Massachusetts General Hospital Cancer Center, Boston, MA.
JCO Oncol Pract. 2020 Jan;16(1):5-14. doi: 10.1200/JOP.19.00244.
The treatment of multiple myeloma (MM) continues to evolve with the approval of numerous agents over the past decade. Advances in treatment have led to the incorporation of these newer therapies into the treatment paradigm, with improvements in overall survival and the possibility of deep responses including a minimal residual disease-negative state. The strategy of triplet therapies for patients with newly diagnosed MM, followed by high-dose chemotherapy and autologous stem-cell transplantation for eligible patients, and subsequently consolidation and maintenance therapy, is the current treatment roadmap for patients. However, patients with MM will ultimately develop refractoriness to antimyeloma therapies. In this article, we summarize our current practice of managing patients with MM. We highlight our approach to patients with newly diagnosed MM who are transplantation eligible and ineligible and highlight risk-adapted strategies for these patients. In addition, we discuss our approach to the management of patients with relapsed or refractory MM. Last, we review standard therapies and emerging strategies such as targeted approaches, immune-based therapies, and drugs with novel mechanisms of action. Trials evaluating chimeric antigen receptor T cells targeting B-cell maturation antigen are ongoing and are only one of several novel approaches targeting cell maturation antigen, which include the use of bispecific T-cell engager antibodies and antibody drug conjugates. Emerging therapies offer the promise of more individualized approaches in the management of patients with MM and ultimately may result in the possibility of being one step closer to curing patients with MM.
在过去十年中，随着众多药物的批准，多发性骨髓瘤（MM）的治疗方法不断发展。治疗方法的进步使得这些新疗法被纳入治疗模式，从而提高了总体生存率，并有可能实现深度反应，包括达到微小残留病灶阴性状态。对于新诊断的 MM 患者，采用三联疗法，然后对符合条件的患者进行高剂量化疗和自体干细胞移植，随后进行巩固和维持治疗，这是目前患者的治疗方案。然而，MM 患者最终会对骨髓瘤治疗产生耐药性。本文总结了我们目前对 MM 患者的管理实践。我们重点介绍了我们对适合和不适合移植的新诊断 MM 患者的治疗方法，并强调了针对这些患者的风险适应策略。此外，我们还讨论了我们对复发或难治性 MM 患者的管理方法。最后，我们回顾了标准治疗方法和新兴策略，如靶向治疗、免疫治疗以及具有新型作用机制的药物。正在进行针对 B 细胞成熟抗原的嵌合抗原受体 T 细胞的临床试验，这只是针对细胞成熟抗原的几种新方法之一，包括使用双特异性 T 细胞衔接抗体和抗体药物偶联物。新兴疗法有望为 MM 患者的管理提供更个体化的方法，最终可能使我们更接近治愈 MM 患者的目标。
