The treatment paradigm in myeloma is constantly changing. Upfront use of monoclonal antibodies like daratumumab along with proteasome inhibitors (PI)s, and immune modulators (IMiD)s have significantly improved survival and outcomes, but also cause unique challenges at the time of relapse. Engaging immune T cells for tumour cell kill with chimeric antigenic T-cell (CAR T-cell) therapy and bispecific antibodies have become important therapeutic options in relapsed multiple myeloma. Bispecific antibodies are dual antigen targeting constructs that engage the T cells to plasma cells through various target antigens like B-cell membrane antigen (BCMA), G-protein-coupled receptor family C group 5 member D (GPRC5D), and Fc receptor-homolog 5 (FcRH5). These agents have proven to induce deep and durable responses in heavily pre-treated myeloma patients with a predictable safety profile and the ease of off-the-shelf availability. Significant research is ongoing to overcome resistance mechanisms like T cell exhaustion, target antigen mutation or loss and high disease burden. Various trials are also studying these agents as first line options in the newly diagnosed setting. These agents play an important role in the relapsed setting, and efforts are underway to optimize their sequencing in the myeloma treatment algorithm.
骨髓瘤的治疗模式正在不断变化。前期使用如达雷妥尤单抗等单克隆抗体，结合蛋白酶体抑制剂和免疫调节剂，显著提高了生存率和治疗结果，但也在复发时带来了独特的挑战。通过嵌合抗原受体T细胞（CAR-T细胞）疗法和双特异性抗体激活免疫T细胞以杀死肿瘤细胞，已成为复发性多发性骨髓瘤的重要治疗选择。双特异性抗体是双抗原靶向结构，通过诸如B细胞膜抗原（BCMA）、G蛋白偶联受体家族C组5成员D（GPRC5D）和Fc受体同源物5（FcRH5）等多种靶抗原，将T细胞与浆细胞连接起来。这些药物已被证明能在经过多重治疗的骨髓瘤患者中诱导深入且持久的反应，具有可预测的安全性和现成可用的便利性。为了克服如T细胞耗竭、靶抗原突变或丢失以及高疾病负担等耐药机制，正在进行大量研究。各种试验也正在研究这些药物作为新诊断情况下一线选择的可能性。这些药物在复发情况下扮演重要角色，并且正在努力优化它们在骨髓瘤治疗算法中的序贯使用。
肿瘤(癌症)患者之家