Section of Hematology, Department of Internal Medicine, Yale School of Medicine University, New Haven, CT, USA.
Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Blood Rev. 2023 Nov;62:101116. doi: 10.1016/j.blre.2023.101116. Epub 2023 Jul 14.
Frontline therapy for multiple myeloma (MM) is evolving to include novel combinations that can achieve unprecedented deep response rates. Several treatment strategies exist, varying in induction regimen composition, use of transplant and or consolidation and maintenance. In this sea of different treatment permutations, the overarching theme is the powerful prognostic factors of disease risk and achievement of minimal residual disease (MRD) negativity. MM has significant inter-patient variability that requires treatment to be individualized. Risk-adapted and response-adapted strategies which are increasingly being explored to define the extent and duration of therapy, and eventually aim for functional curability. In addition, with T-cell redirection therapies rapidly revolutionizing myeloma treatments, the current standard of care for myeloma will change. This review analyzes the current relevant literature in upfront therapy for fit myeloma patients and provides suggestions for treatment approach while novel clinical trials are maturing.
多发性骨髓瘤（MM）的一线治疗正在发展为包括新的联合治疗，以达到前所未有的深度缓解率。有几种治疗策略，其诱导方案组成、移植和/或巩固和维持的应用各不相同。在这众多不同的治疗组合中，最重要的主题是疾病风险和达到微小残留病（MRD）阴性的有力预后因素。MM 存在显著的患者间变异性，需要个体化治疗。风险适应和反应适应策略正在被越来越多地探索，以确定治疗的范围和持续时间，并最终实现功能性治愈。此外，随着 T 细胞重定向疗法迅速改变骨髓瘤的治疗方法，骨髓瘤的当前标准治疗将会改变。本综述分析了适合骨髓瘤患者的一线治疗的当前相关文献，并在新的临床试验不断成熟的情况下提供了治疗方法的建议。
