Tsukada Nobuhiro
Department of Hematology, Japanese Red Cross Medical Center.
Rinsho Ketsueki. 2023;64(9):1066-1073. doi: 10.11406/rinketsu.64.1066.
Treatment outcomes of multiple myeloma (MM) have dramatically improved in the past 20 years. The IFM/DFCI group reported that triplet induction (bortezomib, lenalidomide, and dexamethasone), followed by up-front high-dose melphalan and autologous stem cell transplantation (HDM/ASCT) and maintenance therapy, demonstrated a median progression-free survival (PFS) of 50 months. Therefore, up-front HDM/ASCT is considered standard care even in the era of novel agents. Daratumumab, lenalidomide, and dexamethasone have also been reported to prolong PFS for newly diagnosed transplant-ineligible MM. Quadruplet induction, including anti-CD38 antibody, will be approved even for transplant-eligible MM soon. Conversely, the success of chimeric antigen receptor T-cell therapy revealed that cellular immunotherapy may play an important role in treating MM. This review discussed the current standard of care and future perspectives for transplant-eligible MM.
在过去20年中，多发性骨髓瘤（MM）的治疗效果有了显著改善。IFM/DFCI研究组报告称，三联诱导疗法（硼替佐米、来那度胺和地塞米松），随后进行早期大剂量美法仑和自体干细胞移植（HDM/ASCT）以及维持治疗，显示无进展生存期（PFS）的中位数为50个月。因此，即使在新型药物时代，早期HDM/ASCT仍被视为标准治疗方案。据报道，达雷妥尤单抗、来那度胺和地塞米松也可延长新诊断的不适合移植的MM患者的PFS。包括抗CD38抗体在内的四联诱导疗法很快甚至将被批准用于适合移植的MM患者。相反，嵌合抗原受体T细胞疗法的成功表明，细胞免疫疗法可能在MM治疗中发挥重要作用。本文综述讨论了适合移植的MM患者当前的治疗标准和未来展望。
