Laubach Jacob, Kumar Shaji
Dana-Farber Cancer Institute, Boston, MA, USA.
Mayo Clinic, Rochester, MN, USA.
Cancer Treat Res. 2016;169:145-167. doi: 10.1007/978-3-319-40320-5_9.
Treatment approaches for newly diagnosed myeloma have changed considerably during the past decade, along with a better understanding of the disease heterogeneity. Availability of new drug classes such as proteasome inhibitors and immunomodulatory drugs, and use of these drugs in combinations have led to higher response rates and deeper responses in the vast majority of patients with newly diagnosed myeloma. In addition to improved efficacy, these regimens are tolerated better than those with conventional chemotherapy drugs, which have reduced the early mortality seen in MM, while allowing for successful stem cell collection in patients undergoing stem cell transplant consolidation. Ongoing clinical trials with newer drugs such as monoclonal antibodies are being explored as options for newly diagnosed MM. The optimal regimen continues to evolve and is often dictated by the intent to transplant, age and comorbidities. Despite the increasing response rates seen with the new regimens, autologous stem cell transplantation remains an effective modality for consolidation, further deepening the responses seen with the initial therapy. Post-transplant approaches have further added to the efficacy of this platform with both post-transplant consolidation and maintenance demonstrating value in clinical trials. Currently, the combination of an effective initial therapy followed by one or two autologous stem cell transplants, with or without consolidation followed by maintenance appear to provide the maximum benefit in terms of duration of disease control for patients with newly diagnosed MM.
在过去十年中，随着对疾病异质性的深入了解，新诊断骨髓瘤的治疗方法发生了显著变化。蛋白酶体抑制剂和免疫调节药物等新型药物类别的出现，以及这些药物的联合使用，使绝大多数新诊断骨髓瘤患者的缓解率更高、缓解程度更深。除了疗效提高外，这些治疗方案的耐受性也优于传统化疗药物，降低了多发性骨髓瘤患者的早期死亡率，同时使接受干细胞移植巩固治疗的患者能够成功采集干细胞。正在探索使用单克隆抗体等新型药物进行的临床试验，作为新诊断多发性骨髓瘤的治疗选择。最佳治疗方案仍在不断发展，通常由移植意向、年龄和合并症决定。尽管新方案的缓解率不断提高，但自体干细胞移植仍然是一种有效的巩固治疗方式，可进一步加深初始治疗的缓解程度。移植后治疗方法通过移植后巩固治疗和维持治疗，进一步提高了该治疗平台的疗效，两者在临床试验中均显示出价值。目前，对于新诊断的多发性骨髓瘤患者，有效的初始治疗后进行一到两次自体干细胞移植，无论是否进行巩固治疗后再进行维持治疗，似乎在疾病控制持续时间方面能提供最大益处。
