Peest D, Ganser A, Einsele H
Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
Internist (Berl). 2013 Dec;54(12):1434, 1436-8, 1440-2. doi: 10.1007/s00108-013-3323-7.
Multiple myeloma (MM) is a malignant plasma cell disorder with clonal development. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are precursor stages of MM and both have to be differentiated from MM which is characterized by organ complications. High-dose chemotherapy combined with autologous stem cell support is the therapy of choice for most patients in order to achieve long-lasting complete remission with few symptoms, prevention of new organ complications and survival prolongation. Patients who cannot be intensively treated due to advanced age and comorbidities should be treated with low-dose chemotherapy, normally alkylating agents, for improved quality of life and also survival prolongation. Including thalidomide, lenalidomide, pomalidomide, bortezomib or carfilzomib in both high-dose and low-dose chemotherapy concepts results in a significantly higher remission rate and longer survival. Allogeneic stem cell transplantation is associated with a relatively high mortality during the first year after transplantation which will be refined with the aim of healing in various trials and is an alternative treatment approach for selected patients. A treatment concept for MM patients has to be individually complemented by local irradiation, administration of bisphosphonates and supportive infusions of immunoglobulins.
多发性骨髓瘤（MM）是一种具有克隆性发展的恶性浆细胞疾病。意义未明的单克隆丙种球蛋白病（MGUS）和冒烟型多发性骨髓瘤（SMM）是MM的前驱阶段，两者都必须与以器官并发症为特征的MM相鉴别。大剂量化疗联合自体干细胞支持是大多数患者的首选治疗方法，以实现持久的完全缓解、减少症状、预防新的器官并发症并延长生存期。因年龄较大和合并症而无法接受强化治疗的患者，应采用低剂量化疗，通常为烷化剂，以提高生活质量并延长生存期。在大剂量和低剂量化疗方案中加入沙利度胺、来那度胺、泊马度胺、硼替佐米或卡非佐米，可显著提高缓解率并延长生存期。异基因干细胞移植在移植后的第一年死亡率相对较高，在各种试验中其死亡率将得到改善，是部分特定患者的替代治疗方法。MM患者的治疗方案必须通过局部放疗、双膦酸盐给药和免疫球蛋白支持输注进行个体化补充。
