复发难治多发性骨髓瘤的诊断与治疗困惑

Controversies on the diagnosis and treatment of relapsed/refractory multiple myeloma

随着蛋白酶体抑制剂、免疫调节剂、单克隆抗体及自体干细胞移植在一线的广泛应用,多发性骨髓瘤的疗效越来越好,但绝大部分患者疾病终将复发。复发难治多发性骨髓瘤仍是目前治疗的重点及难点。尽管国内外有多个针对复发难治多发性骨髓瘤的诊治指南或共识,但临床医师在临床实践中仍发现在诊断与治疗中存在一些相互矛盾的方面,本文就此方面的困惑做一述评,以期对临床一线医生的临床实践有所帮助。

With the widely usage of proteasome inhibitors,immunomodulating agents,monoclonal antibodies and autologous stem cell transplantation in the first line,most of multiple myeloma(MM)patients achieved high response rate and prolonged the survival period,but most of MM patients will relapse eventually.There are a lot of unmet needs for the management of relapse and refractory myeloma(RRMM).Although there are several guidelines for the diagnosis and treatment of RRMM,but doctors often find some controversies in clinical practice.The controversies will be discussed in this paper expected to guide the practice of younger doctors.