Hospital Universitario de Salamanca-Instituto Biosanitario de Salamanca, Salamanca, Spain; and.
Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Navarra, Spain.
Hematology Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):498-507. doi: 10.1182/asheducation-2017.1.498.
Multiple myeloma is the second most frequent hematological disease. The introduction of melphalan as high-dose therapy followed by autologous hematopoietic cell transplantation (HDT/ASCT) for young patients and the availability of novel agents for young and elderly patients with multiple myeloma have dramatically changed the perspective of treatment. However, further research is necessary if we want definitively to cure the disease. Treatment goals for transplant-eligible and non-transplant-eligible patients should be to prolong survival by achieving the best possible response while ensuring quality of life. For young patients, HDT-ASCT is a standard of care for treatment, and its efficacy has been enhanced and challenged by the new drugs. For elderly patients, treatment options were once limited to alkylators, but new upfront treatment combinations based on novel agents (proteasome inhibitors and immunomodulatory drugs) combined or not with alkylators have significantly improved outcomes. Extended treatment of young and elderly patients improves the quality and duration of clinical responses; however, the optimal scheme, appropriate doses, and duration of long-term therapy have not yet been fully determined. This review summarizes progress in the treatment of patients with newly diagnosed multiple myeloma, addressing critical questions such as the optimal induction, early vs late ASCT, consolidation and/or maintenance for young patients, and how we can choose the best treatment option for non-transplant-eligible patients.
多发性骨髓瘤是第二大常见的血液系统疾病。马法兰作为大剂量化疗药物的应用，随后在年轻患者中进行自体造血细胞移植（HDT/ASCT），以及新型药物在年轻和老年多发性骨髓瘤患者中的应用，极大地改变了治疗的前景。然而，如果我们想要明确治愈这种疾病，还需要进一步的研究。对于适合移植和不适合移植的患者，治疗目标应该是通过获得最佳反应来延长生存时间，同时确保生活质量。对于年轻患者，HDT-ASCT 是治疗的标准，新型药物增强并挑战了其疗效。对于老年患者，治疗选择曾经仅限于烷化剂，但基于新型药物（蛋白酶体抑制剂和免疫调节剂）的新的一线治疗组合，与烷化剂联合或不联合，显著改善了预后。对年轻和老年患者的延长治疗提高了临床反应的质量和持续时间；然而，最佳方案、适当剂量和长期治疗的持续时间尚未完全确定。本综述总结了新诊断多发性骨髓瘤患者治疗的进展，解决了关键问题，如最佳诱导、早期与晚期 ASCT、年轻患者的巩固和/或维持，以及我们如何为不适合移植的患者选择最佳治疗方案。
