Current and emerging treatment options for patients with relapsed myeloma.
Current and emerging treatment options for patients with relapsed myeloma.
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DOI：
10.4137/cmo.s8014
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发表时间：
2013-08-19
期刊：
影响因子：
--
通讯作者：
Cugno M
中科院分区：
文献类型：
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作者：
Castelli R;Gualtierotti R;Orofino N;Losurdo A;Gandolfi S;Cugno M
多发性骨髓瘤（MM）是一种肿瘤疾病。骨髓中克隆浆细胞增殖产生单克隆蛋白，可在血清或尿液中检测到。MM的临床特征为破坏性骨病变、贫血、高钙血症和肾功能不全。其预后严重，由于频繁复发，诊断后的中位生存期约为3年。复发/难治性MM患者的治疗包括造血细胞移植、使用先前化疗方案的重新挑战或新方案的试验。新药物如沙利度胺、来那度胺和硼替佐米的引入显著改善了MM的预后。当复发发生时，临床医生的挑战是在平衡疗效和毒性的同时为每位患者选择最佳治疗方案。无症状复发的患者可先用两种药物或三种药物联合治疗。复发更严重的患者通常需要多种活性药物的联合治疗。自体干细胞移植对于在病程早期有冷冻保存干细胞的患者应考虑作为首次复发的补救性治疗。本文综述了复发/难治性多发性骨髓瘤治疗的药理学和分子作用。
Multiple myeloma (MM) is a neoplastic disorder. It results from proliferation of clonal plasma cells in bone marrow with production of monoclonal proteins, which are detectable in serum or urine. MM is clinically characterized by destructive bone lesions, anemia, hypercalcemia and renal insufficiency. Its prognosis is severe, with a median survival after diagnosis of approximately 3 years due to frequent relapses. Treatments for patients with relapsed/refractory MM include hematopoietic cell transplantation, a rechallenge using a previous chemotherapy regimen or a trial of a new regimen. The introduction of new drugs such as thalidomide, lenalidomide and bortezomib has markedly improved MM outcomes. When relapse occurs, the clinician’s challenge is to select the optimal treatment for each patient while balancing efficacy and toxicity. Patients with indolent relapse can be first treated with a 2-drug or a 3-drug combination. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Autologous stem cell transplantation should be considered as salvage therapy at first relapse for patients who have cryopreserved stem cells early in the disease course. The aim of this review is to provide an overview on the pharmacological and molecular action of treatments used for patients with relapsed/refractory multiple myeloma.