McCarthy Philip L, Hahn Theresa
1Roswell Park Cancer Institute, BMT Program, Department of Medicine, Buffalo, NY.
Hematology Am Soc Hematol Educ Program. 2013;2013:496-503. doi: 10.1182/asheducation-2013.1.496.
There have been major advances in the past decade in the continuum of therapy for transplantation-eligible multiple myeloma patients. For patients requiring therapy, recommended induction treatment consists of triple drug regimens followed by the collection of hematopoietic stem cells. The question of early versus delayed transplantation is under investigation and may identify patients for whom early transplantation is optimal therapy and those for whom it may be delayed. For transplantation-eligible patients, high-dose melphalan remains the standard regimen. After transplantation, consolidation can be considered for patients with less than a complete remission. Maintenance therapy with bortezomib or lenalidomide (or both in very-high-risk patients) is a reasonable option for long-term disease control and improvement in overall survival. Incorporation of new agents into the continuum of multiple myeloma care should result in improved outcomes and long-term disease control.
在过去十年中，适合移植的多发性骨髓瘤患者的连续治疗取得了重大进展。对于需要治疗的患者，推荐的诱导治疗包括三联药物方案，随后采集造血干细胞。早期移植与延迟移植的问题正在研究中，这可能会确定哪些患者早期移植是最佳治疗方案，哪些患者可能需要延迟移植。对于适合移植的患者，高剂量美法仑仍然是标准方案。移植后，对于未达到完全缓解的患者可考虑进行巩固治疗。使用硼替佐米或来那度胺（或极高风险患者两者联合使用）进行维持治疗是长期控制疾病和提高总生存率的合理选择。将新药物纳入多发性骨髓瘤的连续治疗中应能改善治疗效果并实现长期疾病控制。
