初诊多发性骨髓瘤治疗进展

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1、NDMM治疗杨永公内容提要诊断（略）治疗指征治疗原则常用方案选择特殊人群治疗治疗指征—有症状MM无症状MM1)骨髓浆细胞≥60%。2)血或尿轻链（K和λ）比值≥100。3）MR或Pet-CT显示有一处骨质破坏。有症状MM1)CRAB2)高粘度血症、淀粉样变性、反复感染（2008WHO)治疗原则有治疗指征的MM患者应早系统治疗，包括诱导、巩固治疗（含造血干细胞移植）以及维持治疗。达到MR以上疗效时可用原方案继续治疗，直到获得最大程度的缓解，不建议在治疗有效的病人变更治疗方案；未达到MR患者应变更治疗方案。适合自体干细胞移植者，应尽量用新药诱导治疗+造血干

2、细胞移植。避免使用烷化剂和亚硝基脲类药物。适合临床试验者，应考虑进入临床试验。指南推荐治疗方案UseofDCEPasconsolidationtherapyafterprimarytherapydidnothaveasignificantimpactonresponseratesTheincidenceofsevereadverseeventsreportedwassimilarbetweenthetwogroups.Bortezomib/Doxorubicin/DexamethasoneAbenefitintermsofincreasedPFSwasalso

3、observedinpatientswithdeletionof17p13.Therateofgrade2to4peripheralneuropathywashigherinthosetreatedwiththebortezomib-containingregimenversusVAD(40%vs.18%).Bortezomib/Thalidomide/DexamethasoneCyclophosphamide/Bortezomib/DexamethasoneThreephaseIIstudiesinvolvingnewlydiagnosedpatientsw

4、ithMM(n=495)havedemonstratedhighresponserateswithCyBorDasprimarytreatmentReederetaldemonstratedanORRof88%includingaVGPRorgreaterof61%and39%CR/nearCRwithCyBorDastheprimaryregimen.Cyclophosphamide/Bortezomib/DexamethasoneGermanDSMMXIastudyalsodemonstratedhighresponseswithCyBorDasprim

5、arytreatment(ORRwas84%;with74%PRrateand10%CRrate).Highresponserateswereseeninpatientswithunfavorablecytogenetics。EVOLUTIONstudy,primarytreatmentwithCyBorDdemonstratedORRof75%(22%CRand41%≥VGPR),andone-yearPFSratewas93%.BortezomibBortezomib-basedregimensmaybeofvalueinpatientswithrenal

6、failure,andinthosewithcertainadversecytogeneticfeatures.Bortezomibtreatmenthasbeenassociatedwithanincreasedincidenceofherpeszoster.peripheralneuropathyandgastrointestinaldisturbancecanbehigher.once-weeklyscheduleofbortezomib.Reederetalmodifiedtheregimentoaonce-weeklyscheduleofbortez

7、omib.Inthestudy,patientstreatedwithweeklybortezomibachievedresponsessimilartothetwice-weeklyschedule(ORR93%vs.88%,VGPR60%vs.61%).Inaddition,theyexperiencedlessgrade¾adverseevents(37%/3%vs.48%/12%)Lenalidomide/DexamethasoneSWOGcompareddexamethasonesingleagentwithdexamethasonepluslena

8、lidomideforpatients