多发性骨髓瘤的治疗现状

 多发性骨髓瘤（MM）的治疗取得了突破性进展。20世纪90年代开始,应用造血干细胞移植治疗MM明显提高了疗效,中位总生存期达到5年。近年来,随着多种靶位治疗药物（沙利度胺、硼替佐米、雷利度胺）的临床应用,使得各类型骨髓瘤的预后有了显著改善,据统计中位总生存期又提升了50 %。临床资料最新估计,65岁以下患者中位生存期约为10年,老年患者约5～6年。目前正在研制的新药物必将进一步提高患者的疗效。     

多发性骨髓瘤的靶向治疗

 在过去的近10年中,尽管多发性骨髓瘤（MM）的治疗取得了较大进步,患者的缓解率明显提高,但总的生存期（OS）没有明显改善。随着对MM发病机制研究的深入,以沙利度胺和硼替佐米为代表的靶向治疗药物的应用,使MM的完全缓解率明显提高,OS得到延长,MM成为一种趋于治愈性的疾病。     

多发性骨髓瘤的靶向治疗

 阐述抑制蛋白酶体是癌症治疗一种新方法。波替单抗（商品名：万珂）是第一个批准临床应用的蛋白酶体抑制剂。临床前试验对许多肿瘤细胞株有效。Ⅰ期临床试验确定了最佳剂量与可处理的毒性。两个Ⅱ期试验（SUMMIT与CREST）证明万珂治疗复发和／或难治的骨髓瘤患者安全而有效。Ⅲ期APEX试验比较万珂与大剂量地塞米松治疗复发的骨髓瘤证实万珂能提高有效率、缓解持续时间和总生存期。据此，研究者探索万珂与常规化疗和其他新药的联合。继续进行中的试验用万珂作为第一线药物治疗骨髓瘤结果令人鼓舞。单用万珂与其联合方案治疗血液与实体恶性肿瘤值得进一步研究。     

初发多发性骨髓瘤的治疗进展

多发性骨髓瘤（MM）是一种恶性浆细胞肿瘤。MM患者大多数年龄超过65岁,目前认为65岁以下初发MM患者的标准治疗为大剂量美法仑化疗支持的自体干细胞移植（ASCT）,而65岁以上老年MM患者的标准治疗至今仍认为是口服美法仑和泼尼松（MP）方案。但是一些新药的发明,如沙利度胺、雷利度胺和蛋白酶体抑制剂硼替佐米,能针对骨髓瘤细胞和骨髓微环境进行靶向治疗,联合使用在很大程度上能提高以往化疗方案的临床疗效。     

多发性骨髓瘤治疗新进展

<正>多发性骨髓瘤(multiple myeloma,MM)的传统治疗包括美法仑+泼尼松(MP)、卡氮芥+环磷酰胺+长春新碱+美法仑+泼尼松(M2)、长春新碱+阿霉素+地塞米松(VAD)、长春新碱+卡氮芥+阿霉素+强的松(VBAP)等方案。对于初治Ⅰ、Ⅱ期MM患者,MP、M2方案仍然是首选,但对于难治性、复发性MM患者疗效欠佳。VAD方案对于难治性、复发性MM患者反应率高,起效快,但生存期未见明显延长,主要用于干细胞移植前的大剂量化疗。     

多发性骨髓瘤治疗现状及进展

 多发性骨髓瘤目前仍然是一种不可治愈的疾病,其主要治疗手段为化疗。一些新型靶向药物与传统化疗方案以及造血干细胞移植等治疗手段的联合极大地提高了治疗的完全缓解率,延长了患者的生存期。近年来,根据不同的危险因素和细胞遗传学、分子蛋白组学提供的信息进行分层,选择个体化治疗方案已经成为骨髓瘤治疗的趋势所在。     

多发性骨髓瘤的靶向治疗

在过去的近10年中,尽管多发性骨髓瘤(MM)的治疗取得了较大进步,患者的缓解率明显提高,但总的生存期(OS)没有明显改善.随着对MM发病机制研究的深入,以沙利度胺和硼替佐米为代表的靶向治疗药物的应用,使MM的完全缓解率明显提高,OS得到延长,MM成为一种趋于治愈性的疾病.     

多发性骨髓瘤骨病的诊断与治疗新进展

 约90 %的多发性骨髓瘤（MM）患者存在骨损害。常规X线检查只有在30 %的骨小梁缺失后才能发现溶骨性损害,对于初诊MM患者的分期,常规X线检查仍是"金标准"。在发现小的溶骨性病变方面CT扫描比常规X线检查更敏感,但对怀疑有椎体压迫的患者应行磁共振成像（MRI）或CT扫描。同位素骨扫描常常低估MM患者骨损害的程度。MM骨病的治疗包括双磷酸盐、新的靶向治疗、外科手术、放射治疗等治疗措施。     

多发性骨髓瘤的治疗进展

目的 多发性骨髓瘤(mutciple myelome,MM)是血液系统恶性肿瘤,近年来,MM的治疗已经取得了显著的进展.一些新药沙利度胺、硼替佐米、雷利度胺的应用扩大了MM患者的治疗选择并改善了预后.大量的Ⅲ期临床实验已经表明了新药联合治疗移植和非移植患者的有效性,基于这些研究结果,标准的诱导方案已经受到挑战、甚至被取代.对于适合移植的患者,一些新的诱导缓解方案的有效性优于长春新碱+多柔比星+地塞米松(VAD)方案.同样,对于不适合移植的患者,联合这些新药的一线治疗也被证明优于传统的马法兰+泼尼松(MP)方案.现基于新药的联合治疗策略就MM的治疗进展进行综述.     

多发性骨髓瘤诊断与治疗进展

骨髓瘤常为多发,偶有单发,一般系指多发性骨髓病(MM),为与孤立性骨髓瘤区别,有人称MM为骨髓瘤病.本病起源于骨髓腔组织,由浆细胞的恶变而来的恶性肿瘤,故又称浆细胞肉瘤.肿瘤局限于骨内,浸润骨骼,引起骨骼破坏,高血钙,产生M蛋白,主要是球蛋白的增高和出现异常球蛋白,同时还可因蛋白物质阻塞肾小管,引起肾功能损害(骨髓瘤肾),并引起相应的临床表现如贫血,免疫缺陷而发的感染及并发的淀粉样变和凝血障碍以及骨外病变等一系列复杂问题.     

Combination therapy for multiple myeloma

The effect of six different chemotherapy regimens were evaluated in 462 previously untreated patients with multiple myeloma. In comparison with other treatments, drug combinations that included vincristine and were given at 3-week intervals were associated with higher response rates and longer survival times. No gain was noted from the use of Adriamycin or from combinations of alkylating agents unless vincristine was given and the treatment intervals were short. Seventy-one responding patients were allocated at random to maintenance treatment with intermittent courses of either azathioprine--prednisone or a combination of melphalan--cyclophosphamide--carmustine (BCNU)--prednisone. The survival time was not prolonged with either maintenance treatment in comparison with that for responding patients continued on other therapies or on no therapy in previous studies. Attempts to reduce tumor was maximally with a change in the therapeutic modality, such as with immunotherapy or radiotherapy, remain to be evaluated.     

多发性骨髓瘤靶向治疗研究进展

随着靶向药物如蛋白酶体抑制剂(PI)、免疫调节剂(IMiD)以及自体造血干细胞移植(ASCT)在临床的应用,患者的预后得到了很大改善。但目前多发性骨髓瘤(MM)仍不可治愈,疾病最终会进展或复发。因此,研发不同作用机制的新药以及改良治疗方案以消除肿瘤克隆,提高缓解深度至关重要。目前,国外新药研发方兴未艾,虽然这些新药大多处于临床试验的不同阶段,试验早期的数据显示,新药使得MM患者获得了更深、更持久的缓解,且药物的安全性和有效性也较为可靠,具有较好的临床应用前景。其中,多种新药联合PI或IMiD的治疗方案有望为MM提供新的治疗选择。文章就近年来MM的靶向新药的研究进展进行综述。     

多发性骨髓瘤综合治疗现状与进展

多发性骨髓瘤（MM）是浆细胞克隆增生性恶性肿瘤,其治疗效果较差,迄今仍视为不可治愈的疾病。近年来着眼于MM细胞内信号通路、骨髓微环境及二者的相互作用,MM的治疗有了很大进展。该文综述了MM的化学治疗、造血干细胞移植、生物治疗、支持治疗及免疫治疗现状及其进展。     

Progress in drug therapy for multiple myeloma

Multiple myeloma remains incurable with conventional treatments. However, new active drugs, including the immunomodulatory agents, thalidomide and lenalidomide,and the proteasome inhibitors bortezomib and NPI-0052, and other targeted therapies, have shown promising anti-myeloma activity. These agents represent a new generation of treatments for multiple myeloma that affect both specific intracellular signaling pathways and the tumor microenvironment. This review therefore focuses on the extensive clinical data available from studies of these drugs in the treatment of newly diagnosed, refractory and relapsed multiple myeloma.     

Maintenance and continuous therapy for multiple myeloma

Introduction: In multiple myeloma (MM), maintenance therapy is a longer, less intensive treatment course than initial therapy that is administered postinduction to delay disease progression. Maintenance and continuous therapy have been shown to suppress minimal residual disease and deepen and prolong responses, with the goal of improving progression-free survival and overall survival.

Areas covered: In this review, we have summarized current clinical trial data on maintenance and continuous therapy in newly diagnosed MM and relapsed/refractory MM (RRMM), focusing on lenalidomide and bortezomib. We have also analyzed the potential uses of newer agents, including carfilzomib, daratumumab, elotuzumab, pomalidomide, and ixazomib.

Expert commentary: Although lenalidomide- and bortezomib-containing regimens have demonstrated safety and efficacy, only lenalidomide is approved for maintenance; it is the preferred agent in the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines. Furthermore, results from the FIRST trial support lenalidomide plus low-dose dexamethasone (Rd) as a standard of care for continuous therapy. In RRMM, newer agents have been successfully added to Rd and data from additional trials are awaited. The vital roles of maintenance and continuous therapy and their benefits are now more clearly understood, but important questions remain regarding optimal duration of therapy and regimens.     

Advances in oral therapy for multiple myeloma

Conventional intravenous chemotherapy regimens are toxic, cumbersome, and negatively affect patients' quality of life, with oral treatment preferable to most patients with cancer. Multiple myeloma is the second most common haematological malignant disease, but cannot be cured with conventional and high-dose chemotherapy. New oral treatments that target myeloma cells or bone marrow are being developed that are highly effective yet have low toxic effects, such as the immunomodulatory drugs thalidomide and lenalidomide. Several treatments in early development have shown antimyeloma activity, including: CHIR-258, which inhibits fibroblast growth factor receptor 3; NVP-ADW742, which inhibits insulin-like growth factor receptor 1; and PTK787, which inhibits vascular endothelial growth factor. Additional drugs aimed at switching off silenced genes include histone deacetylase inhibitors. The availability of these various oral treatments is hoped to improve regimens that, if used sequentially or in combination, offer the potential of making multiple myeloma a chronic disease, thereby extending patients' lifespans and improving quality of life.