Erstlinientherapie des behandlungsbedürftigen Multiplen Myeloms – Aktuelle Empfehlungen

Abstract

Due to the introduction of novel therapeutic agents, the prognosis of Multiple Myeloma has greatly improved over the last decades. The current standard for fit patients is a bortezomib-based induction therapy, followed by high-dose chemotherapy and autologous stem cell transplantation and lenalidomide-based maintenance therapy. For older, non-transplant-eligible patients, daratumumab in combination with bortezomib or lenalidomide offers a well-tolerated, effective treatment option. Despite large improvements, there is still no cure for most myeloma patients, the aim of therapy is therefore to reach a deep remission to prevent lasting damage followed by a continuous maintenance therapy to uphold the remission and prolong overall survival.

Durch die autologe Blutstammzelltransplantation und neue Substanzen in der Induktions-und Erhaltungstherapie hat sich das Multiple Myelom in den letzten Jahrzehnten von einer nur kurzfristig palliativ behandelbaren Krankheit zu einer bei vielen Patienten gut kontrollierbaren, chronischen Erkrankung entwickelt. Der Beitrag präsentiert einen Überblick über Therapiestrategien und verwendete Medikamente beim neu diagnostizierten Multiplen Myelom.

Schlüsselwörter

Multiples Myelom - Erstlinientherapie - autologe Stammzelltransplantation

Key words

multiple Myeloma - first-line treatment - autologous stem-cell transplantation

Publikationsverlauf

Artikel online veröffentlicht:
17. Juni 2020

• Literatur

• 1 Sant M, Allemani C, Tereanu C. et al Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood 2010; 116: 3724-3734 . doi:10.1182/blood-2010-05-282632
• 2 Rajkumar SV, Dimopoulos MA, Palumbo A. et al International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15: e538-e548 . doi:10.1016/S1470-2045(14)70442-5
• 3 McCarthy PL, Holstein SA, Petrucci MT. et al Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis. J Clin Oncol 2017; 35: 3279-3289 . doi:10.1200/JCO.2017.72.6679
• 4 Holstein SA, McCarthy PL. Immunomodulatory Drugs in Multiple Myeloma: Mechanisms of Action and Clinical Experience. Drugs 2017; 77: 505-520 . doi:10.1007/s40265-017-0689-1
• 5 Scheid C, Sonneveld P, Schmidt-Wolf I. et al Bortezomib before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in newly diagnosed multiple myeloma: a subgroup analysis from the HOVON-65/GMMG-HD4 trial. Haematologica 2014; 99: 148-154 . doi:10.3324/haematol.2013.087585
• 6 Neben K, Lokhorst HM, Jauch A. et al Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. Blood 2012; 119: 940-948 . doi:10.1182/blood-2011-09-379164
• 7 Scheid C, Munder M, Salwender H. et al Infusion of Daratumumab in Combination Therapies – Practical Information for The Outpatient Area. Dtsch Med Wochenschr 2018; 143: 1201-1206 . doi:10.1055/a-0595-5397
• 8 Sonneveld P, Goldschmidt H, Rosinol L. et al Bortezomib-based versus nonbortezomib-based induction treatment before autologous stem-cell transplantation in patients with previously untreated multiple myeloma: a meta-analysis of phase III randomized, controlled trials. J Clin Oncol 2013; 31: 3279-3287 . doi:10.1200/JCO.2012.48.4626
• 9 Leiba M, Kedmi M, Duek A. et al Bortezomib-cyclophosphamide-dexamethasone (VCD) versus bortezomib-thalidomide-dexamethasone (VTD) -based regimens as induction therapies in newly diagnosed transplant eligible patients with multiple myeloma: a meta-analysis. Br J Haematol 2014; 166: 702-710 . doi:10.1111/bjh.12946
• 10 Durie B, Hoering A, Abidi M. et al Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017; 389: 519-527 . doi:10.1016/S0140-6736(16)31594-X
• 11 Mateos MV, Cavo M, Blade J. et al Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (ALCYONE): a randomised, open-label, phase 3 trial. Lancet 2020; 395: 132-141 . doi:10.1016/s0140-6736(19)32956-3
• 12 Facon T, Kumar S, Plesner T. et al Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma. N Engl J Med 2019; 380: 2104-2115 . doi:10.1056/NEJMoa1817249
• 13 Dhakal B, Szabo A, Chhabra S. et al Autologous Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Novel Agent Induction: A Systematic Review and Meta-analysis. JAMA oncology 2018; 4: 343-350 . doi:10.1001/jamaoncol.2017.4600
• 14 Cavo M, Gay F, Patriarca F. et al Double autologous stem cell transplantation significantly prolongs progression-free survival and overall survival in comparison with single autotransplantation in newly diagnosed multiple myeloma: an analysis of Phase 3 EMN02 / HO95 Study. Im Internet (Stand: 14.02.2020): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/281/CN-01453281/frame.html
• 15 Naymagon L, Abdul-Hay M. Novel agents in the treatment of multiple myeloma: a review about the future. J Hematol Oncol 2016; 9: 52 . doi:10.1186/s13045-016-0282-1