (MP). Novel agents (thalidomide, lenalidomide, bortezomib) are dramatically changing frontline therapy of MM. Randomized studies have shown the superiority of adding one novel agent to MP, either thalidomide (MPT) or bortezomib (MPV). The combination of lenalidomide with low doses of dexamethasone is another attractive alternative. Recent results show that maintenance therapy with low-dose lenalidomide may prolong progression-free survival. The objective of these improved treatment regimens should be to achieve complete response, as in younger patients. However, toxicity is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status. Weekly bortezomib appears to induce severe peripheral neuropathy less frequently than the same agent administered twice weekly. Autologous stem cell transplantation is feasible in selected fit patients over 65 years of age, and its results are improved by the addition of novel agents before and after high-dose therapy. However, considering the progress in non-intensive therapy, autologous transplantation should not currently be offered to elderly patients outside of a clinical trial.
直到最近，不适合自体干细胞移植的老年多发性骨髓瘤（MM）患者的标准治疗方法是用马法兰加泼尼松（MP）联合治疗。新型药物（沙利度胺、来那度胺、硼替佐米）正在显著改变 MM 的一线治疗方法。随机研究表明，在 MP 中添加一种新型药物（沙利度胺（MPT）或硼替佐米（MPV））具有优越性。来那度胺联合低剂量地塞米松的联合也是另一种有吸引力的选择。最近的结果表明，低剂量来那度胺维持治疗可能会延长无进展生存期。这些改进的治疗方案的目标应该是达到完全缓解，就像在年轻患者中一样。然而，毒性是一个重大问题，对于 75 岁以上或体能状态较差的患者，应减少沙利度胺和骨髓抑制药物的剂量。每周硼替佐米的使用似乎比同样的每周两次的药物引起严重周围神经病变的频率要低。在选择合适的 65 岁以上患者中，自体干细胞移植是可行的，并且在高剂量治疗前后添加新型药物可以改善其结果。然而，考虑到非强化治疗的进展，目前不应该在临床试验之外向老年患者提供自体移植。
