摘要
This review summarizes the therapeutic strategies and the drugs actually in development for the management of myeloma patients. Multiple myeloma is caused by the expansion of monoclonal plasma cells and secretion of M-protein(immunoglobulins, Bence Jones protein and free light chains). Multiple myeloma still remains an incurable disease with a high incidence rate in the elderly, despite the introduction of several new therapeutic agents(bortezomib, lenalidomide and thalidomide) which have changed its natural history. The high heterogeneity of this disease leads to large differences in clinical responses to treatments. Thus, the choice of the best treatment is a difficult issue. However, the introduction of new drugs has made it possible to achieve high response rates and good quality respons-es with long-term disease control. Interactions between tumor cells and their bone marrow microenvironment play a pivotal role in the development, maintenance, and progression of myeloma, inducing also drug resistance. These knowledges have improved treatment options, leading to the approval of new drugs which not only target the malignant cell itself, but also its microenvironment. These agents are in preclinical/early clinical evaluation and they appear to further improve disease control, but their use is still not approved outside of clinical trials.
This review summarizes the therapeutic strategies and the drugs actually in development for the management of myeloma patients. Multiple myeloma is caused by the expansion of monoclonal plasma cells and secretion of M-protein （immunoglobulins, Bence Jones protein and free light chains）. Multiple myeloma still remains an incurable disease with a high incidence rate in the elderly, despite the introduction of several new thera-peutic agents （bortezomib, lenalidomide and thalido-mide） which have changed its natural history. The high heterogeneity of this disease leads to large differences in clinical responses to treatments. Thus, the choice of the best treatment is a difficult issue. However, the introduction of new drugs has made it possible to achieve high response rates and good quality respons-es with long-term disease control. Interactions between tumor cells and their bone marrow microenvironment play a pivotal role in the development, maintenance, and progression of myeloma, inducing also drug resistance. These knowledges have improved treatment options, leading to the approval of new drugs which not only target the malignant cell itself, but also its microenviron-ment. These agents are in preclinical/early clinical evalu-ation and they appear to further improve disease control, but their use is still not approved outside of clinical trials.
作者
Roberto Ria
Antonia Reale
Angelo Vacca
Roberto Ria;Antonia Reale;Angelo Vacca(Section of Internal Medicine,Department of Biomedical Sciences and Human On-cology,University of Bari Medical School,I-70124 Bari,Italy)
基金
Supported by Associazione Italiana per la Ricerca sul Cancro(Italian Association for Cancer Research-AIRC),Investigator Grant and the 5 per thousand Molecular Clinical Oncology Special Program,No.9965
Milan,to AV,the European Commission's Seventh Framework programme(EU-FPT7)under grant agreement(OVER-My R)to AV,No.278706
EU FPT7(2007-2013)under grant agreement to DR,No.278570
grants from MIUR PRIN to RR,No.2009WCNS5C_004
grants from MIUR PRIN to AV,No.2010NECHBX
