a "Seràgnoli" Institute of Hematology and Medical Oncology , Bologna University School of Medicine , Bologna , Italy.
b Department of Clinical Therapeutics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
Expert Rev Hematol. 2018 Mar;11(3):219-237. doi: 10.1080/17474086.2018.1437345. Epub 2018 Feb 16.
Guidelines provide recommendations on the management of multiple myeloma (MM), but there are no standard algorithms for the choice and sequencing of treatments. As a result, there is widespread variation in the interpretation and implementation of these guidelines. Areas covered: This review will cover: the real-world data on MM treatment patterns; the approved agents available for the treatment of MM; a comparative summary of the national and international clinical guidelines; a discussion on the impact reimbursement decisions have on treatment availability. Expert commentary: In the future, treatment choices may become even more complex as clonal heterogeneity is better understood in the context of response to treatment, and next-generation agents become available. Although information on real-world practice patterns can provide further guidance, to date, few studies have generated data on patients treated with the newer agents in real-world settings. Furthermore, the translation of guideline recommendations into clinical practice across Europe is inconsistent. Additional real-world data are therefore vital to understanding current clinical practice patterns, so that new agents can be effectively incorporated into existing treatment strategies. Such information may aid the development of better guidance, which will ultimately help to ensure that patients receive the best possible care.
指南提供了多发性骨髓瘤（MM）治疗的建议，但对于治疗的选择和顺序没有标准的算法。因此，这些指南的解释和实施存在广泛的差异。
MM 治疗模式的真实世界数据；可用于 MM 治疗的已批准药物；对国家和国际临床指南的比较总结；关于报销决策对治疗可及性的影响的讨论。
随着对治疗反应背景下的克隆异质性的理解的加深，以及下一代药物的出现，未来的治疗选择可能会变得更加复杂。尽管关于真实世界实践模式的信息可以提供进一步的指导，但迄今为止，很少有研究在真实环境中对使用新型药物治疗的患者生成数据。此外，欧洲各地将指南建议转化为临床实践的情况并不一致。因此，额外的真实世界数据对于了解当前的临床实践模式至关重要，以便将新的药物有效地纳入现有的治疗策略中。这些信息可能有助于制定更好的指导方针，最终有助于确保患者得到最佳的护理。
