Dimopoulos Meletios A, Terpos Evangelos, Boccadoro Mario, Moreau Philippe, Mateos María-Victoria, Zweegman Sonja, Cook Gordon, Engelhardt Monika, Delforge Michel, Hajek Roman, Schjesvold Fredrik, Gay Francesca, Manier Salomon, Weisel Katja C, Kaiser Martin, van de Donk Niels W C J, Zamagni Elena, Rodriguez-Otero Paula, Perrot Aurore, Driessen Christoph, Bila Jelena, Laane Edward, Dytfeld Dominik, Touzeau Cyrille, Beksac Meral, Raab Marc S, Cavo Michele, Mohty Mohamad, Spencer Andrew, Ludwig Heinz, Einsele Hermann, San-Miguel Jesus, Sonneveld Pieter
Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
University Division of Hematology, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Nat Rev Clin Oncol. 2025 Jul 7. doi: 10.1038/s41571-025-01041-x.
Since the publication in 2021 of the European Hematology Association (EHA) Clinical Practice Guidelines for the treatment of patients with smouldering multiple myeloma (SMM) and multiple myeloma (MM), developed in collaboration with the European Society for Medical Oncology, a novel international staging system (R2-ISS) has been developed, several prognostic factors are entering clinical practice (such as minimal residual disease, circulating plasma cells and monoclonal protein assessed by mass spectrometry) and, at the time of writing, 14 novel regimens have been approved by the EMA and/or the FDA for the treatment of patients with MM. A multidisciplinary group of experts from the EHA and European Myeloma Network, based in various institutions mostly located in Europe, have updated the previous guidelines and produced algorithms for everyday clinical practice that incorporate levels of evidence and grades of recommendation based on the aforementioned new data. In these Evidence-Based Guidelines, we provide key treatment recommendations for both patients with newly diagnosed MM and those with relapsed and/or refractory MM, including guidance for the use of established drugs as well as contemporary immunotherapies. Novel approaches for the management of patients with SMM focus on those who might require early intervention. Finally, we provide recommendations for myeloma-related complications and adverse events, such as bone disease, renal impairment and infections, as well as for those associated with T cell-mobilizing therapies, such as cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome.
自2021年与欧洲医学肿瘤学会合作制定的欧洲血液学协会（EHA）关于冒烟型多发性骨髓瘤（SMM）和多发性骨髓瘤（MM）患者治疗的临床实践指南发布以来，一种新的国际分期系统（R2-ISS）已被开发出来，多种预后因素正在进入临床实践（如微小残留病、循环浆细胞和通过质谱评估的单克隆蛋白），并且在撰写本文时，已有14种新方案被欧洲药品管理局（EMA）和/或美国食品药品监督管理局（FDA）批准用于治疗MM患者。来自EHA和欧洲骨髓瘤网络的多学科专家小组，大多来自位于欧洲的不同机构，他们更新了先前的指南，并制定了适用于日常临床实践的算法，这些算法纳入了基于上述新数据的证据水平和推荐等级。在这些循证指南中，我们为新诊断的MM患者以及复发和/或难治性MM患者提供了关键的治疗建议，包括使用既定药物以及当代免疫疗法的指导。SMM患者管理的新方法侧重于那些可能需要早期干预的患者。最后，我们为骨髓瘤相关并发症和不良事件提供了建议，如骨病、肾功能损害和感染，以及与T细胞动员疗法相关的并发症和不良事件，如细胞因子释放综合征和免疫效应细胞相关神经毒性综合征。
