Tandon Nidhi, Kumar Shaji K
Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55906 USA.
Indian J Hematol Blood Transfus. 2017 Jun;33(2):153-158. doi: 10.1007/s12288-017-0796-x. Epub 2017 Feb 28.
This review discusses the landmark studies in the field of multiple myeloma (MM) which were presented at American society of hematology annual meeting, 2016. There were contrary results from two large phase III trials (one from US and one from Europe) that evaluated the role of additional interventions like tandem autologous transplant (ASCT) and consolidation after induction therapy followed by ASCT in newly diagnosed MM (NDMM) patients, but there were critical differences between the two studies. Novel agents like carfilzomib and ixazomib proved to be of benefit when used as induction and post ASCT consolidation and maintenance in NDMM. The early data on subcutaneous administration of daratumumab (DARA) looked promising. The high rate of minimal residual disease negativity after using DARA even in relapsed/refractory MM (RRMM) setting reinforces the benefit of targeting CD38. The responses seen with venetoclax in RRMM with t(11;14)(high BCL-2, low BCL-XL and MCL-1) and selinexor in penta-refractory myeloma which fulfills the FDA category of unmet need, opens up newer options for these patients. BCMA CAR-T infusion shows encouraging results in advanced refractory myeloma patients.
本综述讨论了在2016年美国血液学会年会上发表的多发性骨髓瘤(MM)领域的里程碑式研究。两项大型III期试验(一项来自美国,一项来自欧洲)评估了串联自体移植(ASCT)等额外干预措施以及诱导治疗后进行ASCT巩固治疗在新诊断MM(NDMM)患者中的作用,结果相互矛盾,但两项研究存在关键差异。卡非佐米和伊沙佐米等新型药物在NDMM患者中用作诱导治疗以及ASCT后的巩固和维持治疗时被证明有益。皮下注射达雷妥尤单抗(DARA)的早期数据看起来很有前景。即使在复发/难治性MM(RRMM)患者中使用DARA后,微小残留病阴性率也很高,这进一步证明了靶向CD38的益处。维奈克拉在伴有t(11;14)(高BCL-2、低BCL-XL和MCL-1)的RRMM患者中以及塞利尼索在符合美国食品药品监督管理局未满足需求类别标准的五重难治性骨髓瘤患者中所观察到的反应,为这些患者开辟了新的选择。B细胞成熟抗原嵌合抗原受体T细胞(BCMA CAR-T)输注在晚期难治性骨髓瘤患者中显示出令人鼓舞的结果。