Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison S, Mollee P, Roberts A, Horvath N, Talaulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince H M
Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2015 Mar;45(3):335-43. doi: 10.1111/imj.12688.
Options for treatment of elderly patients with multiple myeloma have expanded substantially following the development of immunomodulatory drugs (IMiD), proteasome inhibitors and with enhancement in safety of high-dose therapy and autologous stem cell transplant (HDT + ASCT). The recognition of biological heterogeneity among elderly patients has made delivery of therapy more challenging. An individualised approach to treatment selection is recommended in an era in which highly efficacious treatment options are available for transplant-ineligible patients. Here, we summarise recommendations for patients who are considered unsuitable for HDT + ASCT, including pretreatment considerations, and induction, maintenance and supportive care therapies.
随着免疫调节药物(IMiD)、蛋白酶体抑制剂的发展以及大剂量治疗和自体干细胞移植(HDT + ASCT)安全性的提高,老年多发性骨髓瘤患者的治疗选择已大幅增加。老年患者生物学异质性的认识使得治疗的实施更具挑战性。在有高效治疗选择可供不符合移植条件患者使用的时代,建议采用个体化的治疗选择方法。在此,我们总结了针对被认为不适合HDT + ASCT患者的建议,包括预处理注意事项、诱导、维持和支持性护理治疗。