Sonneveld Pieter, Broijl Annemiek
Erasmus MC Cancer Institute, Department of Hematology, Rm Na824, Rotterdam, the Netherlands
Erasmus MC Cancer Institute, Department of Hematology, Rm Na824, Rotterdam, the Netherlands.
Haematologica. 2016 Apr;101(4):396-406. doi: 10.3324/haematol.2015.129189.
The approach to the patient with relapsed or relapsed/refractory multiple myeloma (RRMM) requires a careful evaluation of the results of previous treatments, the toxicities associated with them and an assessment of prognostic factors. Since the majority of patients will have received prior therapy with drug combinations including a proteasome inhibitor and/or an immunomodulatory drug (IMiD), it is the physician's task to choose the right moment for the start of therapy and define with the patient which goals need to be achieved. The choice of regimen is usually based on prior responsiveness, drugs already received, prior adverse effects, the condition of the patient and expected effectiveness and tolerability. Many double and triple drug combinations are available. In addition, promising new drugs like pomalidomide, carfilzomib and monoclonal antibodies are, or will be, available shortly, while other options can be tried in clinical studies. Finally, supportive care and palliative options need to be considered in some patients. It is becoming increasingly more important to consider the therapeutic options for the whole duration of the disease rather than take a step by step approach, and to develop a systematic approach for each individual patient.
对于复发或复发/难治性多发性骨髓瘤（RRMM）患者的治疗方法，需要仔细评估先前治疗的结果、与之相关的毒性以及预后因素。由于大多数患者此前已接受过包括蛋白酶体抑制剂和/或免疫调节药物（IMiD）在内的联合药物治疗，因此医生的任务是选择合适的治疗起始时机，并与患者明确需要实现的目标。治疗方案的选择通常基于先前的反应性、已使用的药物、先前的不良反应、患者状况以及预期的有效性和耐受性。有许多双联和三联药物组合可供选择。此外，像泊马度胺、卡非佐米和单克隆抗体等有前景的新药已经或即将上市，而其他选择可在临床研究中尝试。最后，在某些患者中需要考虑支持性治疗和姑息治疗方案。考虑疾病整个病程的治疗选择而非采取循序渐进的方法，并为每个患者制定系统的治疗方法变得越来越重要。
