Der Onkologe

, Volume 16, Issue 3, pp 282–288

Therapieoptionen im Rezidiv des multiplen Myeloms

Leitthema
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Zusammenfassung

Während die Primärtherapie des multiplen Myeloms mit der Differenzierung in jüngere, ältere und fragile Patienten weitgehend standardisiert ist, erfordert die Rezidivtherapie eine stärkere Individualisierung. In die Therapieentscheidung im Rezidiv gehen neben Effektivität und Toxizität der vorangegangenen Behandlung auch patientenseitige Faktoren wie Zeitpunkt und Kinetik des Rezidivs, mittlerweile erreichtes Lebensalter, ganz wesentlich die Patientenpräferenz und letztlich auch der Zulassungsstatus der verfügbaren Medikamente ein. Kombinationen erzielen im Rezidiv ein schnelleres und qualitativ besseres Therapieansprechen als Monotherapien, welches sich meist auch in eine längere Erkrankungskontrolle umsetzt. In einer wenig dynamischen Rezidivsituation eines älteren Menschen kann jedoch eine Monotherapie oder eine Kombination von lediglich zwei Substanzen ausreichend sein. Die folgende Übersicht beschreibt die aktuellen Therapieoptionen im Rezidiv, insbesondere die beiden neuen Substanzklassen – den Proteasominhibitor Bortezomib sowie die immunmodulatorischen Substanzen (ImIDs) Thalidomid und Lenalidomid – und beschränkt sich dabei im Wesentlichen auf die zugelassenen Indikationen.

Schlüsselwörter

Multiples Myelom Thalidomid Bortezomib Lenalidomid Bendamustin 

Therapy options for recurrent multiple myeloma

Abstract

Although the initial treatment of multiple myeloma is largely standardized with a differentiation between younger patients and the elderly and fragile, the therapy for recurrences needs to be more strictly individualized. Treatment choice at relapse should be influenced by the effectiveness and toxicity of prior therapies with consideration given to the age of the patient, kinetics of relapse, approval status and, most importantly, patient preference. Compared to single agent treatments, combination therapies have been associated with higher response rates which mostly translate into prolonged disease control. Combinations are preferred when a rapid and profound response is required whereas in a less dynamic relapse of an elderly patient single agent treatment or a combination of only two drugs may be appropriate. This review focuses in particular on clinical data of the two recently introduced drug classes, the proteasome inhibitor bortezomib and the immunomodulatory drugs (ImIDs) thalidomide and lenalidomide with special emphasis on the approval status.

Keywords

Multiple myeloma Thalidomide Bortezomib Lenalidomide Bendamustine 

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Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  1. 1.Medizinische Klinik AUniversitätsklinikum MünsterMünsterDeutschland

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