复发难治性多发性骨髓瘤治疗进展

Treatment of relapsed and refractory multiple myeloma

随着新药的广泛应用,多发性骨髓瘤(MM)患者的缓解时间及生存期逐渐延长,但是最终将复发或进展。复发难治患者的异质性较大,需要对复发患者进行个体化评估从而决定治疗时间,既不要过早也不要过晚治疗。硼替佐米、来那度胺及沙利度胺是治疗复发MM的关键药物,常与在功能上具有相加或协同作用的药物联合使用。自体造血干细胞移植也是复发难治性MM的治疗选择,异基因造血干细胞移植在治疗中的地位尚不明确。对硼替佐米及来那度胺均耐药的患者,可以考虑使用新一代的蛋白酶体抑制剂、免疫调节剂或单克隆抗体等药物的联合治疗。

Despite the widely use of novel drugs, which results in the longer time of response and survival, MM patients will eventually relapse or progress. Relapse and refractory patients are heterogeneous, and require individual assessments to ensure that treatment is neither too early nor too late. Bortezomib, lenalidomide and thalidomide are the Big Three components in the treatment of relapsed disease, often used in combination with drugs with addititive or synergistic effect. Autologous stem cell transplantation （auto-sct） should be considered as a feasible option for these patients. The role of allogeneic stem cell transplantation has not been extensively studied in relapse MM patients after the first time ofauto-sct therap~ For patients who have developed double-resistance to bortezomib and lenalidomide, the combination use of the newer generation ofproteasome inhibitor, immunomodulatory agent, or with monoclonal antibody should be considered.