International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation
International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation
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DOI：
10.1182/blood-2011-02-297325
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发表时间：
2011-06-09
期刊：
影响因子：
20.3
通讯作者：
Lonial, Sagar
中科院分区：
文献类型：
--
作者：
Cavo, Michele;Rajkumar, S. Vincent;Lonial, Sagar
高剂量治疗后自体干细胞移植（ASCT）在多发性骨髓瘤（MM）治疗中的作用在新药物时代继续发展。诱导治疗的选择已经从传统的化疗转移到新的方案，包括免疫调节衍生物沙利度胺或来那度胺和蛋白酶体抑制剂硼替佐米。这些药物联合收割机与传统疗法很好地结合，并彼此结合形成各种双联、三联和四联方案。这些诱导治疗的前期使用，特别是3种药物的组合，已经影响了前所未有的完全缓解率，与之前使用常规化疗和随后的ASCT所观察到的完全缓解率相媲美。在基于新药的诱导方案后应用自体移植进一步改善了反应的深度，这一增益转化为延长的无进展生存期，并可能延长总生存期。免疫调节衍生物和硼替佐米在ASCT前表现出的高活性最近导致其用作自体移植后的巩固和维持疗法。新型药物和ASCT是MM的补充治疗策略。本文回顾了目前的文献，并就当前年轻、符合移植条件的MM患者的最佳管理的主要问题提供了重要的观点和指导。（血。2011;117（23）：6063-6073）
The role of high-dose therapy followed by autologous stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. The choice of induction therapy has moved from conventional chemotherapy to newer regimens incorporating the immunomodulatory derivatives thalidomide or lenalidomide and the proteasome inhibitor bortezomib. These drugs combine well with traditional therapies and with one another to form various doublet, triplet, and quadruplet regimens. Up-front use of these induction treatments, in particular 3-drug combinations, has affected unprecedented rates of complete response that rival those previously seen with conventional chemotherapy and subsequent ASCT. Autotransplantation applied after novel-agent-based induction regimens provides further improvement in the depth of response, a gain that translates into extended progression-free survival and, potentially, overall survival. High activity shown by immunomodulatory derivatives and bortezomib before ASCT has recently led to their use as consolidation and maintenance therapies after autotransplantation. Novel agents and ASCT are complementary treatment strategies for MM. This article reviews the current literature and provides important perspectives and guidance on the major issues surrounding the optimal current management of younger, transplantation-eligible MM patients. (Blood. 2011;117(23):6063-6073)