多发性骨髓瘤的免疫治疗进展

Progress in Immunotherapy of Multiple Myeloma

多发性骨髓瘤是血液科常见恶性肿瘤之一,往往出现多系统受累,患者生活质量及预后较差。近年来新药的出现及自体造血干细胞移植的应用虽然已经显著改善多发性骨髓瘤的预后。但复发/难治的多发性骨髓瘤目前仍然是困扰临床医生的难题,需要更多的治疗策略来进一步改善患者的生活质量和预后。免疫治疗的出现为多发性骨髓瘤患者带来了希望。单克隆抗体,包括elotuzumab、daratumumab、pembrolizumab等,进行大量的临床试验,结果显示单克隆抗体联合其他药物治疗多发性骨髓瘤的良好疗效。基因工程T细胞的过继免疫治疗,包括嵌合抗原受体T细胞技术和T细胞受体修饰的T细胞技术,显示多种不同靶点对于治疗多发性骨髓瘤的可能性,且不良反应轻微。树突状细胞疫苗通过增强细胞毒性T细胞而发挥抗多发性骨髓瘤作用,可与其他免疫调节药合用。这些免疫治疗在未来可能会给多发性骨髓瘤患者提供更多的治疗选择。

Multiple myeloma is one of the most common hematology malignancies often with multiple system involvement,poor quality of life and poor prognosis.Although the application of new drugs and autologous hematopoietic stem cell transplantation have significantly improved its prognosis,relapse/refractory multiple myeloma is still a tough problem for clinicians.More strategies are needed to improve the quality of life and prognosis of patients.Emergence of immunotherapy brings hope for patients with multiple myeloma.Monoclonal antibodies,including elotuzumab,daratumumab,pembrolizumab and others,have undergone clinical trials and the results demonstrate that monoclonal antibodies in combination with other drugs show some efficacy for the treatment of multiple myeloma.Adoptive immunotherapy of genetically engineered T cells,including chimeric antigen receptor T cells and TCR-engineered T cells,shows the potential of different targets for the treatment of multiple myeloma with minimal adverse reactions.Dendritic cell vaccines exert anti-multiple myeloma effects by enhancing cytotoxic T cells and can be used in combination with immunomodulators.These immunotherapies may offer more options for patients with multiple myeloma in the future.