新药时代硼替佐米在初治多发性骨髓瘤中的一线诱导治疗地位会受到挑战吗？

Will the first-line induction therapy of bortezomib for newly diagnosed multiple myeloma be challenged in the era of novel drugs？

对于初治多发性骨髓瘤（MM）患者，以硼替佐米为基础的化疗方案获得了较高的完全缓解率、较长的无进展生存及总生存，其在可移植及非可移植患者中均具有一线诱导治疗地位。近年来，新型药物（如蛋白酶体抑制剂、免疫调节剂、单克隆抗体及细胞免疫疗法等）由于具有较好的疗效和安全性，对硼替佐米的一线治疗地位提出了挑战。口服蛋白酶体抑制剂联合免疫调节剂和地塞米松、单克隆抗体联合免疫调节剂和地塞米松未来有望成为初治MM患者的一线诱导治疗方案。在更远的将来，嵌合抗原受体T细胞免疫疗法（CAR-T）也可能成为一线治疗的一部分，尤其是用于高危患者的诱导或清除微小残余病变的巩固治疗。

For newly diagnosed muhiple myeloma （MM） patients, bortizomib based on chemotherapy has achieved desirable complete remission rate, good progression-free survival and overall survival, which is now a first-line choice in both transplant-eligible and transplant-ineligible patients. In recent years, other new treatment options such as proteasome inhibitors, immunomodulators, monoclonal antibody and cellular immunotherapy have posed a challenge to the first-line therapeutic status of bortizomib because of their favorable efficacy and safety. Oral proteasome inhibitor or monoclonal antibody combined with immunomodulators and dexamethasone might become the first-line induction therapy of newly-diagnosed MM patients. Moreover, chimeric antigen receptor T-cell immunotherapy （CAR-~ may also play a role in the first- line treatment, especially for the induction therapy of high-risk patients and the consolidation treatment of the elimination in minimal residual disease.