Multiple myeloma with high-risk cytogenetics and its treatment approach.
Multiple myeloma with high-risk cytogenetics and its treatment approach.
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高危细胞遗传学多发性骨髓瘤及其治疗方法。
DOI：
10.1007/s12185-022-03353-5
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发表时间：
2022-06
影响因子：
2.1
通讯作者：
Hanamura, Ichiro
中科院分区：
文献类型：
--
作者：
Hanamura, Ichiro
尽管抗骨髓瘤治疗取得了实质性进展，但早期复发和死亡仍然是某些亚群的问题。细胞遗传学异常（CA）是多发性骨髓瘤（MM）预后不良的最广泛接受的预测因子，如t（4;14），t（14;16），t（14;20），gain/amp（1 q21），del（1 p）和del（17 p）。共存的高风险CA（HRCA）往往与更差的预后相关。最近，无论细胞遗传学风险如何，持续微小残留病（MRD）阴性的实现已成为延长生存期的替代指标。来自新的临床试验的信息表明，延长强化治疗可以帮助HRCA患者实现MRD阴性，这可能会改善结局。治疗应考虑包括3种或4种药物诱导方案（PI/IMiD/Dex或PI/IMiD/Dex/抗CD 38抗体）、自体移植和来那度胺± PI巩固/维持治疗。正在进行的高风险人群临床试验的结果将揭示所研究方案的确切疗效。MM细胞的遗传异常是决定肿瘤特征的内在关键因素，其反映了疾病的自然过程和药物敏感性。本文综述了与不良预后相关的基因组异常的临床病理学特征，重点关注临床实践中最相关的HRCA，并概述了目前新诊断MM伴HRCA的最佳治疗方法。
Despite substantial advances in anti-myeloma treatments, early recurrence and death remain an issue in certain subpopulations. Cytogenetic abnormalities (CAs) are the most widely accepted predictors for poor prognosis in multiple myeloma (MM), such as t(4;14), t(14;16), t(14;20), gain/amp(1q21), del(1p), and del(17p). Co-existing high-risk CAs (HRCAs) tend to be associated with an even worse prognosis. Achievement of sustained minimal residual disease (MRD)-negativity has recently emerged as a surrogate for longer survival, regardless of cytogenetic risk. Information from newer clinical trials suggests that extended intensified treatment can help achieve MRD-negativity in patients with HRCAs, which may lead to improved outcomes. Therapy should be considered to include a 3- or 4-drug induction regimen (PI/IMiD/Dex or PI/IMiD/Dex/anti-CD38 antibody), auto-transplantation, and consolidation/maintenance with lenalidomide ± a PI. Results from ongoing clinical trials for enriched high-risk populations will reveal the precise efficacy of the investigated regimens. Genetic abnormalities of MM cells are intrinsic critical factors determining tumor characteristics, which reflect the natural course and drug sensitivity of the disease. This paper reviews the clinicopathological features of genomic abnormalities related to adverse prognosis, focusing on HRCAs that are the most relevant in clinical practice, and outline current optimal therapeutic approaches for newly diagnosed MM with HRCAs.
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DOI：
10.1073/pnas.93.24.13931
发表时间：
1996-11-26
影响因子：
11.1
作者：
Bergsagel, PL;Chesi, M;Kuehl, WM
通讯作者：
Kuehl, WM
影响因子：
39.2
作者：
DIMOPOULOS, MA;BARLOGIE, B;ALEXANIAN, R
通讯作者：
ALEXANIAN, R
影响因子：
6.5
作者：
Shaughnessy JD;Zhou Y;Haessler J;van Rhee F;Anaissie E;Nair B;Waheed S;Alsayed Y;Epstein J;Crowley J;Barlogie B
通讯作者：
Barlogie B
影响因子：
12.8
作者：
Durie, Brian G. M.;Hoering, Antje;Barlogie, Bart
通讯作者：
Barlogie, Bart
影响因子：
20.3
作者：
Drach, J;Ackermann, J;Huber, H
通讯作者：
Huber, H