Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
Myeloma Unit, Division of Hematology, University of Turin, Turin, Italy.
Blood Rev. 2021 Sep;49:100808. doi: 10.1016/j.blre.2021.100808. Epub 2021 Feb 9.
Despite the recent introduction of new therapies for multiple myeloma (MM), it remains an incurable disease. As MM progresses, patients experience cycles of relapse and remission, with remission periods becoming increasingly shorter as the disease becomes less treatment-sensitive. The treatment of relapsed refractory MM (RRMM) remains a significant clinical challenge. Patients with RRMM are a highly heterogeneous group and choosing the most appropriate treatment requires careful consideration. Furthermore, the number of treatment options for MM is continually growing with no definitive consensus to guide treating clinicians. The emergence of second-generation proteasome inhibitors (e.g., carfilzomib and ixazomib), immunomodulatory drugs (e.g., pomalidomide) and monoclonal antibodies (e.g., isatuximab) has expanded an already complex treatment landscape. This review provides a clear summary of the available treatments for MM and discusses how to tailor treatments to individual patients' needs. Novel treatments currently under clinical development, including venetoclax, melflufen and CAR T-cell therapies, are also discussed.
尽管最近已经引入了多种多发性骨髓瘤 (MM) 的新疗法，但它仍然是一种不可治愈的疾病。随着 MM 的进展，患者经历复发和缓解的周期，随着疾病对治疗的敏感性降低，缓解期变得越来越短。复发性难治性多发性骨髓瘤 (RRMM) 的治疗仍然是一个重大的临床挑战。RRMM 患者是一个高度异质的群体，选择最合适的治疗方法需要仔细考虑。此外，MM 的治疗选择数量不断增加，没有明确的共识来指导治疗临床医生。第二代蛋白酶体抑制剂（如卡非佐米和伊沙佐米）、免疫调节药物（如泊马度胺）和单克隆抗体（如依沙妥昔单抗）的出现，使已经复杂的治疗领域进一步扩大。这篇综述清楚地总结了 MM 的现有治疗方法，并讨论了如何根据患者的个体需求定制治疗方法。目前正在临床开发中的新型治疗方法，包括 venetoclax、melflufen 和 CAR T 细胞疗法，也进行了讨论。
