高危多发性骨髓瘤的研究现状

Research status on multiple myeloma with high-risk factors

过去10+年中,随着诊疗技术的不断发展,多发性骨髓瘤(MM)患者的生存得以极大改善,但是仍有10%~20%的高危MM(HRMM)患者预后较差。HRMM患者的临床识别主要通过宿主因素、肿瘤负荷、肿瘤生物学因素和治疗反应4个方面。蛋白酶体抑制剂(PI)、免疫调节剂(IMiD)及CD38单克隆抗体的三/四药联合诱导方案,可提高HRMM患者的微小残留病(MRD)阴性率,从而改善其预后。对适合自体造血干细胞移植(auto-HSCT)的HRMM患者,诱导缓解后进行单/双次auto-HSCT,序贯PI联合IMiD的维持治疗十分重要。对不适合auto-HSCT者使用诱导有效方案进行持续治疗较为重要。笔者拟就目前HRMM的定义及其临床识别,是否适合auto-HSCT、难治/复发HRMM患者的治疗策略进行阐述,旨在为HRMM患者的诊疗提供理论参考。

Survival of multiple myeloma(MM)has significantly improved over the past decade.However,there are still 10%to 20%high-risk(HR)MM patients with poor prognosis.The clinical identification of HRMM patients is mainly through four aspects,namely host factors,tumor load,tumor biological factors and treatment response.Three/four drug induction chemotherapy regimen of proteas inhibitor(PI),immunomodulatory drug(IMiD)and CD38 monoclonal antibody can improve the negative rate of minimal residual disease(MRD)in HRMM patients,which may improve their prognosis.For HRMM patients suitable for autologous hematopoietic stem cell transplantation(auto-HSCT),it is very important to carry out single/double auto-HSCT and maintenance treatment of PI combined with IMiD after remission.It is important to use effective induction regimen for continuous treatment of patients who are not suitable for transplantation.This article focuses on the current definition of HRMM and its clinical identification,as well as the treatment strategies for HRMM patients who are suitable or not suitable for auto-HSCT,and refractory/recurrent HRMM patients,in order to provide a theoretical reference for the diagnosis and treatment of HRMM patients.