Morè Sonia, Corvatta Laura, Manieri Valentina Maria, Olivieri Attilio, Offidani Massimo
Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy.
Unità Operativa Complessa di Medicina, Ospedale Profili, 60044 Fabriano, Italy.
Cancers (Basel). 2023 Apr 8;15(8):2203. doi: 10.3390/cancers15082203.
Multiple Myeloma (MM) remains a difficult to treat disease mainly due to its biological heterogeneity, of which we are more and more knowledgeable thanks to the development of increasingly sensitive molecular methods that allow us to build better prognostication models. The biological diversity translates into a wide range of clinical outcomes from long-lasting remission in some patients to very early relapse in others. In NDMM transplant eligible (TE) patients, the incorporation of mAb as daratumumab in the induction regimens, followed by autologous stem cell transplantation (ASCT) and consolidation/maintenance therapy, has led to a significant improvement of PFS and OS.; however, this outcome remains poor in ultra-high risk MM or in those who did not achieve a minimal residual disease (MRD) negativity. Several trials are exploring cytogenetic risk-adapted and MRD-driven therapies in these patients. Similarly, quadruplets-containing daratumumab, particularly when administered as continuous therapies, have improved outcome of patients not eligible for autologous transplant (NTE). Patients who become refractory to conventional therapies have noticeably poor outcomes, making their treatment a difficult challenge in need of novel strategies. In this review, we will focus on the main points regarding risk stratification, treatment and monitoring of MM, highlighting the most recent evidence that could modify the management of this still incurable disease.
多发性骨髓瘤（MM）仍然是一种难以治疗的疾病，主要原因在于其生物学异质性。由于越来越敏感的分子方法的发展，我们对这种异质性的了解越来越多，这些方法使我们能够建立更好的预后模型。生物学多样性转化为广泛的临床结果，从一些患者的长期缓解到另一些患者的早期复发。在适合移植（TE）的新诊断多发性骨髓瘤（NDMM）患者中，在诱导方案中加入达雷妥尤单抗等单克隆抗体（mAb），随后进行自体干细胞移植（ASCT）和巩固/维持治疗，显著改善了无进展生存期（PFS）和总生存期（OS）；然而，在超高风险MM患者或未实现微小残留病（MRD）阴性的患者中，这一结果仍然较差。多项试验正在探索针对这些患者的细胞遗传学风险适应性和MRD驱动的治疗方法。同样，含达雷妥尤单抗的四联方案，特别是连续给药时，改善了不适合自体移植（NTE）患者的预后。对传统治疗难治的患者预后明显较差，使其治疗成为一项需要新策略的艰巨挑战。在本综述中，我们将重点关注MM风险分层、治疗和监测的要点，突出可能改变这种仍无法治愈疾病管理的最新证据。
