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Primärtherapie beim Multiplen Myelom

First-line treatment of multiple myeloma

  • Schwerpunkt: Multiples Myelom
  • Published:
Der Internist Aims and scope Submit manuscript

An Erratum to this article was published on 18 March 2019

This article has been updated

Zusammenfassung

Die Therapielandschaft des neu diagnostizierten multiplen Myeloms hat sich im Verlauf der letzten beiden Jahrzehnte entscheidend verändert. Die Einführung der Hochdosistherapie mit Melphalan und nachfolgender autologer Blutstammzelltransplantation führte zunächst zu einem verbesserten Gesamtüberleben bei jüngeren Patienten, darüber hinaus scheinen nun insbesondere Hochrisikopatienten von einer Tandemtransplantation zu profitieren. Der Risikostratifizierung zum Zeitpunkt der Therapieeinleitung wird daher eine besondere Bedeutung beigemessen. Die Integration der sogenannten „neuen Substanzen“, wie Thalidomid, Lenalidomid und Bortezomib, in die Erstlinientherapie eröffnete sowohl Patienten, die für eine Hochdosistherapie geeignet sind, als auch nicht transplantationsfähigen Patienten neue Perspektiven. Standardinduktion in Deutschland vor geplanter Hochdosistherapie ist derzeit eine Kombination von Bortezomib, Cyclophosphamid und Dexamethason, jedoch wird zunehmend die Kombination von Lenalidomid, Bortezomib und Dexamethason angewendet. Für nicht transplantationsfähige Patienten stehen in der Erstlinientherapie Kombinationen mit Bortezomib oder Lenalidomid zur Verfügung. Erstmalig in der Primärtherapie dieser Patienten wurde kürzlich eine Therapie mit dem Anti-CD38-Antikörper Daratumumab in Kombination mit Bortezomib, Melphalan und Prednison zugelassen. Eine allogene Transplantation kann bei Patienten ohne relevante Komorbiditäten mit einer Hochrisikokonstellation oder mit Frührezidiv nach autologer Blutstammzelltransplantation erwogen werden, sollte jedoch nur innerhalb klinischer Studien und an spezialisierten Zentren erfolgen.

Abstract

Within the last two decades the therapeutic options for newly diagnosed multiple myeloma have changed dramatically. The implementation of high-dose chemotherapy with melphalan and subsequent autologous blood stem cell transplantation initially led to prolonged survival in younger, fit patients. Furthermore, recent data suggest that patients with high-risk disease seem to benefit most from tandem transplantation approaches. Therefore, risk stratification at initiation of first-line treatment is of great importance. With the advent and integration of the so-called novel agents, such as thalidomide, lenalidomide and bortezomib into first-line treatment, both transplant eligible and ineligble patients gained new therapeutic perspectives. In Germany, the combination of bortezomib with cyclophosphamide and dexamethasone is currently considered the standard of care as induction regimen before high-dose treatment and transplantation; however, the combination of lenalidomide, bortezomib and dexamethasone is increasingly being used, but is still not yet approved in Germany. For patients where high-dose therapy and stem cell transplantation are not feasible, bortezomib and lenalidomide are available as backbone agents of various combination regimens. Recently, the anti-CD38 antibody daratumumab has been approved in combination with bortezomib, melphalan and prednisone as primary treatment for newly diagnosed patients. An allogeneic stem cell transplantation can be considered for younger patients without relevant comorbidities and with high-risk disease or early relapse after autologous blood stem cell transplantation but should only be performed within controlled clinical trials and in specialized centers.

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Change history

  • 18 March 2019

    Erratum zu:

    Internist 2018

    https://doi.org/10.1007/s00108-018-0527-x

    Im Originalbeitrag ist Tab. 2 fehlerhaft. Die Fehler betreffen die Spalte „Ansprechrate/Überlebenszeiten“ bei der Studie Mateos et al. [20]. Bitte beachten Sie nachfolgend diesen Abschnitt der Tabelle, der die korrekten Zahlen …

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I. Breitkreutz erhielt finanzielle Unterstützung von der Firma Celgene zum Besuch von Fortbildungsveranstaltungen. M. Raab erhielt Honorare, Reisekostenunterstützungen bzw. Forschungsmittel von Janssen, Celgene, BMS, Novartis, Sanofi, Takeda. H. Goldschmidt erhielt Honorare, Reisekostenunterstützungen und Forschungsmittel von Janssen, Celgene, BMS, Novartis, Sanofi.

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Breitkreutz, I., Raab, M. & Goldschmidt, H. Primärtherapie beim Multiplen Myelom. Internist 60, 23–33 (2019). https://doi.org/10.1007/s00108-018-0527-x

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