在第一次复发时多发性骨髓瘤的当前治疗策略
Evangelos Mavrothalassitis1, Konstantinos Triantafyllakis1, Panagiotis Malandrakis1
1Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Journal of clinical medicine
|March 17, 2025
概括
多发性骨髓瘤 (MM) 在第一次复发时的治疗是复杂的,因为药物耐药性. 本综述指导临床医生制定最佳策略,包括新兴疗法,如CAR T细胞和三重疗法,以实现个性化的患者护理.
科学领域:
- 血液瘤学 血液瘤学
- 癌症治疗方法 癌症治疗方法
- 临床实践指南 临床实践指南
背景情况:
- 多发性骨髓瘤 (MM) 是一种无法治愈的血液癌症,在初始治疗后经常复发.
- 治疗的有效性随着每次复发而下降,使得第一个复发成为治疗决策的关键点.
- 对于关键药物类别的耐药性出现,在管理复发性MM方面提出了重大挑战.
研究的目的:
- 为临床医生提供基于证据的策略,用于管理首次复发多发性骨髓瘤.
- 审查新兴的治疗方案,指导个性化治疗选择.
- 为了解决复杂的不断变化的治疗环境复杂性在复发MM.
主要方法:
- 审查当前的临床实践指南和治疗策略,以首次复发MM.
- 关于已建立的三重疗法 (carfilzomib,pomalidomide,selinexor) 的证据的巩固.
- 评估新兴疗法,包括嵌合式抗原受体T细胞 (Cilta-cel) 疗法.
主要成果:
- 三重疗法仍然是首次复发MM的基石,最佳组合取决于先前的耐药性和患者因素.
- 化学抗原受体T细胞疗法对长期缓解有希望,但面临着可访问性挑战.
- 个性化治疗选择至关重要,考虑到疾病生物学,先前的治疗方法 (特别是抗CD38抗体和莱纳利多米德) 和并发症.
结论:
- 首次复发MM的最佳管理需要仔细考虑个体患者的因素和先前的治疗史.
- 既有三重疗法和 CAR T 细胞等新疗法的组合提供了更好的结果.
- 本综述为临床医生提供了一个框架,以在复发性多发性骨髓瘤中进行复杂的治疗决策.
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