Department of Haematology, St Vincent's Hospital, Sydney, Australia.
University of New South Wales, Medicine and Health, Sydney, Australia.
Br J Haematol. 2022 Oct;199(2):190-204. doi: 10.1111/bjh.18295. Epub 2022 Jul 7.
For patients with newly diagnosed multiple myeloma, survival outcomes continue to improve significantly: however, nearly all patients will relapse following induction treatment. Optimisation of induction therapy is essential to provide longer term disease control and the current standard of care for most patients incorporates an immunomodulatory agent and proteasome inhibitor, most commonly lenalidomide and bortezomib in combination with dexamethasone (RVD), with maintenance until progression. Historically there has been limited access to RVD as an induction strategy outside of the United States; fortunately, there is now increasing access worldwide. This review discusses the rationale for use of RVD as induction therapy and aims to provide guidance in prescribing this regimen in order to optimise efficacy while minimising the toxicities of treatment. We also highlight the increasing evidence for the utility of addition of a monoclonal antibody to the RVD backbone to deepen responses and potentially provide longer disease control.
对于新诊断为多发性骨髓瘤的患者，其生存结果继续显著改善：然而，几乎所有患者在诱导治疗后都会复发。诱导治疗的优化对于提供更长期的疾病控制至关重要，目前大多数患者的护理标准包括免疫调节剂和蛋白酶体抑制剂，最常见的是来那度胺和硼替佐米联合地塞米松（RVD），并在进展前维持治疗。历史上，在美国以外地区，RVD 作为诱导策略的应用机会有限；幸运的是，现在全球范围内获得 RVD 的机会越来越多。这篇综述讨论了将 RVD 作为诱导治疗的原理，并旨在为开具该方案提供指导，以优化疗效，同时将治疗的毒性降至最低。我们还强调了添加单克隆抗体到 RVD 骨干以加深反应并可能提供更长的疾病控制的证据越来越多。
