Roussel Murielle, Facon Thierry, Moreau Philippe, Harousseau Jean-Luc, Attal Michel
Hématologie Clinique, CHU Purpan, Toulouse, France.
Recent Results Cancer Res. 2011;183:189-206. doi: 10.1007/978-3-540-85772-3_9.
High dose therapy (HDT) with autologous stem cell transplantation (ASCT) is the standard of care for eligible newly diagnosed MM patients. Several randomized studies demonstrated a survival advantage for patients undergoing transplantation, compared with conventional chemotherapy. Introduction of new drugs in this setting have markedly increased survival rates within the last 10 years. Efforts to further improve response rates and survival in those patients are still needed, mainly by increasing the depth of tumor reduction and the duration of response through more effective induction, consolidation and maintenance therapies. Nevertheless, this approach is currently challenged by the promising results of long-term treatment with novel agents. Recent data suggest that the upfront combination of a proteasome inhibitor plus one immunomodulatory drug (IMiD) is highly effective. The most promising 3-drug association might be Bortezomib, Lenalidomide and dexamethasone (VRD). Adjunction of a 4th drug is not proven to be more efficient. Consolidation and maintenance therapies are emerging in all trials with great results. For elderly patients, or not eligible for ASCT, the introduction of novel agents has also changed the management of the disease. Melphalan-prednisone-thalidomide and bortezomib-melphalan-prednisone are the two standards of care. Current trials are challenging the role of alkylators in the frontline setting. Maintenance therapy is also undergoing evaluation.
高剂量疗法（HDT）联合自体干细胞移植（ASCT）是符合条件的新诊断多发性骨髓瘤（MM）患者的标准治疗方案。多项随机研究表明，与传统化疗相比，接受移植的患者具有生存优势。在过去10年中，在此背景下引入新药显著提高了生存率。仍需要努力进一步提高这些患者的缓解率和生存率，主要是通过更有效的诱导、巩固和维持治疗来增加肿瘤缩小的深度和缓解的持续时间。然而，这种方法目前受到新型药物长期治疗取得的有前景结果的挑战。最近的数据表明，蛋白酶体抑制剂与一种免疫调节药物（IMiD）的 upfront 联合非常有效。最有前景的三联药物组合可能是硼替佐米、来那度胺和地塞米松（VRD）。添加第四种药物尚未被证明更有效。巩固和维持治疗在所有试验中都崭露头角，效果显著。对于老年患者或不符合ASCT条件的患者，新型药物的引入也改变了该疾病的治疗方式。美法仑-泼尼松-沙利度胺和硼替佐米-美法仑-泼尼松是两种标准治疗方案。当前的试验正在挑战烷化剂在一线治疗中的作用。维持治疗也正在接受评估。
