Tuchman S A, Chao N J, Gasparetto C G
Division of Medical Oncology and Hematological Malignancies Program, Duke University Medical Center, Durham, NC 27710, USA.
Adv Hematol. 2012;2012:712613. doi: 10.1155/2012/712613. Epub 2012 May 30.
Although multiple myeloma remains incurable outside of allogeneic hematopoietic stem cell transplantation, novel agents made available only in the last few decades have nonetheless tremendously improved the landscape of myeloma treatment. Lenalidomide, of the immunomodulatory class of drugs, is one of those novel agents. In the non-transplant and relapsed/refractory settings, lenalidomide clearly benefits patients in terms of virtually all meaningful outcomes including overall survival. Data supporting the usage of lenalidomide as part of treatment approaches incorporating high-dose chemotherapy with autologous stem cell support (ASCT) are less mature as pertains to such long-term outcomes and toxicity, and lenalidomide is not currently approved by regulatory agencies for use in the context of ASCT in either the United States or Europe. That said, relatively preliminary efficacy data describing lenalidomide as a component of ASCT-based treatment approaches to MM are indeed promising, and consequently lenalidomide's role in ASCT-based treatment strategies is growing. In this review we summarize existing data that pertains to lenalidomide in the specific context of ASCT, and we share our thoughts on how our own group applies these data to approach this complex issue clinically.
尽管在异基因造血干细胞移植之外，多发性骨髓瘤仍然无法治愈，但仅在过去几十年中才出现的新型药物极大地改善了骨髓瘤的治疗局面。来那度胺属于免疫调节类药物，是这些新型药物之一。在非移植和复发/难治性情况下，来那度胺在几乎所有有意义的结局方面，包括总生存期，都明显使患者受益。就这种长期结局和毒性而言，支持将来那度胺用作包含大剂量化疗和自体干细胞支持（ASCT）的治疗方法一部分的数据还不够成熟，并且目前美国和欧洲的监管机构均未批准来那度胺用于ASCT。话虽如此，将来那度胺描述为基于ASCT的MM治疗方法组成部分的相对初步的疗效数据确实很有前景，因此来那度胺在基于ASCT的治疗策略中的作用正在增强。在这篇综述中，我们总结了与来那度胺在ASCT特定背景下相关的现有数据，并分享了我们自己的团队如何应用这些数据在临床上处理这个复杂问题的想法。
