Kumar Lalit, Verma Rakesh, Radhakrishnan Venkat Raman
Dr B.R. Ambedkar Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Natl Med J India. 2010 Jul-Aug;23(4):210-8.
Multiple myeloma is a disease of malignant plasma cells in the bone marrow. Interaction of malignant plasma cells with the bone marrow microenvironment plays a key role in the pathogenesis of the disease. The Introduction of two new classes of molecules, namely immunomodulators (e.g. thalidomide, lenalidomide), and proteasome inhibitors (e.g., bortezomib) has led to improvement in the management of myeloma. Induction therapy with these novel drugs in combination with dexamethasone is associated with higher response rates including complete response in one-fourth of patients with bortezomib combinations. Further consolidation with intensive chemotherapy supported by autologous stem cell transplant in young, eligible patients results in complete response in 50%-70% of patients with improved survival. Simplified criteria for staging, uniform response criteria, more sensitive methods for detection of residual disease (immunofixation and free light chain assay), and recognition of potential adverse cytogenetic and genomic abnormalities have further refined the management of patients with myeloma. Along with earlier diagnosis, improved treatment and better management of complications have resulted in longer disease control and survival with a better quality of life.
多发性骨髓瘤是一种骨髓中恶性浆细胞的疾病。恶性浆细胞与骨髓微环境的相互作用在该疾病的发病机制中起关键作用。两类新分子的引入，即免疫调节剂（如沙利度胺、来那度胺）和蛋白酶体抑制剂（如硼替佐米），已使骨髓瘤的治疗得到改善。这些新型药物与地塞米松联合进行诱导治疗，其反应率更高，包括使用硼替佐米联合方案的患者中有四分之一达到完全缓解。在年轻、符合条件的患者中，通过自体干细胞移植支持的强化化疗进行进一步巩固治疗，可使50%-70%的患者达到完全缓解，生存期得到改善。简化的分期标准、统一的反应标准、检测残留疾病的更敏感方法（免疫固定和游离轻链检测）以及对潜在不良细胞遗传学和基因组异常的认识，进一步完善了骨髓瘤患者的治疗。随着早期诊断，治疗的改善以及并发症的更好管理，已实现了更长的疾病控制和生存期，生活质量也更高。
