Leczenie chorych na szpiczaka mnogiego poniżej 65.–70. roku życia oraz rola terapii podtrzymującej po przeszczepieniu komórek macierzystych Artykuł przeglądowy
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Opublikowane:
gru 30, 2011
Słowa kluczowe:
szpiczak, terapia dopasowana do ryzyka, leki immunodulujące, inhibitory proteasomów, przeszczep komórek macierzystych
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Leczenie chorych na szpiczaka mnogiego uległo w ostatnim dziesięcioleciu istotnym zmianom, które są wynikiem lepszego zrozumienia biologii schorzenia, zastosowania skuteczniejszych leków i lepszej opieki wspomagającej. Wysokodozowana chemioterapia wspomagana autologicznym przeszczepem komórek macierzystych (SCT, ang. stem cell transplantation) jest skuteczną metodą leczenia choroby oraz istotnym elementem postępowania terapeutycznego. W związku z potencjalnym wpływem leczenia na ewentualną mobilizację komórek macierzystych, decyzje dotyczące wstępnej terapii zależą od tego, czy pacjent kwalifikuje się do przeszczepu, czy też nie spełnia kryteriów wykonania tej procedury. Celami leczenia wstępnego pozostają szybkie opanowanie choroby, pozwalające na odwrócenie jej powikłań, oraz zmniejszenie ryzyka przedwczesnego zgonu przy zachowaniu minimalnej toksyczności. Wprowadzenie nowych leków, takich jak talidomid, bortezomib i lenalidomid, umożliwiło osiągnięcie tych celów, a skojarzenie tych specyfików doprowadziło również do uzyskania odpowiedzi terapeutycznych o bezprecedensowej głębokości. Badane jest również zastosowanie nowszych preparatów w leczeniu podtrzymującym po przeszczepie komórek macierzystych (KM). W niniejszym artykule dokonano przeglądu aktualnych sposobów leczenia nowo rozpoznanego szpiczaka u pacjentów kwalifikujących się do przeszczepu.
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Jurczyszyn A. Leczenie chorych na szpiczaka mnogiego poniżej 65.–70. roku życia oraz rola terapii podtrzymującej po przeszczepieniu komórek macierzystych. OncoReview [Internet]. 30 grudzień 2011 [cytowane 6 lipiec 2024];1(4(4):258-69. Dostępne na: https://journalsmededu.pl/index.php/OncoReview/article/view/273
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Utwór dostępny jest na licencji Creative Commons Uznanie autorstwa – Użycie niekomercyjne 4.0 Międzynarodowe.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
Bibliografia
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14. Harousseau J.L., Attal M., Avet-Loiseau H. et al.: Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J. Clin. Oncol. 2010; 28: 4621-29.
15. Rajkumar S.V., Hayman S.R., Lacy M.Q. et al.: Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood 2005; 106: 4050-3.
16. Rajkumar S.V., Jacobus S., Callander N.S. et al.: Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010; 11: 29-37.
17. Cavo M., Perrone G., Buttignol S. et al.: Bortezomib-thalidomide-dexamethasone compared with thalidomide-dexamethasone as induction and consolidation therapy before and after double autologous transplantation in newly diagnosed multiple myeloma: results from a randomized phase 3 study [abstract]. ASH Annual Meeting Abstracts 2010; 116: 42.
18. Lacy M.Q., Gertz M.A., Dispenzieri A. et al.: Long-term results of response to therapy, time to progression, and survival with lenalidomide plus dexamethasone in newly diagnosed myeloma. Mayo Clin. Proc. 2007; 82: 1179-84.
19. Fermand J.P., Ravaud P., Chevret S. et al.: High-dose therapy and autologous peripheral blood stem cell transplantation in multiple myeloma: up-front or rescue treatment? Results of a multicenter sequential randomized clinical trial. Blood 1998; 92: 3131-6.
20. Attal M., Harousseau J.L., Facon T. et al.: Single versus double autologous stem-cell transplantation for multiple myeloma. N. Engl. J. Med. 2003; 349: 2495-502.
21. Cavo M., Tosi P., Zamagni E. et al.: Prospective, randomized study of single compared with double autologous stem-cell transplantation for multiple myeloma: Bologna 96 clinical study. J. Clin. Oncol. 2007; 25(17): 2434-41.
22. Sonneveld P., van der Holt B., Vellenga E. et al.: Intensive versus double intensive therapy in untreated multiple myeloma: final analysis of the HOVON 24 trial [abstract]. Blood (ASH Annual Meeting Abstracts) 2005; 106: 2545.
23. Garban F., Attal M., Michallet M. et al.: Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft (IFM99- 03 trial) with tandem autologous stem cell transplantation (IFM99-04 trial) in high-risk de novo multiple myeloma. Blood 2006; 107: 3474-80.
24. Morgan G.J., Davies F.E., Gregory W.M. et al.: First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a randomised controlled trial. Lancet 2010; 376: 1989-99.
25. Attal M., Harousseau J.L., Leyvraz S. et al.: Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006; 108: 3289-94.
26. Attal M., Cances Lauwers V., Marit G. et al.: Maintenance treatment with lenalidomide after transplantation for MYELOMA: final analysis of the IFM 2005-02 [abstract 310]. Blood (ASH Annual Meeting Abstracts) 2010; 116(21): 310.
27. McCarthy P.L., Owzar K., Anderson K.C. et al.: Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous hematopoietic stem cell transplantation (AHSCT) for multiple myeloma: CALGB 100104 [abstract 37]. Blood (ASH Annual Meeting Abstracts) 2010; 116(21): 37.
28. Cavo M., Tacchetti P., Patriarca F. et al.: Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet 2010; 376:2075-85.
29. Blokhin N., Larionov L., Perevodchikova N., Chebotareva L., Merkulova N.: Clinical experiences with sarcolysin in neoplastic diseases. Ann. N.Y. Acad. Sci. 1958; 68(3): 1128-32.
30. Kyle R.A., Pierre R.V., Bayrd E.D.: Multiple myeloma and acute myelomonocytic leukemia. N. Engl. J. Med. 1970; 283(21): 1121-5.
31. Leleu X., Tamburini J., Roccaro A. et al.: Balancing risk versus benefit in the treatment of Waldenström’s Macroglobulinemia patients with nucleoside analogue based therapy. Clin. Lymphoma Myeloma 2009; 9(1): 71-3.
2. Landgren O., Kyle R.A., Pfeiffer R.M. et al.: Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood 2009; 113: 5412-7.
3. Kumar S.K., Mikhael J.R., Buadi F.K. et al.: Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk adapted Therapy (mSMART) consensus guidelines. Mayo Clin. Proc. 2009; 84: 1095-1110.
4. Fonseca R., Barlogie B., Bataille R. et al.: Genetics and cytogenetics of multiple myeloma: a workshop report. Cancer Res. 2004; 64: 1546-58.
5. Greipp P.R., San Miguel J., Durie B.G. et al.: International staging system for multiple myeloma. J. Clin. Oncol. 2005; 23: 3412-20.
6. Attal M., Harousseau J.L., Stoppa A.M. et al.: A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N. Engl. J. Med. 1996; 335: 91-7.
7. Kumar S.K., Dingli D., Lacy M.Q. et al.: Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: results from a matched pair analysis. Am. J. Hematol. 2008; 83: 614-7.
8. Rajkumar S.V., Hayman S., Gertz M.A. et al.: Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma. J. Clin. Oncol. 2002; 20: 4319-23.
9. Rajkumar S.V., Blood E., Vesole D., Fonseca R., Greipp P.R., Eastern Cooperative Oncology G.: Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J. Clin. Oncol. 2006; 24: 431-6.
10. Rajkumar S.V., Rosinol L., Hussein M. et al.: Multicenter, randomized, double-blind, placebo-controlled study of thalidomide plus dexamethasone compared with dexamethasone as initial therapy for newly diagnosed multiple myeloma. J. Clin. Oncol. 2008; 26: 2171-7.
11. Lokhorst H.M., Schmidt-Wolf I., Sonneveld P. et al.: Thalidomide in induction treatment increases the very good partial response rate before and after high-dose therapy in previously untreated multiple myeloma. Haematologica 2008; 93: 124-7.
12. Morgan G.J., Davies F.E., Gregory W.M. et al.: The addition of thalidomide to the induction treatment of newly presenting myeloma patients increases the CR rate which is likely to translate into improved PFS and OS [abstract]. ASH Annual Meeting Abstracts 2009; 114: 352.
13. Richardson P.G., Sonneveld P., Schuster M. et al.: Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trial. Blood 2007; 110: 3557-60.
14. Harousseau J.L., Attal M., Avet-Loiseau H. et al.: Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J. Clin. Oncol. 2010; 28: 4621-29.
15. Rajkumar S.V., Hayman S.R., Lacy M.Q. et al.: Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood 2005; 106: 4050-3.
16. Rajkumar S.V., Jacobus S., Callander N.S. et al.: Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010; 11: 29-37.
17. Cavo M., Perrone G., Buttignol S. et al.: Bortezomib-thalidomide-dexamethasone compared with thalidomide-dexamethasone as induction and consolidation therapy before and after double autologous transplantation in newly diagnosed multiple myeloma: results from a randomized phase 3 study [abstract]. ASH Annual Meeting Abstracts 2010; 116: 42.
18. Lacy M.Q., Gertz M.A., Dispenzieri A. et al.: Long-term results of response to therapy, time to progression, and survival with lenalidomide plus dexamethasone in newly diagnosed myeloma. Mayo Clin. Proc. 2007; 82: 1179-84.
19. Fermand J.P., Ravaud P., Chevret S. et al.: High-dose therapy and autologous peripheral blood stem cell transplantation in multiple myeloma: up-front or rescue treatment? Results of a multicenter sequential randomized clinical trial. Blood 1998; 92: 3131-6.
20. Attal M., Harousseau J.L., Facon T. et al.: Single versus double autologous stem-cell transplantation for multiple myeloma. N. Engl. J. Med. 2003; 349: 2495-502.
21. Cavo M., Tosi P., Zamagni E. et al.: Prospective, randomized study of single compared with double autologous stem-cell transplantation for multiple myeloma: Bologna 96 clinical study. J. Clin. Oncol. 2007; 25(17): 2434-41.
22. Sonneveld P., van der Holt B., Vellenga E. et al.: Intensive versus double intensive therapy in untreated multiple myeloma: final analysis of the HOVON 24 trial [abstract]. Blood (ASH Annual Meeting Abstracts) 2005; 106: 2545.
23. Garban F., Attal M., Michallet M. et al.: Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft (IFM99- 03 trial) with tandem autologous stem cell transplantation (IFM99-04 trial) in high-risk de novo multiple myeloma. Blood 2006; 107: 3474-80.
24. Morgan G.J., Davies F.E., Gregory W.M. et al.: First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a randomised controlled trial. Lancet 2010; 376: 1989-99.
25. Attal M., Harousseau J.L., Leyvraz S. et al.: Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006; 108: 3289-94.
26. Attal M., Cances Lauwers V., Marit G. et al.: Maintenance treatment with lenalidomide after transplantation for MYELOMA: final analysis of the IFM 2005-02 [abstract 310]. Blood (ASH Annual Meeting Abstracts) 2010; 116(21): 310.
27. McCarthy P.L., Owzar K., Anderson K.C. et al.: Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous hematopoietic stem cell transplantation (AHSCT) for multiple myeloma: CALGB 100104 [abstract 37]. Blood (ASH Annual Meeting Abstracts) 2010; 116(21): 37.
28. Cavo M., Tacchetti P., Patriarca F. et al.: Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet 2010; 376:2075-85.
29. Blokhin N., Larionov L., Perevodchikova N., Chebotareva L., Merkulova N.: Clinical experiences with sarcolysin in neoplastic diseases. Ann. N.Y. Acad. Sci. 1958; 68(3): 1128-32.
30. Kyle R.A., Pierre R.V., Bayrd E.D.: Multiple myeloma and acute myelomonocytic leukemia. N. Engl. J. Med. 1970; 283(21): 1121-5.
31. Leleu X., Tamburini J., Roccaro A. et al.: Balancing risk versus benefit in the treatment of Waldenström’s Macroglobulinemia patients with nucleoside analogue based therapy. Clin. Lymphoma Myeloma 2009; 9(1): 71-3.