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Therapiekonzepte bei jüngeren Patienten mit multiplem Myelom

Therapy concepts in younger patients with multiple myeloma

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Therapieergebnisse für Patienten mit multiplem Myelom konnten in den letzten 20 Jahren schrittweise verbessert werden.

Ziel

Darstellung des aktuellen Entwicklungsstands der Therapiekonzepte für jüngere Patienten mit multiplem Myelom.

Material und Methoden

Auswahl, Nennung, Bewertung und Diskussion der praxisrelevanten großen klinischen Studien in der Primärtherapie des multiplen Myeloms. Vergleichende Betrachtung der verschiedenen Transplantationsformen.

Ergebnisse

Bei jüngeren Patienten mit multiplem Myelom wird eine Hochdosistherapie mit autologer Blutstammzelltransplantation breit national und international eingesetzt. Eine Tandemtransplantation kann den Effekt einer ersten Hochdosistherapie verbessern und konsoldieren – mit vorteilhaftem progressionsfreiem Überleben und Gesamtüberleben. Durch den Einsatz neuer Substanzen wie Bortezomib und Lenalidomid in der Induktionstherapie (vor Hochdosistherapie) sowie Konsolidierungs- und Erhaltungstherapie (nach Hochdosistherapie) können die Remissionsraten, das progressionsfreie Überleben und teilweise auch das Gesamtüberleben der Patienten verbessert werden. Die allogene Transplantation stellt eine Option für Patienten in gutem Allgemeinzustand und zytogenetischen oder klinischen Hochrisikomerkmalen dar und sollte möglichst im Rahmen von klinischen Studien erfolgen. Zytogenetische Veränderungen wie Translokation t(4;14) oder 17p-Deletion sind mit einer schlechteren Prognose assoziiert, können allerdings in ihrer negative Bedeutung durch die neuen Therapieansätze teilweise überwunden werden.

Diskussion

Die Hochdosistherapie mit autologer Blutstammzelltransplantation bewährt sich weiterhin als Standardtherapie jüngerer Patienten mit multiplem Myelom. Die Gesamtergebnisse der Therapie können durch den zusätzlichen und kombinierten Einsatz neuer Substanzen nachweislich verbessert werden. Die Auswirkungen auf das Gesamtüberleben können allerdings noch nicht abschließend beurteilt werden. Die zunehmende Verfügbarkeit von weiteren neuartigen Medikamenten lässt auf weitere Therapieverbesserungen und möglicherweise Heilungschancen hoffen.

Abstract

Background

The treatment results in patients with multiple myeloma could be gradually improved over the last 20 years.

Aim

This article presents the current developments in treatment concepts for younger patients with multiple myeloma.

Material and methods

This article gives a selection, presentation, assessment and discussion of practice relevant large clinical trials on the primary treatment of multiple myeloma. The results of the various transplantation procedures were compared.

Results

High-dose therapy with autologous transplantation is widely used both nationally and internationally. A tandem transplantation can improve and consolidate the effect of an initial high-dose therapy resulting in a favorable progression-free survival and overall. Novel agents, such as bortezomib and lenalidomide administered during induction (before high-dose therapy) and also as consolidation or maintenance treatment (after high-dose therapy) can increase the remission rate, progression-free survival and partly also overall survival of patients. Allogeneic transplantation is an option for patients with a good performance status and cytogenetic or clinical high-risk features and should preferably be performed within the framework of clinical studies. Cytogenetic aberrations, such as translocation t(4;14) or 17p deletion are associated with a worse prognosis which can partly be overcome by novel treatment approaches.

Discussion

High-dose therapy with autologous blood stem cell transplantation remains the standard treatment for younger patients with multiple myeloma. The overall treatment results can be improved by the additional and combined use of novel agents. The consequences for overall survival, however, cannot be clearly determined so far. The increasing availability of further novel pharmaceuticals suggests further improvements and possibly a chance for a cure in the future.

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Ethische Richtlinien

Interessenkonflikt. H. Einsele, S. Knop und C. Straka weisen auf folgenden Interessenkonflikt hin: Speakers Büro/Advisory Board Celgene, Janssen-Cilag und Novartis. Es sind keine Studien an Mensch und Tier enthalten.

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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. Hämatologie/Onkologie, Schön Klinik Starnberger See, 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. Therapiekonzepte bei jüngeren Patienten mit multiplem Myelom. Onkologe 20, 229–234 (2014). https://doi.org/10.1007/s00761-013-2570-5

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  • DOI: https://doi.org/10.1007/s00761-013-2570-5

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