多发性骨髓瘤
Niels W C J van de Donk1, Charlotte Pawlyn2, Kwee L Yong3
1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands.
Lancet (London, England)
|January 31, 2021
概括
多发性骨髓瘤是一种常见的血液癌症, 早期检测和风险分层是有效治疗策略和改善患者结果的关键.
科学领域:
- 血液学
- 癌症学
- 遗传学
背景情况:
- 在高收入国家, 多发性骨髓瘤是第二常见的血液恶性瘤.
- 它通常源于前体疾病,如意义不明的单克隆性骨髓瘤或热多发性骨髓瘤.
- 这些前体状态已经存在遗传异常,包括多倍积分和免疫球蛋白重链转移.
研究的目的:
- 要区分需要治疗的症状性多发性骨髓瘤及其前体.
- 强调风险分层对预后和治疗计划的重要性.
- 概述多发性骨髓瘤治疗的当前研究方向.
主要方法:
- 诊断调查以确定症状多发性骨髓瘤与前体疾病.
- 风险分层包括患者特异性因素 (如表现状况) 和疾病特异性因素 (如高风险细胞遗传学).
主要成果:
- 尽管治疗方面取得了进展 (免疫调节药物,蛋白酶抑制剂,CD38抗体),但患者的生存率仍然有限.
- 疾病的进展和复发是由亚克隆进化和抗药性增加驱动的.
- 患者经常出现高血症,功能衰竭,贫血或骨解损伤.
结论:
- 准确的诊断和风险分层对于治疗多发性骨髓瘤及其前体疾病至关重要.
- 目前正在进行的研究重点是最小残留疾病测定,免疫治疗和早期拦截热多发性骨髓瘤.
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