SOHO State of the Art Updates and Next Questions | Late/Deferred ASCT in Myeloma.

IF 2.7 4区 医学 Q2 HEMATOLOGY
Clifton C Mo, Yuxin Liu, Monique A Hartley-Brown, Omar Nadeem, Shonali Midha, Paul G Richardson
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引用次数: 0

Abstract

High-dose melphalan with autologous stem cell transplant (HDM-ASCT) remains a standard-of-care for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM), with data from randomized studies demonstrating progression-free survival (PFS) benefit with transplant versus nontransplant approaches. However, with increasing overall survival (OS) in this setting, associated with the substantial efficacy of triplet and quadruplet regimens and multiple novel treatment approaches, strategic considerations are key, together with a holistic approach taking into account patients' preferences and needs, for treatment decision-making. In this context, the approach of deferring HDM-ASCT is being increasingly considered, associated with various drivers. Rationales for deferring HDM-ASCT include the acute and long-term toxicities and sequelae associated with undergoing transplant, such as the increased mutational burden and elevated risk of secondary leukemia arising following HDM. Given these downsides, another driver for considering deferred HDM-ASCT is that substantial variability in magnitude of PFS benefit has been seen across patient subgroups. Furthermore, despite significant PFS benefit, randomized studies have not shown OS benefit in the era of triplet induction/consolidation and multiple active treatment options at relapse. Additionally, very high rates of minimal residual disease (MRD)-negative responses have been demonstrated with emerging standard-of-care quadruplet induction regimens for NDMM, facilitating potential HDM-ASCT-sparing, MRD-adapted treatment approaches. Finally, novel therapies such as chimeric antigen receptor (CAR) T-cell and bispecific antibody therapies are beginning to be investigated as upfront alternatives in transplant-eligible patients. Thus, associated with these multiple drivers, late or deferred HDM-ASCT is emerging as a potential standard-of-care approach for select transplant-eligible patients with NDMM.

SOHO最新进展和下一个问题:骨髓瘤晚期/延期ASCT。
大剂量美法兰联合自体干细胞移植(HDM-ASCT)仍然是新诊断多发性骨髓瘤(NDMM)患者的标准治疗方案,随机研究的数据表明,移植与非移植方法相比,无进展生存(PFS)获益。然而,随着这种情况下总生存期(OS)的增加,以及三联和四联方案的实质性疗效和多种新型治疗方法的出现,策略考虑以及考虑患者偏好和需求的整体方法是治疗决策的关键。在这种情况下,推迟HDM-ASCT的方法正越来越多地被考虑,与各种驱动因素相关。推迟HDM- asct的理由包括与移植相关的急性和长期毒性和后遗症,例如增加的突变负担和HDM后继发性白血病的风险升高。考虑到这些缺点,考虑延迟HDM-ASCT的另一个驱动因素是,在不同的患者亚组中,PFS获益的程度存在很大差异。此外,尽管有显著的PFS获益,但随机研究并未显示在三胞胎诱导/巩固和复发时多种积极治疗方案的时代有OS获益。此外,新兴的标准护理四联体诱导NDMM方案已经证明了非常高的最小残留病(MRD)阴性反应率,促进了潜在的hdm - asct节约,MRD适应的治疗方法。最后,嵌合抗原受体(CAR) t细胞疗法和双特异性抗体疗法等新疗法正开始被研究作为符合移植条件的患者的前期选择。因此,与这些多重驱动因素相关,晚期或延迟的HDM-ASCT正在成为选择符合移植条件的NDMM患者的潜在标准治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.70
自引率
3.70%
发文量
1606
审稿时长
26 days
期刊介绍: Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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