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Therapie des multiplen Myeloms

Indikationen und Möglichkeiten

Therapy of multiple myeloma: indications and options

  • Schwerpunkt: Was ist gesichert in der Therapie?
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Zusammenfassung

Das multiple Myelom (MM) gehört zu den B-Zell-Neoplasien und macht bei einer Inzidenz von 3–4/100.000 ca. 1% aller Tumorneuerkrankungen aus. Therapeutisch wichtig ist die Abgrenzung des therapiebedürftigen MM vom „Smoldering Multiple Myeloma“ (SMM) und von der monoklonalen Gammopathie unbestimmter Signifikanz (MGUS). Die Basisbehandlung des MM ist eine systemische Chemotherapie, individuell ergänzt durch lokale Strahlentherapie und supportive Behandlungsmaßnahmen einschließlich der Bisphosphonate. Bei jüngeren Patienten (<60–65 Jahre) wird in der Regel eine möglichst weitgehende Remission mit Aussicht auf Langzeitremission, bei älteren, komorbiden Patienten eine gute Teilremission mit Erhaltung oder Verbesserung der Lebensqualität angestrebt. Für ältere Patienten und solche mit Kontraindikationen für eine intensive Chemotherapie kann mit konventioneller Chemotherapie aus Melphalan und Prednison eine Lebensverlängerung und Verbesserung der Lebensqualität erreicht werden. Die Hochdosischemotherapie, häufig als Tandemtransplantation, gilt als Standardbehandlung bei Patienten unter 65 Jahren. Allerdings bietet die allogene Blutstammzelltransplantation den gegenwärtig einzig kurativen Therapieansatz beim MM. Neue Substanzen sind zur Behandlung des Rezidivs zugelassen (Bortezomib, Lenalidomid) oder im Zulassungsverfahren (Thalidomid).

Abstract

The multiple myeloma (MM) has an incidence of 3–4/100,000 in the Caucasian population. MM has to be distinguished from smouldering MM and monoclonal gammopathy of uncertain significance (MGUS). In younger patients (<65 years) a good long-term remission is the aim of therapy, while in the elderly patients with comorbidities the aim is a good partial remission with good quality of life. In the elderly this can be achieved with a combination of melphalan and prednisone. High-dose chemotherapy, often as a tandem transplantation, is part of standard therapy of MM patients <65 years. However, allogeneic stem cell transplantation is the only curative approach. New substances approved for treatment of relapsed MM include bortezomib, thalidomide, and lenalidomide.

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  1. Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    D. Peest &  A. Ganser

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  1. D. Peest
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  2. A. Ganser
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Peest, D., Ganser, A. Therapie des multiplen Myeloms. Internist 48, 1343–1348 (2007). https://doi.org/10.1007/s00108-007-1959-x

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