Multiple myeloma
Multiple myeloma
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DOI：
10.1038/nrdp.2017.46
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发表时间：
2017-07-20
影响因子：
81.5
通讯作者：
Anderson, Kenneth C.
中科院分区：
文献类型：
--
作者：
Kumar, Shaji K.;Rajkumar, Vincent;Anderson, Kenneth C.
多发性骨髓瘤是一种终末分化浆细胞的恶性肿瘤，患者通常表现为骨髓中克隆性浆细胞和血清和/或尿液中的克隆蛋白。多发性骨髓瘤的诊断是当明确的可归因于浆细胞增生性疾病的终末器官损害时，或当发现其发展的可能性很高时。将需要治疗的症状性多发性骨髓瘤与尚未确定意义的单克隆性伽玛病的先驱期和阴燃多发性骨髓瘤区分开来是很重要的，因为观察是这些情况的标准。在过去十年中，在了解疾病生物学和个体化治疗方法方面取得了很大进展。一些新的药物，如蛋白酶体抑制剂和免疫调节药物，加入了传统的医疗手段(皮质类固醇、烷化剂和蒽环类药物)，并与大剂量治疗和自体造血干细胞移植一起，导致了更深层次和持久的临床反应。事实上，越来越多的患者正在实现持久缓解，这增加了治愈这种疾病的可能性。成功可能取决于联合使用有效的药物和在疾病的早期阶段治疗患者，例如阴燃的多发性骨髓瘤患者。
Multiple myeloma is a malignancy of terminally differentiated plasma cells, and patients typically present with bone marrow infiltration of clonal plasma cells and monoclonal protein in the serum and/or urine. The diagnosis of multiple myeloma is made when clear end-organ damage attributable to the plasma cell proliferative disorder or when findings that suggest a high likelihood of their development are present. Distinguishing symptomatic multiple myeloma that requires treatment from the precursor stages of monoclonal gammopathy of undetermined significance and smouldering multiple myeloma is important, as observation is the standard for those conditions. Much progress has been made over the past decade in the understanding of disease biology and individualized treatment approaches. Several new classes of drugs, such as proteasome inhibitors and immunomodulatory drugs, have joined the traditional armamentarium (corticosteroids, alkylating agents and anthracyclines) and, along with high-dose therapy and autologous haemopoietic stem cell transplantation, have led to deeper and durable clinical responses. Indeed, an increasing proportion of patients are achieving lasting remissions, raising the possibility of cure for this disease. Success will probably depend on using combinations of effective agents and treating patients in the early stages of disease, such as patients with smouldering multiple myeloma.