Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Blood Cancer J. 2020 Aug 22;10(8):84. doi: 10.1038/s41408-020-00350-x.
Multiple myeloma (MM) is a clonal plasma cell malignancy affecting a predominantly elderly population. The continued development of newer therapies with novel mechanisms of action has reshaped the treatment paradigm of this disorder in the last two decades, leading to a significantly improved prognosis. This has in turn resulted in an increasing number of patients in need of therapy for relapsed/refractory disease. Immune-based therapies, including monoclonal antibodies, immune checkpoint inhibitors, and most promisingly, adoptive cellular therapies represent important therapeutic strategies in these patients due to their non-cross resistant mechanisms of actions with the usual frontline therapies comprising of immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs). The anti-CD38 antibodies daratumumab and more recently isatuximab, with their excellent efficacy and safety profile along with its synergy in combination with IMiDs and PIs, are being increasingly incorporated in the frontline setting. Chimeric antigen receptor-T cell (CART) therapies and bi-specific T-cell engager (BiTE) represent exciting new options that have demonstrated efficacy in heavily pretreated and refractory MM. In this review, we discuss the rationale for use of immune-based therapies in MM and summarize the currently available literature for common antibodies and CAR-T therapies that are utilized in MM.
多发性骨髓瘤（MM）是一种影响主要为老年人群的克隆性浆细胞恶性肿瘤。在过去二十年中，新型作用机制的新型疗法的不断发展，改变了这种疾病的治疗模式，显著改善了预后。这反过来又导致越来越多的患者需要治疗复发/难治性疾病。免疫疗法，包括单克隆抗体、免疫检查点抑制剂，以及最有希望的是，过继细胞疗法，由于其与通常包括免疫调节剂（IMiDs）和蛋白酶体抑制剂（PIs）的一线治疗药物的非交叉耐药机制，在这些患者中代表了重要的治疗策略。抗 CD38 抗体达雷妥尤单抗和最近的伊沙妥昔单抗，因其出色的疗效和安全性，以及与 IMiDs 和 PIs 的协同作用，正越来越多地被纳入一线治疗。嵌合抗原受体-T 细胞（CART）疗法和双特异性 T 细胞衔接器（BiTE）是令人兴奋的新选择，它们在经过大量预处理和难治性 MM 中显示出疗效。在这篇综述中，我们讨论了在 MM 中使用免疫疗法的基本原理，并总结了目前在 MM 中使用的常见抗体和 CAR-T 疗法的现有文献。
