Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Hematology Am Soc Hematol Educ Program. 2012;2012:354-61. doi: 10.1182/asheducation-2012.1.354.
The treatment of multiple myeloma is evolving rapidly. A plethora of doublet, triplet, and quadruplet combinations have been studied for the treatment of newly diagnosed myeloma. Although randomized trials have been conducted comparing older regimens such as melphalan-prednisone with newer regimens containing drugs such as thalidomide, lenalidomide, or bortezomib, there are few if any randomized trials that have compared modern combinations with each other. Even in the few trials that have done so, definitive overall survival or patient-reported quality-of-life differences have not been demonstrated. Therefore, there is marked heterogeneity in how newly diagnosed patients with myeloma are treated around the world. The choice of initial therapy is often dictated by availability of drugs, age and comorbidities of the patient, and assessment of prognosis and disease aggressiveness. This chapter reviews the current data on the most commonly used and tested doublet, triplet, and quadruplet combinations for the treatment of newly diagnosed myeloma and provides guidance on choosing the optimal initial treatment regimen.
多发性骨髓瘤的治疗正在迅速发展。大量的双联、三联和四联组合已被研究用于治疗新诊断的骨髓瘤。尽管已经进行了比较来那度胺、硼替佐米等新药与马法兰-泼尼松等旧药的随机试验，但很少有随机试验比较现代组合之间的差异。即使在少数进行了这样比较的试验中，也没有证明总生存或患者报告的生活质量差异有统计学意义。因此，世界各地新诊断骨髓瘤患者的治疗方法存在明显的异质性。初始治疗的选择通常取决于药物的可用性、患者的年龄和合并症，以及预后和疾病侵袭性的评估。本章综述了目前最常用于治疗新诊断骨髓瘤的双联、三联和四联组合的最新数据，并就如何选择最佳初始治疗方案提供了指导。
