Agarwal Amit, Chow Eric, Bhutani Manisha, Voorhees Peter M, Friend Reed, Usmani Saad Z
Division of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ.
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
Clin Lymphoma Myeloma Leuk. 2017 Feb;17(2):69-77. doi: 10.1016/j.clml.2016.11.010. Epub 2016 Nov 23.
Considerable advances have been made in the treatment of relapsed and relapsed/refractory multiple myeloma, with numerous novel agents and combination strategies receiving regulatory approval worldwide during the past several years. An increasing body of phase III data has clearly demonstrated increased overall response rates, improved depths of response, and more durable responses when a third novel agent is incorporated into lenalidomide-dexamethasone and bortezomib-dexamethasone platforms, in most cases with acceptable toxicity. The carfilzomib-dexamethasone doublet has also demonstrated promising activity. With this rapid progress has come many new questions. We review the data supporting the use of these novel treatment paradigms for relapsed/refractory multiple myeloma, discuss the place of autologous and allogeneic hematopoietic stem cell transplantation in this rapidly evolving treatment space, and propose strategies to best use these regimens, considering the disease, host, and previous treatment factors.
在复发和复发/难治性多发性骨髓瘤的治疗方面已经取得了相当大的进展，在过去几年中，众多新型药物和联合治疗策略在全球范围内获得了监管批准。越来越多的III期数据清楚地表明，当在来那度胺-地塞米松和硼替佐米-地塞米松方案中加入第三种新型药物时，总体缓解率提高、缓解深度改善且缓解更持久，在大多数情况下毒性可接受。卡非佐米-地塞米松双联方案也显示出有前景的活性。随着这一快速进展出现了许多新问题。我们回顾支持将这些新型治疗模式用于复发/难治性多发性骨髓瘤的数据，讨论自体和异基因造血干细胞移植在这个快速发展的治疗领域中的地位，并考虑疾病、宿主和既往治疗因素，提出最佳使用这些方案的策略。
