Myeloma: management of the newly diagnosed high-risk patient
Myeloma: management of the newly diagnosed high-risk patient
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DOI：
10.1182/asheducation-2016.1.485
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发表时间：
2016-12-01
影响因子：
3
通讯作者：
Dispenzieri, Angela
中科院分区：
文献类型：
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作者：
Dispenzieri, Angela
尽管高危骨髓瘤有许多定义，但最近对新诊断多发性骨髓瘤（NMM）患者风险分类的共识来自国际骨髓瘤工作组。最近出版的修订版国际分期系统包括del（17 p）或t（4; 14）（通过荧光原位杂交）、B-2微球蛋白、白蛋白和乳酸脱氢酶。所有NMM患者均应采集这些元素。HR骨髓瘤的最佳治疗方法尚未完全确定;因此，应考虑对这些患者进行临床试验。对于不适合自体干细胞移植（ASCT）的患者，应考虑使用硼替佐米而不是沙利度胺的治疗方案，治疗持续时间至少为1年。迄今为止效果最好的方案是硼替佐米、美法仑和泼尼松。也可以考虑非沙利度胺维持治疗。对于符合ASCT条件的患者，应给予硼替佐米和免疫调节药物诱导方案3至6个月，然后进行2次ASCT。最后，应给予包含至少1年硼替佐米的巩固/维持治疗方案，然后进行维持治疗。为了患者的方便，可以使用非沙利度胺的口服药物作为维持治疗。最后，在HR骨髓瘤患者中，同种异体SCT可能与合理的结局相关，但这也需要进一步研究。
Although there have been many definitions for high-risk (HR) myeloma, most recent consensus for classifying risk in patients with newly diagnosed multiple myeloma (NMM) comes from the International Myeloma Working Group. This recently published revised International Staging System includes del(17p) or t(4; 14) by fluorescence in situ hybridization, b-2 microglobulin, albumin, and lactate dehydrogenase. These elements should be captured in all NMM patients. The optimal treatments for HR myeloma have not been fully worked out; therefore, these patients should be considered for clinical trials. Outside of the trial setting for those patients who are not eligible for autologous stem cell transplantation (ASCT), a regimen with bortezomib, but not thalidomide, should be considered, with a duration of therapy of at least 1 year. The regimen with the best results to date is bortezomib, melphalan, and predisone. A nonthalidomide maintenance could also be considered. In patients who are eligible for ASCT, an induction regimen with bortezomib and an immunomodulatory drug should be administered for 3 to 6 months followed by 2 ASCTs. Finally, a consolidation/maintenance regimen containing at least 1 year of bortezomib should be administered followed by maintenance thereafter. For patient convenience, an oral agent that is not thalidomide could be prescribed as maintenance. Finally, in patients with HR myeloma, allogeneic SCT may be associated with reasonable outcomes, but this too will require further research.