Treatment of multiple myeloma: a comprehensive review.
Treatment of multiple myeloma: a comprehensive review.
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DOI：
10.3816/clm.2009.n.056
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发表时间：
2009-08
期刊：
影响因子：
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通讯作者：
Rajkumar SV
中科院分区：
文献类型：
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作者：
Kyle RA;Rajkumar SV
多发性骨髓瘤（MM）是一种导致终末器官损伤（高钙血症、肾功能不全、贫血或骨骼病变）的肿瘤性浆细胞疾病。患者不应接受治疗，除非他们有症状（终末器官损伤）MM。他们应被归类为具有高风险或标准风险的疾病。如果患者存在亚二倍体或常规细胞遗传学检测的13号染色体缺失（del [13]），荧光原位杂交检测的t（4：14）、t（14; 16）、t（14; 20）易位或del（17 p），则将其归类为高风险。高危疾病约占症状性MM患者的25%。如果患者被认为符合自体干细胞移植（ASCT）的条件，3或4个周期的来那度胺和低剂量地塞米松，或硼替佐米和地塞米松，或沙利度胺和地塞米松是合理的选择。然后应该收集干细胞，并可以进行ASCT。如果患者有完全缓解或非常好的部分缓解（VGPR），则可以在不进行维持治疗的情况下对患者进行随访。如果患者的VGPR小于VGPR，则鼓励进行第二次ASCT。如果患者属于高危组，含硼替佐米的方案达到最大缓解，然后再进行2个周期的治疗是合理的方法。来那度胺和低剂量地塞米松是维持治疗直至进展的另一种选择。如果患者被认为不适合ASCT，则建议标准风险患者使用美法仑、泼尼松和沙利度胺，高风险患者使用美法仑、泼尼松和硼替佐米（MPV）。复发性或难治性MM的治疗包括在内。新的治疗方法沙利度胺、硼替佐米和来那度胺提高了生存率。并对MM的并发症进行了描述。多发性骨髓瘤是一种浆细胞肿瘤，其特征在于浆细胞的单个克隆产生单克隆蛋白（M蛋白）。浆细胞的恶性增殖产生骨骼破坏，导致骨痛和病理性骨折。M蛋白可能导致肾功能衰竭、高粘滞综合征，或通过抑制未参与的免疫球蛋白、复发性感染。贫血和高钙血症是常见的并发症。
Multiple myeloma (MM) is a neoplastic plasma cell disorder that results in end-organ damage (hypercalcemia, renal insufficiency, anemia, or skeletal lesions). Patients should not be treated unless they have symptomatic (end-organ damage) MM. They should be classified as having high-risk or standard-risk disease. Patients are classified as high risk in the presence of hypodiploidy or deletion of chromosome 13 (del[13]) with conventional cytogenetics, the presence of t(4:14), t(14;16), t(14;20) translocations or del(17p) with fluorescence in situ hybridization. High-risk disease accounts for about 25% of patients with symptomatic MM. If the patient is deemed eligible for an autologous stem cell transplantation (ASCT), 3 or 4 cycles of lenalidomide and low-dose dexamethasone, or bortezomib and dexamethasone, or thalidomide and dexamethasone are reasonable choices. Stem cells should then be collected and one may proceed with an ASCT. If the patient has a complete response or a very good partial response (VGPR), the patient may be followed without maintenance therapy. If the patient has a less than VGPR, a second ASCT is encouraged. If the patient is in the high-risk group, a bortezomib-containing regimen to maximum response followed by 2 additional cycles of therapy is a reasonable approach. Lenalidomide and low-dose dexamethasone is another option for maintenance until progression. If the patient is considered ineligible for an ASCT, then melphalan, prednisone, and thalidomide is suggested for the standard-risk patient, and melphalan, prednisone, and bortezomib (MPV) for the high-risk patient. Treatment of relapsed or refractory MM is covered. The novel therapies—thalidomide, bortezomib, and lenalidomide—have resulted in improved survival rates. The complications of MM are also described. Multiple myeloma is a plasma cell neoplasm that is characterized by a single clone of plasma cells producing a monoclonal protein (M-protein). The malignant proliferation of plasma cells produces skeletal destruction that leads to bone pain and pathologic fractures. The M-protein might lead to renal failure, hyperviscosity syndrome, or through the suppression of uninvolved immunoglobulins, recurrent infections. Anemia and hypercalcemia are common complications.