The current standard of care model for newly diagnosed fit multiple myeloma (NDMM) patients is the sequential treatment of induction, high dose melphalan, autologous stem cell transplantation (ASCT), and maintenance. Adequate induction is required to achieve good disease control and induce deep response rates while minimizing toxicity as a bridge to transplant. Doublet induction regimens have greatly fallen out of favor, with current international guidelines favoring triplet or quadruplet induction regimens built around the backbone of the proteasome inhibitor bortezomib and dexamethasone (Vd). In fact, the updated 2021 European Haematology Association (EHA) and European Society for Medical Oncology (ESMO) clinical practice guidelines recommend the use of either lenalidomide-Vd (VRd), or daratumumab-thalidomide-Vd (Dara-VTd) as first-line options for transplant-eligible NDMM patients, and when not available, thalidomide-Vd (VTd) or cyclophosphamide-Vd (VCd) as acceptable alternatives. Quadruplet regimens featuring anti-CD38 monoclonal antibodies are extremely promising and remain heavily investigated, as is the incorporation of more recent proteasome inhibitors such as carfilzomib. This review will focus on induction therapies prior to ASCT examining the latest data and guidelines on triplet and quadruplet regimens.
当前适合移植的新诊断多发性骨髓瘤（NDMM）患者的标准治疗方案是序贯治疗，包括诱导治疗、大剂量马法兰、自体干细胞移植（ASCT）及维持治疗。充分的诱导治疗是实现良好疾病控制、诱导深度缓解的关键，同时需最小化毒性，为移植创造条件。双药诱导方案已基本被淘汰，现行国际指南推荐以蛋白酶体抑制剂硼替佐米和地塞米松（Vd）为核心的三联或四联诱导方案。实际上，2021年更新的欧洲血液学协会（EHA）和欧洲肿瘤内科学会（ESMO）临床实践指南推荐来那度胺-Vd（VRd）或达雷妥尤单抗-沙利度胺-Vd（Dara-VTd）作为适合移植NDMM患者的一线选择；若无法获得上述方案，则沙利度胺-Vd（VTd）或环磷酰胺-Vd（VCd）可作为替代选择。以抗CD38单克隆抗体为主的四联方案前景广阔，目前仍在深入研究中，同时新型蛋白酶体抑制剂如卡非佐米的联合方案也备受关注。本综述将聚焦ASCT前的诱导治疗，重点探讨三联及四联方案的最新数据和指南。
肿瘤(癌症)患者之家