Bobin Arthur, Leleu Xavier
Department of Hematology, University Hospital of Poitiers, 2 rue de la Milétrie, CHU de Poitiers, Poitiers, France.
Fac Rev. 2022 Sep 29;11:28. doi: 10.12703/r/11-28. eCollection 2022.
The recent history of multiple myeloma has been marked by tremendous advances in the treatments available, which have ultimately improved the patients' survival. Immune-based therapies, starting with the emergence of anti-CD38 monoclonal antibodies, whose impact is seen across all groups of patients, are probably the greatest evolution in the field of myeloma so far. Building on the efficacy of immunotherapy, "modern" immunological treatments such as CAR-T cells or bispecific antibodies are being developed. There clearly are lots of expectations for these novel immunotherapies, and, though first developed in relapsed myeloma, they will surely challenge the current strategies in early lines of treatment. Immunotherapy, since the development of anti-CD38, is a milestone in the treatment of myeloma and has already led to many paradigm shifts. Nevertheless, myeloma remains an incurable disease and diversified options are still required, notably for heavily pretreated patients. Non-immune-based treatments, which were responsible for most successes previously, are not to be completely abandoned. Novel pathophysiological mechanisms have been unraveled in the past few years, and thus, new targets have been identified, leading to the development of new drugs and new drug classes, such as XPO1 inhibitors and anti-BCL-2. Overall, the future of multiple myeloma is full of possibilities and considerable changes are still expected in the sequencing of treatments in the years to come.
多发性骨髓瘤的近期发展历程以现有治疗方法的巨大进步为标志，这些进步最终提高了患者的生存率。基于免疫的疗法，从抗CD38单克隆抗体的出现开始，其影响在所有患者群体中都能看到，这可能是迄今为止骨髓瘤领域最大的进展。在免疫疗法疗效的基础上，正在开发诸如CAR-T细胞或双特异性抗体等“现代”免疫治疗方法。显然，人们对这些新型免疫疗法寄予厚望，而且，尽管它们最初是在复发型骨髓瘤中开发的，但肯定会挑战早期治疗的现有策略。自抗CD38开发以来，免疫疗法是骨髓瘤治疗的一个里程碑，已经导致了许多模式转变。然而，骨髓瘤仍然是一种无法治愈的疾病，仍然需要多样化的选择，特别是对于经过大量预处理的患者。以前取得了大多数成功的非免疫疗法也不应被完全抛弃。在过去几年里，新的病理生理机制已经被揭示，因此，新的靶点已经被确定，从而导致了新药和新药物类别的开发，如XPO1抑制剂和抗BCL-2。总体而言，多发性骨髓瘤的未来充满可能性，预计在未来几年治疗顺序方面仍会有相当大的变化。
