From transplant to novel cellular therapies in multiple myeloma: European Myeloma Network guidelines and future perspectives.
From transplant to novel cellular therapies in multiple myeloma: European Myeloma Network guidelines and future perspectives.
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DOI：
10.3324/haematol.2017.174573
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发表时间：
2018-03
期刊：
影响因子：
10.1
通讯作者：
Sonneveld P
中科院分区：
文献类型：
--
作者：
Gay F;Engelhardt M;Terpos E;Wäsch R;Giaccone L;Auner HW;Caers J;Gramatzki M;van de Donk N;Oliva S;Zamagni E;Garderet L;Straka C;Hajek R;Ludwig H;Einsele H;Dimopoulos M;Boccadoro M;Kröger N;Cavo M;Goldschmidt H;Bruno B;Sonneveld P
骨髓瘤患者的生存率随着自体干细胞移植和新型药物如蛋白酶体抑制剂、免疫调节药物和单克隆抗体的使用而大大提高。与单独以硼替佐米和来那度胺为基础的方案相比，自体移植后加入大剂量美法兰可显著提高无进展生存期，尽管在所有试验中并未观察到总体生存获益。此外，近期试验的随访时间仍然太短，无法显示生存率的任何差异。鉴于这些发现，新型药物诱导后自体移植被认为是符合条件的患者的标准前期治疗（证据等级：1A）。移植后巩固和维持治疗可进一步改善患者预后（1A）。几种新型药物的可用性导致了多种联合治疗方案的发展，如救助治疗方案。在这种情况下，打捞性自体移植和同种异体移植的作用还没有得到广泛的评估。在前期自体移植后缓解期延长的情况下，复发时可以考虑另一次自体移植（2B）。早期复发和/或具有高危特征的患者预后较差，可能被认为是临床试验的候选者，在年轻和健康的患者中，也可能包括异体移植物联合新型药物（2B）。正在进行的研究正在评估新型细胞疗法的作用，例如包含基于抗体的三胞胎和四胞胎，以及嵌合抗原受体- t细胞。尽管初步结果令人鼓舞，但在广泛推荐这些新疗法的临床应用之前，还需要更长的随访时间和更多的患者数量。
Survival of myeloma patients has greatly improved with the use of autologous stem cell transplantation and novel agents, such as proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies. Compared to bortezomib- and lenalidomide-based regimens alone, the addition of high-dose melphalan followed by autologous transplantation significantly improves progression-free survival, although an overall survival benefit was not observed in all trials. Moreover, follow up of recent trials is still too short to show any difference in survival. In the light of these findings, novel agent-based induction followed by autologous transplantation is considered the standard upfront treatment for eligible patients (level of evidence: 1A). Post-transplant consolidation and maintenance treatment can further improve patient outcome (1A). The availability of several novel agents has led to the development of multiple combination regimens such as salvage treatment options. In this context, the role of salvage autologous transplantation and allotransplant has not been extensively evaluated. In the case of prolonged remission after upfront autologous transplantation, another autologous transplantation at relapse can be considered (2B). Patients who experience early relapse and/or have high-risk features have a poor prognosis and may be considered as candidates for clinical trials that, in young and fit patients, may also include an allograft in combination with novel agents (2B). Ongoing studies are evaluating the role of novel cellular therapies, such as inclusion of antibody-based triplets and quadruplets, and chimeric antigen receptor-T cells. Despite encouraging preliminary results, longer follow up and larger patient numbers are needed before the clinical use of these novel therapies can be widely recommended.
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影响因子：
168.9
作者：
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