Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Expert Rev Hematol. 2021 Dec;14(12):1059-1069. doi: 10.1080/17474086.2021.1984225. Epub 2021 Sep 28.
Multiple myeloma is preceded by the early stages: monoclonal gammopathy of unknown significance (M.G.U.S.) and smoldering myeloma (S.M.M.), which are less genomically complex and where patients are overall healthier with preserved quality of life.
This review focuses on the current evidence in risk stratification and initial therapy for these patients with the goal to delay progression to and/or cure multiple myeloma.
Advances in the understanding of the factors that contribute to myeloma evolution coupled with new therapeutics that have high efficacy and limited toxicity have revolutionized our approach to early myeloma. Although our current recommendation continues to be to observe S.M.M. outside of clinical trials, the clinical benefit of lenalidomide sets the stage for combinations with immunotherapy, which, in our opinion, will likely lead to regulatory approvals and more widespread treatment of early myeloma.
多发性骨髓瘤之前存在早期阶段：意义未明的单克隆丙种球蛋白血症（MGUS）和冒烟型骨髓瘤（SMM），这些阶段的基因组复杂性较低，患者整体更为健康，生活质量得以保持。
本文重点介绍了这些患者的风险分层和初始治疗的最新证据，旨在延缓多发性骨髓瘤的进展和/或治愈。
对导致骨髓瘤演变的因素的理解的进步，加上具有高疗效和低毒性的新型治疗方法，彻底改变了我们对早期骨髓瘤的治疗方法。尽管我们目前的建议仍然是在临床试验之外观察 SMM，但来那度胺的临床获益为免疫治疗的联合治疗奠定了基础，我们认为，这可能会导致监管部门的批准，并更广泛地治疗早期骨髓瘤。
