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Der Onkologe

, Volume 24, Issue 8, pp 613–624 | Cite as

Therapie des rezidivierten und refraktären multiplen Myeloms

  • M. Engelhardt
  • G. Graziani
  • R. Javorniczky
  • J. Neubauer
  • M. Köhler
  • G. W. Herget
  • R. Wäsch
Leitthema
  • 231 Downloads

Zusammenfassung

Hintergrund

Die Rezidivbehandlung beim multiplen Myelom (MM) ist durch Zulassung vieler neuer Substanzen komplexer geworden.

Ziel

Es sollen aktuelle Therapieoptionen für das rezidivierte und refraktäre MM (RRMM) dargestellt werden.

Material und Methoden

Nach aktueller Literaturrecherche internationaler Studien- bzw. Übersichtsartikel werden Antimyelomtherapien beim RRMM beschrieben.

Ergebnisse und Schlussfolgerungen

Aufgrund des deutlich verlängerten Überlebens von MM-Patienten erleiden nahezu alle ein oder mehrere Rezidive während ihres Krankheitsverlaufs. Zahlreiche neue zugelassene Substanzen im Rezidiv sowie zahlreiche Substanzen in klinischen Studien haben die Prognose beim RRMM erheblich verbessert, lassen die Therapiewahl aber auch komplexer ausfallen. Zu berücksichtigen sind hierbei patienten-, krankheits- und therapiespezifische Faktoren. Interdisziplinäre Tumorboards zur Planung eines bestmöglichen therapeutischen Vorgehens sind dabei hilfreich. Zahlreiche neue zugelassene Substanzen, die im Rezidiv auch bei intensiv vorbehandelten Patienten eingesetzt werden, umfassen neue immunmodulatorische Substanzen wie Pomalidomid, neue Proteasomeninhibitoren wie Carfilzomib und Ixazomib, Antikörper wie Daratumumab und Elotuzumab sowie den Histondeacetylase(HDAC)-Inhibitor Panobinostat. Die autologe Stammzelltransplantation (SZT) spielt in der Rezidivsituation bei genügend fitten Patienten ebenfalls eine Rolle, insbesondere, um eine tiefe Remission zu induzieren oder – nach bereits durchgeführter erster SZT und bei mindestens 18 Monaten Remissionsinduktion – um eine länger anhaltende Remission erneut zu erreichen. Neben der Antimyelomtherapie ist auch die Supportivtherapie essenziel und umfasst u. a. die suffiziente Schmerztherapie, die Vermeidung bzw. Behandlung von Osteolysen oder Frakturen und von Infektkomplikationen.

Schlüsselwörter

Rezidivtherapie Antikörper Neue Substanzen Refraktärität Klinische Studien 

Treatment of relapsed and refractory multiple myeloma

Abstract

Background

Treatment of relapsed and refractory multiple myeloma (RRMM) is more demanding today due to various possible new treatment options.

Objective

Presentation of the current treatment options for RRMM.

Material and methods

This summary report is based on evidence from published international data including clinical studies, meta-analyses and systematic reviews.

Results and conclusion

Due to the longer survival of MM patients, nearly all of them relapse once or several times during their clinical course. Numerous newly approved drugs with excellent results from phase 1–4 clinical trials have significantly improved the prognosis of RRMM patients; however, they have also made RRMM treatment and the selection of the best available option more complex. Patient, disease and therapy-related factors have to be considered before RRMM treatment is initiated. Interdisciplinary tumor boards are valuable for the planning of the best treatment options,. Newly approved drugs, which can currently be used for RRMM patients include new immunomodulatory drugs, such as pomalidomide, new proteasome inhibitors, such as carfilzomib and ixazomib, the two monoclonal antibodies daratumumab and elotuzumab and the histone deacetylase (HDAC) inhibitor panobinostat. Autologous stem cell transplantation (SCT) plays an additional role in sufficiently fit RRMM patients, to achieve deep remission and should also be considered in those patients who achieved long-ongoing remission after initial SCT. Besides antimyeloma treatment itself, supportives are highly relevant for RRMM patients and include appropriate pain management, prevention and treatment of osteolysis and fractures and of infections.

Keywords

Relapse treatment Antibodies Novel agents Refractoriness Clinical trials 

Notes

Förderung

Die Arbeiten von ME + RW werden von der Deutschen Krebshilfe unterstützt: DKH #111424.

Einhaltung ethischer Richtlinien

Interessenkonflikt

Die Autoren geben folgende Interessenkonflikte an: M. Engelhardt: educational grants Amgen, Celgene, MSD, Janssen, Unterstützung der Deutschen Krebshilfe (DKH #111424); R. Wäsch: educational grants Amgen, Celgene, MSD, Janssen, Unterstützung der Deutschen Krebshilfe (DKH #111424). G. Graziani, R. Javorniczky, J. Neubauer, M. Köhler und G.W. Herget geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • M. Engelhardt
    • 1
  • G. Graziani
    • 1
  • R. Javorniczky
    • 1
  • J. Neubauer
    • 2
  • M. Köhler
    • 1
  • G. W. Herget
    • 3
  • R. Wäsch
    • 1
  1. 1.Klinik Innere Medizin I, Hämatologie, Onkologie & Stammzelltransplantation, Fakultät FreiburgUniversitätsklinikum FreiburgFreiburgDeutschland
  2. 2.Klinik für RadiologieUniversitätsklinikum FreiburgFreiburgDeutschland
  3. 3.Tumororthopädie, Klinik für Orthopädie und UnfallchirurgieUniversitätsklinikum FreiburgFreiburgDeutschland

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