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Therapiestrategien beim multiplen Myelom im Rezidiv oder Progress nach Primärtherapie

Therapeutic strategies for multiple myeloma in relapse or progession after primary therapy

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Zusammenfassung

Das multiple Myelom ist eine in der Regel inkurable Erkrankung. Auch wenn es zunehmend gelingt, mit modernen Therapiestrategien lang anhaltende Remissionen zu erzielen, sind fast alle Patienten im weiteren Verlauf wieder progredient und benötigen dann eine erneute Therapie. Im Gegensatz zur primären Induktionstherapie ist in der Situation eines Rezidivs bzw. Progresses das therapeutische Vorgehen weniger klar standardisiert und von der Vorbehandlung sowie patientenspezifischen Faktoren abhängig. Die Grundlage der Therapie des multiplen Myeloms im Rezidiv bzw. Progress ist eine medikamentöse Therapie (Chemotherapie und/oder Targettherapie), bedarfsweise ergänzt durch chirurgische Verfahren bei Frakturen, sowie durch Strahlentherapie zur Konsolidierung frakturierter oder frakturgefährdeter Bereiche bzw. zur Schmerztherapie. Das Toxizitätsmanagement gewinnt vor dem Hintergrund eines zunehmend längeren Überlebens an Bedeutung. In dem vorliegenden Beitrag werden Kriterien zur Therapieauswahl aufgezeigt, die den Leser in die Lage versetzen sollen, eine optimierte Behandlungsstrategie zu entwickeln.

Abstract

Multiple myeloma is as a rule an incurable disease. Even though it is increasingly possible to achieve long lasting remission nearly all patients eventually show relapse or progression and then need treatment again. Unlike in first-line therapy, treatment recommendations in relapse or progression are far less standardized and depend on the previous treatment as well as patient-specific factors. Myeloma therapy in relapse is based on drug therapy (e.g. antineoplastic chemotherapy and/or targeted therapy) and can be supplemented by surgery in the case of fractures, by radiotherapy of compromised bones or to treat skeletal pain. The management of side effects gains importance in the light of improved survival. In this article criteria for the selection of the appropriate drugs are presented in order to enable the reader to develop an optimized treatment strategy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. L.-O. Mügge: Referentenhonorare von Celgene, Janssen-Cilag, Novartis; Forschungsfinanzierung: Celgene, Novartis. R. Kruschel und J. Walter: kein Interessenkonflikt.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Innere Medizin II, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    L.-O. Mügge

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena, Deutschland

    R. Kruschel

  3. Klinik für Neurochirurgie, Universitätsklinikum Jena, Jena, Deutschland

    J. Walter

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  1. L.-O. Mügge
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  2. R. Kruschel
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  3. J. Walter
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Correspondence to L.-O. Mügge.

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Mügge, LO., Kruschel, R. & Walter, J. Therapiestrategien beim multiplen Myelom im Rezidiv oder Progress nach Primärtherapie. Onkologe 21, 639–650 (2015). https://doi.org/10.1007/s00761-015-2976-3

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  • DOI: https://doi.org/10.1007/s00761-015-2976-3

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