Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes St Herblain, France.
Ann Oncol. 2012 Sep;23 Suppl 10:x334-8. doi: 10.1093/annonc/mds311.
The introduction of novel agents (thalidomide, bortezomib and lenalidomide) in the frontline therapy of multiple myeloma has markedly improved the outcome both in younger patients who are candidates for high-dose therapy plus autologous stem-cell transplantation (HDT/ASCT) and in elderly patients. In the HDT/ASCT paradigm, novel agents may be used as induction therapy or after HDT/ASCT as consolidation and/or maintenance therapy. It is now possible to achieve up to 70% complete plus very good partial remission after HDT/ASCT and 70% 3-year progression-free survival (PFS). However long-term non-intensive therapy may also yield high response rates and prolonged PFS. Randomized trials comparing these two strategies are underway. In elderly patients, six randomized studies show the benefit of adding thalidomide to melphalan-prednisone (MP). a large randomized trial has also shown that the combination of bortezomib-MP is superior to MP for all parameters measuring the response and outcome. Finally, the role of maintenance is currently evaluated and a randomized trial shows that low-dose lenalidomide maintenance prolongs PFS.
新型药物（沙利度胺、硼替佐米和来那度胺）在多发性骨髓瘤的一线治疗中的应用显著改善了年轻患者（适合接受大剂量化疗联合自体造血干细胞移植（HDT/ASCT）治疗的患者）和老年患者的预后。在 HDT/ASCT 方案中，新型药物可作为诱导治疗或 HDT/ASCT 后巩固和/或维持治疗。现在，HDT/ASCT 后可达到高达 70%的完全缓解加非常好的部分缓解率，3 年无进展生存率（PFS）为 70%。然而，长期非强化治疗也可能获得高缓解率和延长 PFS。正在进行比较这两种策略的随机试验。在老年患者中，六项随机研究表明，在马法兰-泼尼松（MP）中添加沙利度胺可带来获益。一项大型随机试验也表明，硼替佐米-MP 联合治疗在所有衡量反应和结局的参数上均优于 MP。最后，维持治疗的作用正在评估中，一项随机试验表明，低剂量来那度胺维持治疗可延长 PFS。
