Moreau Philippe, Touzeau Cyrille, Vij Ravi, Goldsmith Scott R, Rosko Ashley E
Department of Hematology, University Hospital, Nantes, France.
Washington University School of Medicine, St. Louis, MO.
Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-15. doi: 10.1200/EDBK_280221.
Over the last few years, there has been great progress in the treatment of multiple myeloma (MM), with many new agents and combinations having been approved and being now routinely incorporated into treatment strategies for newly diagnosed patients. As a result, patients are experiencing benefits in terms of survival and better tolerance. However, the multitude of treatment options also presents a challenge to select the best options tailored to the specific patient situation. Frontline autologous stem cell transplantation (ASCT) is the standard of care for fit patients younger than age 71 who are newly diagnosed with MM, and triplet combinations are the backbone of induction therapy before ASCT. Post-transplant consolidation and prolonged lower-intensity maintenance are two strategies that have been used to deepen responses and delay progression. For older patients not eligible for ASCT, lenalidomide (len) is increasingly being used as part of frontline therapy, and current approaches are now targeting combinations of anti-CD38 antibodies. Strategies for selecting therapeutic regimens for older adults newly diagnosed with MM can be augmented with use of predictive tools to better capture physiologic age and estimate treatment tolerance. Here we review a decade of trials identifying clinical endpoints and toxicities relevant for the frontline treatment of younger patients and older adults.
在过去几年中，多发性骨髓瘤（MM）的治疗取得了巨大进展，许多新药物和联合方案已获批准，目前已常规纳入新诊断患者的治疗策略中。因此，患者在生存和耐受性方面都受益。然而，众多的治疗选择也带来了挑战，即要为特定患者情况选择最佳方案。一线自体干细胞移植（ASCT）是年龄小于71岁、新诊断为MM的适合患者的标准治疗方法，三联组合是ASCT前诱导治疗的基础。移植后巩固和延长低强度维持是用于加深缓解和延迟进展的两种策略。对于不符合ASCT条件的老年患者，来那度胺（len）越来越多地被用作一线治疗的一部分，目前的方法正以抗CD38抗体的联合使用为目标。使用预测工具可以更好地把握生理年龄并估计治疗耐受性，从而增强为新诊断的老年MM患者选择治疗方案的策略。在此，我们回顾了十年来的试验，这些试验确定了与年轻患者和老年患者一线治疗相关的临床终点和毒性。
