Multiple myeloma: 2018 update on diagnosis, risk‐stratification, and management.
Multiple myeloma: 2018 update on diagnosis, risk‐stratification, and management.
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DOI：
10.1002/ajh.25117
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发表时间：
2018-08-16
影响因子：
12.8
通讯作者：
Rajkumar SV
中科院分区：
文献类型：
--
作者：
Rajkumar SV
多发性骨髓瘤约占血液恶性肿瘤的10%。诊断需要≥10%的克隆骨髓浆细胞或活检证实的浆细胞瘤，加上一个或多个多发性骨髓瘤定义事件（MDE）的证据：蟹（高钙血症、肾衰竭、贫血或溶解性骨病变）与浆细胞疾病相关的特征，骨髓克隆性浆细胞增多≥ 60%，血清受累/未受累游离轻链（FLC）比值≥100（前提是受累FLC ≥100 mg/L），或磁共振成像上>1处局灶性病变。del（17 p）、t（14;16）和t（14;20）患者为多发性骨髓瘤高危患者。t（4;14）易位并获得1 q的患者有中度风险。所有其他人都被认为是标准风险。初始治疗包括硼替佐米、来那度胺、地塞米松（VRd）。在高风险患者中，卡非佐米、来那度胺、地塞米松（KRd）是VRd的替代药物。在符合条件的患者中，给予初始治疗约3-4个周期，然后进行自体干细胞移植（ASCT）。标准风险患者可以在首次复发时选择延迟ASCT。不适合移植的患者用VRd治疗约8-12个周期，然后用来那度胺或来那度胺加地塞米松治疗。ASCT后，推荐标准风险患者维持来那度胺，而中度或高危疾病患者需要以硼替佐米为基础的方案维持。大多数患者在复发时需要三联方案，方案的选择随每次连续复发而变化。髓外浆细胞瘤或浆细胞白血病侵袭性复发可能需要含蒽环类药物的联合化疗方案。
Multiple myeloma accounts for approximately 10% of hematologic malignancies. The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging. Patients with del(17p), t(14;16), and t(14;20) have high-risk multiple myeloma. Patients with t(4;14) translocation and gain(1q) have intermediate-risk. All others are considered standard-risk. Initial treatment consists of bortezomib, lenalidomide, dexamethasone (VRd). In high-risk patients, carfilzomib, lenalidomide, dexamethasone (KRd) is an alternative to VRd. In eligible patients, initial therapy is given for approximately 3–4 cycles followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT at first relapse. Patients not candidates for transplant are treated with VRd for approximately 8–12 cycles followed by lenalidomide or lenalidomide plus dexamethasone. After ASCT, lenalidomide maintenance is recommended for standard risk patients, while maintenance with a bortezomib-based regimen is needed for patients with intermediate or high-risk disease. Most patients require a triplet regimen at relapse, with the choice of regimen varying with each successive relapse. Aggressive relapse with extramedullary plasmacytomas or plasma cell leukemia may require anthracycline containing combination chemotherapy regimens.
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影响因子：
168.9
作者：
Dispenzieri, Angela;Katzmann, Jerry A.;Kyle, Robert A.;Larson, Dirk R.;Melton, L. Joseph, III;Colby, Colin L.;Therneau, Terry M.;Clark, Raynell;Kumar, Shaji K.;Bradwell, Arthur;Fonseca, Rafael;Jelinek, D. F.;Rajkumar, S. Vincent
通讯作者：
Rajkumar, S. Vincent
影响因子：
168.9
作者：
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Baccarani, Michele
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通讯作者：
Crowley, JC
影响因子：
8
作者：
Bergsagel, PL;Kuehl, WM
通讯作者：
Kuehl, WM
影响因子：
20.3
作者：
Bladé, J
通讯作者：
Bladé, J