Shifts in the Therapeutic Paradigm for Patients Newly Diagnosed with Multiple Myeloma: Maintenance Therapy and Overall Survival
Shifts in the Therapeutic Paradigm for Patients Newly Diagnosed with Multiple Myeloma: Maintenance Therapy and Overall Survival
复制标题
DOI：
10.1158/1078-0432.ccr-10-1925
复制
发表时间：
2011-03-15
影响因子：
11.5
通讯作者：
Roussel, Murielle
中科院分区：
文献类型：
--
作者：
Palumbo, Antonio;Attal, Michel;Roussel, Murielle
高剂量治疗（HDT）联合自体干细胞移植（ASCT）是符合条件的新诊断多发性骨髓瘤（MM）患者的标准治疗。几项随机研究表明，与常规化疗相比，接受移植的患者的生存优势。在过去的10年里，在这种情况下引入新的药物显着提高了生存率。仍然需要努力进一步提高这些患者的缓解率和生存率，主要是通过更有效的诱导、巩固和维持治疗来增加肿瘤缩小的深度和缓解的持续时间。然而，这种方法目前受到新药物长期治疗的前景的挑战。最近的数据表明，蛋白酶体抑制剂加1种免疫调节化合物（IMiD）的前期组合非常有效。硼替佐米、沙利度胺和地塞米松（VTD）联合治疗已被证明作为一线治疗非常有效，在ASCT前后显著上级长春新碱、多柔比星和地塞米松（VAD）或沙利度胺和地塞米松（Thal-Dex），毒性模式非常可控。最有希望的3种药物联合可能是硼替佐米、来那度胺和地塞米松（VRD）。第四种药物的添加尚未证明更有效。在不适合ASCT的患者中，新型药物的引入改变了多发性骨髓瘤的管理。美法仑、泼尼松和沙利度胺的组合以及硼替佐米、美法仑和泼尼松的组合与美法仑和泼尼松单独相比显示出改善的无进展生存期和总生存期。美法仑、泼尼松、沙利度胺和硼替佐米、美法仑和泼尼松现在是老年患者的新护理标准。初步结果也支持了美法仑、泼尼松和来那度胺联合治疗，随后用来那度胺维持治疗在老年患者治疗中的作用。医生现在有更广泛的治疗选择，以根据病人的特点定制最合适和有效的治疗方法。临床癌症研究; 17（6）; 1253-63。（C）2011年《非洲标准化评论》。
High-dose therapy (HDT) with autologous stem cell transplantation (ASCT) is the standard of care for eligible newly diagnosed multiple myeloma (MM) patients. Several randomized studies showed a survival advantage for patients undergoing transplantation, compared with conventional chemotherapy. Introduction of new drugs in this setting has markedly increased survival rates within the last 10 years. Efforts to further improve response rates and survival in those patients are still needed, mainly by increasing the depth of tumor reduction and the duration of response through more effective induction, consolidation, and maintenance therapies. Nevertheless, this approach is currently challenged by the promising results of long-term treatment with novel agents. Recent data suggest that the upfront combination of a proteasome inhibitor plus 1 immunomodulatory compound (IMiD) is highly effective. The combination of bortezomib, thalidomide, and dexamethasone (VTD) has proven to be highly effective as a frontline treatment and is significantly superior to vincristine, doxorubicin, and dexamethasone (VAD) or thalidomide and dexamethasone (Thal-Dex) before and after ASCT with a very manageable toxicity pattern. The most promising 3-drug association might be bortezomib, lenalidomide, and dexamethasone (VRD). Adjunction of a 4th drug has not proven to be more efficient. In patients not eligible for ASCT, the introduction of novel agents has changed the management of multiple myeloma. The combinations of melphalan, prednisone, and thalidomide and of bortezomib, melphalan, and prednisone have shown improved progression-free survival and overall survival in comparison with melphalan and prednisone alone. Melphalan, prednisone, and thalidomide and bortezomib, melphalan, and prednisone are now the new standards of care for elderly patients. Preliminary results also support the role of the combination of melphalan, prednisone, and lenalidomide followed by maintenance therapy with lenalidomide in the treatment of elderly patients. Physicians now have a wider variety of treatment options to tailor the most appropriate and efficacious treatment according to their patients' characteristics. Clin Cancer Res; 17(6); 1253-63. (C)2011 AACR.