Lei Matthew, Kim E Bridget, Branagan Andrew, Lou Uvette, Zemel Melanie, Raje Noopur
Department of Pharmacy, Massachusetts General Hospital.
Division of Hematology Oncology, Massachusetts General Hospital Cancer Center.
Rinsho Ketsueki. 2019;60(9):1243-1256. doi: 10.11406/rinketsu.60.1243.
Multiple myeloma is a malignant plasma cell neoplasm that is incurable despite significant progress in treatment over the past several decades. The incorporation of novel agents and combinations into the MM treatment paradigm has resulted in improved survival and tolerability, as well as deeper responses including achieving a minimal residual disease negative state. The addition of new treatment options and combinations has added complexity in treatment selection for myeloma patients. The current strategy for newly diagnosed myeloma involves induction, consolidation, and maintenance therapy. However, nearly all myeloma patients will develop refractory disease. This highlights the need for more effective therapies targeting the myeloma cells and their microenvironment. In this article, we summarize current management of transplant eligible and ineligible newly diagnosed patients in both the upfront and relapsed refractory setting, highlighting risk adapted strategies. We also summarize emerging therapies, such as immune and targeted approaches, as well as drugs with novel mechanisms of action. Emerging strategies offer individualized treatment options and may ultimately offer the possibility of a cure for myeloma patients.
多发性骨髓瘤是一种恶性浆细胞肿瘤，尽管在过去几十年的治疗中取得了显著进展，但仍无法治愈。将新型药物和联合方案纳入多发性骨髓瘤治疗模式已带来生存率提高、耐受性改善，以及包括达到微小残留病阴性状态在内的更深度缓解。新的治疗选择和联合方案的增加给骨髓瘤患者的治疗选择带来了复杂性。新诊断骨髓瘤的当前策略包括诱导、巩固和维持治疗。然而，几乎所有骨髓瘤患者都会发展为难治性疾病。这凸显了针对骨髓瘤细胞及其微环境的更有效疗法的必要性。在本文中，我们总结了在初始治疗和复发难治情况下，适合和不适合移植的新诊断患者的当前管理方法，重点介绍风险适应性策略。我们还总结了新兴疗法，如免疫和靶向方法，以及具有新作用机制的药物。新兴策略提供了个性化治疗选择，并最终可能为骨髓瘤患者带来治愈的可能性。
