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Fortschritte in der Behandlung von Patienten mit multiplem Myelom

Hochdosistherapie und Stammzelltransplantation

Progress in treating patients with multiple myeloma

High-dose chemotherapy and stem cell transplantation

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Der Onkologe Aims and scope

Zusammenfassung

Die Entwicklung der Melphalan-Hochdosischemotherapie mit nachfolgender Transplantation autologer Blutstammzellen seit Beginn der 1980er Jahre gehört zweifelsfrei zu den „Meilensteinen“ in der Behandlung des multiplen Myeloms. Mittlerweile wird die Hochdosistherapie bei Patienten im Alter bis zu 70 Jahren international als eine Standardtherapie akzeptiert. Zwei im Abstand von wenigen Monaten durchgeführte autologe Transplantationen jeweils nach hoch dosiertem Melphalan gelten aktuell als die Behandlungsoption mit der längsten rezidivfreien Überlebenszeit. Da allenfalls eine Minderheit der Patienten trotz dieses intensiven Verfahrens geheilt werden kann, wurde und wird mit verschiedensten Strategien an einer Verfeinerung der Hochdosistherapie gearbeitet. Zu den effektivsten Konzepten gehört vermutlich aktuell der Einsatz der neuen Substanzen Thalidomid, Bortezomib und Lenalidomid kombiniert mit Dexamethason als Induktionstherapie zur anfänglichen Zytoreduktion. Ihr Stellenwert als Konsolidierungs- bzw. Erhaltungstherapie ist dagegen noch nicht abschließend geklärt.

Abstract

Several therapeutic milestones have been achieved in the treatment of multiple myeloma with the alkylator melphalan being the backbone since the 1960’s. This drug is currently used at high doses followed by autologous stem cell transplantation (ASCT) to ameliorate hematologic toxicity in patients up to 70 years old. In subjects eligible for ASCT, initial cytoreduction should nowadays be performed using one of the novel compounds, thalidomide, bortezomib or lenalidomide, in combination with dexamethasone due to enhanced response both before and after ASCT when compared to standard anthracycline/dexamethasone treatment. However, it has not yet been determined which combination should best be used in a given patient. Whether consolidative or maintenance treatment with either of these drugs further improves prognosis still needs confirmatory results from currently ongoing clinical trials.

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Interessenskonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Speakers’s Bureau Celgene/Ortho Biotech

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland

    H. Einsele & S. Knop

  2. Schön-Kliniken, Berg, Deutschland

    C. Straka

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  1. H. Einsele
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  2. S. Knop
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  3. C. Straka
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Correspondence to H. Einsele.

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Einsele, H., Knop, S. & Straka, C. Fortschritte in der Behandlung von Patienten mit multiplem Myelom. Onkologe 16, 263–273 (2010). https://doi.org/10.1007/s00761-010-1791-0

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