摘要
背景:多发性骨髓瘤(MM)是由克隆浆细胞增殖引起的血液癌症,导致贫血,肾衰竭,高钙血症和破坏性骨损伤,导致显着的发病。随着免疫调节药物(IMiDs)和蛋白酶体抑制剂(PI)的并入,总体存活显着改善。 目的:在这里,我们提供了关于IMiD的综合评估,包括分子机制,治疗应用的最新进展和治疗MM的毒性管理。 方法:通过选择性搜索PubMed检索同行评审期刊中的相关出版物。系统评价,荟萃分析,随机对照试验和治疗建议进行了综述,并在此总结。 结果:第一代IMID沙利度胺与老年患者有显着的毒性相关。来那度胺是一种比沙利度胺更少的副作用更有效的第二代IMiD,通常用于新诊断的多发性骨髓瘤,复发性难治性骨髓瘤和自体干细胞移植(ASCT)后的维持治疗。 Pomalidomide是第三代IMiD,比来那度胺的效力高出10倍,在复发的MM患者和来那度胺和硼替佐米难治的患者中显示出令人印象深刻的结果。 结论:MM在IM中的临床应用显着改善了长期生存和生活质量。未来的研究正在研究新的生物标志物预测MM的结局,以及来那度胺和Pomalidomde与PI,单克隆抗体,免疫检测点阻滞剂和其他几种化学疗法的新组合。
关键词: 免疫调节药物,多发性骨髓瘤,血液肿瘤,IMiD,自体干细胞移植
Current Cancer Drug Targets
Title:Immunomodulatory Drugs (IMiDs) in Multiple Myeloma
Volume: 17 Issue: 9
关键词: 免疫调节药物,多发性骨髓瘤,血液肿瘤,IMiD,自体干细胞移植
摘要: Background: Multiple myeloma (MM) is a hematological cancer caused by a proliferation of clonal plasma cells, leading to anemia, renal failure, hypercalcemia and destructive bone lesions resulting in significant morbidity. The overall survival has significantly improved with the incorporation of immunomodulatory drugs (IMiDs) and proteasome inhibitors (PI).
Objective: Here we provide a comprehensive review on IMiDs including molecular mechanisms, recent advances in therapeutic applications and management of toxicities in the treatment of MM.
Methods: Relevant publications in peer reviewed journals were retrieved by a selective search of PubMed. Systemic reviews, meta-analyses, randomized controlled trials, and treatment recommendations were reviewed and are summarized here.
Results: Thalidomide, a first generation IMiD, is associated with significant toxicity in older patients. Lenalidomide, a more potent second generation IMiD with fewer side effects than thalidomide, is commonly used in newly-diagnosed multiple myeloma, relapsed refractory myeloma and as maintenance therapy after autologous stem cell transplantation (ASCT). Pomalidomide, a third generation IMiD, is 10 times more potent than lenalidomide and has shown impressive results in relapsed MM patients and in those refractory to both lenalidomide and bortezomib.
Conclusion: The clinical use of IMiDs in MM has significantly improved long-term survival and quality of life. Future studies are looking into novel biomarkers predictive of outcome in MM and new combinations of lenalidomide and pomalidomde with PI, monoclonal antibodies, immune checkpoint blockers and several other chemotherapies.
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Immunomodulatory Drugs (IMiDs) in Multiple Myeloma, Current Cancer Drug Targets 2017; 17 (9) . https://dx.doi.org/10.2174/1568009617666170214104426
DOI https://dx.doi.org/10.2174/1568009617666170214104426 |
Print ISSN 1568-0096 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5576 |
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