德克萨米他在多发性骨髓瘤和AL氨基粉症中的过去,现在和未来
Rahul Banerjee1,2, Tracy King3,4, Beth Faiman5
1Fred Hutchinson Cancer Center, Seattle, WA.
概括
德克萨米他是长期用于治疗多发性骨髓瘤等等离子体细胞疾病的药物,导致显著的毒性. 皮质类固醇节约疗法提供了更好的耐受性和疗效,需要进一步研究.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 50多年来,甲一直是血细胞疾病的基石疗法,包括多发性骨髓瘤 (MM) 和轻链 (AL) 粉样化症.
- 高剂量,长期使用德克萨米他与剂量依赖的毒性 (如白内障,感染) 和急性副作用 (如失眠,) 相关,这些副作用会损害生活质量.
- 最近的临床试验强调了MM中皮质类固醇节约策略的有效性和更好的耐受性.
研究的目的:
- 综合审查和评估德克萨米他在现代血细胞疾病管理中的不断变化的作用.
- 评估长期使用德克萨米他在各种治疗环境中的风险效益比.
- 讨论在MM和AL氨基粉症中使用皮质类固醇缓解疗法的潜力.
主要方法:
- 综述最近的临床试验和关于使用德克萨米他治疗多发性骨髓瘤和AL氨基粉症的现有文献.
- 在不同治疗环境中分析德克萨米他的疗效,耐受性和毒性概况.
- 评估德克萨梅他在新诊断,复发/耐药和维护环境中的作用,以及在特定场景中,如CD38抗体前期治疗.
主要成果:
- 对于新诊断的MM,在老年/脆弱的患者中,支持计划性停止德甲治疗.
- 在维护环境中长期使用德克萨米他具有不利的风险/收益比.
- 在复发性/耐药性MM中,在三倍/四倍疗法中,德甲的益处是不确定的,无限期使用可能会阻碍后续治疗. 对于AL氨基粉症,每周40毫克6个月是过度的.
结论:
- 皮质类固醇节约疗法证明了有效性和更好的耐受性,挑战了传统的依赖德克萨米他.
- 由于有毒性问题,应重新考虑使用德克萨米他,特别是在维持疗法和特定患者群体中.
- 对皮质类固醇节约策略的前性调查对于所有血细胞疾病至关重要,以优化患者的治疗结果和生活质量.
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