基于单克隆抗体的治疗作为多发性骨髓瘤的一种新的治疗策略。

Monoclonal antibody-based therapy as a new treatment strategy in multiple myeloma.

机构信息

Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Leukemia. 2012 Feb;26(2):199-213. doi: 10.1038/leu.2011.214. Epub 2011 Aug 19.

Abstract

The introduction of autologous stem cell transplantation combined with the introduction of immunomodulatory drugs (IMiDs) and proteasome inhibitors has significantly improved survival of multiple myeloma patients. However, ultimately the majority of patients will develop refractory disease, indicating the need for new treatment modalities. In preclinical and clinical studies, promising results have been obtained with several monoclonal antibodies (mAbs) targeting the myeloma tumor cell or the bone marrow microenvironment. The mechanisms underlying the therapeutic efficacy of these mAbs include direct induction of tumor cell apoptosis via inhibition or activation of target molecules, complement-dependent cytotoxicity and antibody-dependent cell-mediated cytotoxicity (ADCC). The capability of IMiDs to enhance ADCC and the modulation of various important signaling cascades in myeloma cells by both bortezomib and IMiDs forms the rationale to combine these novel agents with mAbs as new treatment strategies for myeloma patients. In this review, we will give an overview of various mAbs directly targeting myeloma tumor cells or indirectly via effects on the bone marrow microenvironment. Special focus will be on the combination of these mAbs with IMiDs or bortezomib.

摘要

自体干细胞移植联合免疫调节药物(IMiDs)和蛋白酶体抑制剂的引入显著改善了多发性骨髓瘤患者的生存。然而,最终大多数患者会发展为难治性疾病,这表明需要新的治疗方式。在临床前和临床研究中,几种针对骨髓瘤肿瘤细胞或骨髓微环境的单克隆抗体(mAbs)取得了有前途的结果。这些 mAbs 的治疗效果的机制包括通过抑制或激活靶分子直接诱导肿瘤细胞凋亡、补体依赖性细胞毒性和抗体依赖性细胞介导的细胞毒性(ADCC)。硼替佐米和 IMiDs 均能增强 ADCC,并调节骨髓瘤细胞中各种重要信号级联反应,这为将这些新型药物与 mAbs 联合作为骨髓瘤患者的新治疗策略提供了依据。在这篇综述中,我们将概述直接针对骨髓瘤肿瘤细胞或通过对骨髓微环境的影响间接靶向骨髓瘤肿瘤细胞的各种 mAbs。特别关注的是将这些 mAbs 与 IMiDs 或硼替佐米联合使用。

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