复发多发性骨髓瘤的治疗策略

随着新药的不断问世,多发性骨髓瘤(MM)的疗效有了极大提高,但是所有患者都要面临复发的难题.对于复发患者,首先要判断何时开始治疗并明确治疗目的 .在重新判定其分期后,需综合考虑患者体能状态、既往治疗方案的疗效及药物的耐受性、是否接受维持治疗、首次复发还是二次或多次复发、是否接受过移植等因素制定治疗策略.联合一种以上新药为主的三药方案是复发患者的主要治疗方案,若能入组新药临床试验则为最优选择.异基因造血干细胞移植也许能真正改善年轻、高危、髓外或浆细胞白血病患者的预后.

Treatment strategies of relapsed multiple myeloma

With the advent of new drugs, the efficacy of multiple myeloma (MM) has been improved greatly, but all patients have to face the problem of relapse. Before the initiation of therapy for relapsed MM patients, the starting time of treatment and the treatment purposes must be determined. After rejudging the stage of relapsed MM patients, multiple factors need to be considered comprehensively to establish the strategies including the patients' physical state and the efficacy of treatment strategies, the drug resistence, whether or not to receive maintenance therapy, suffering the first relapse or second or repeated relapse, whether or not to receive transplantation. Triplets based on the at least one novel agent is the major treatment for relapsed patients, and it will become optimal choice when enrolled the novel agents clinical trails. Allogeneic hematopoietic stem cell transplantation may improve the prognosis of young patients with high-risk disease, extramedullary or plasmacytoma leukemia.