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preface
Multiple myeloma (MM), like many cancers, inevitably progresses again after first-line treatment, requiring re-treatment, threatening the patient's long-term survival
.
With the widespread clinical use of proteasome inhibitors, immunomodulators, and autologous hematopoietic stem cell transplantation, survival in patients with MM has improved, but all patients will eventually develop relapsed/refractory MM.
Therefore, normative treatment is an important way to
prolong the survival of MM patients and improve their prognosis.
Especially newly diagnosed MM patients, if they receive timely, effective and standardized long-term treatment, they can often obtain better prognosis
.
At present, the treatment of multiple myeloma (MM) patients has been greatly increased, and under the endless multi-line treatment of new drugs, myeloma patients have entered the era of
chronic disease treatment.
At present, the accessibility of new drugs such as bortezomib, lenalidomide, and daratumumab commonly used in the first-line treatment of myeloma has been greatly improved, and more and more patients have the conditions to
choose new drugs.
best full treatment effect 。 Of the first-line regimens for patients without transplantation, the most effective first-line regimen that has been shown to be daratumab + bortezomib + melphalan + prednisone, with an average time to disease recurrence of up to 71 months after first-line therapy; After comparing the combination of 30 different first- and second-line regimens being used clinically, the second-line regimen with carfilzomib or erlustuzumab + lenalidomide + dexamethasone achieved the longest expected overall survival of 7.
5 years
after selecting the most effective first-line regimen.
1 It can be seen that only when the best response is selected in the first-line treatment can the longest overall survival be guaranteed
.
From the perspective of the whole process of disease management, first-line treatment needs to be paid great attention to, and the best efficacy plan should be selected as much as possible, so as to obtain deep remission in the early stage of disease treatment, prolong the time of the first recurrence, and lay a solid foundation
for long-term survival 。 02Reduce the cost of treatment and improve the quality of life At the same time, although the above treatment package includes the more expensive monoclonal antibody drugs and next-generation proteasome inhibitors, the total treatment cost of this treatment combination is only moderate among the thirty different treatment combinations, because the total treatment cost includes the cost
of hospitalization due to disease recurrence.
1 If the option that can achieve the longest remission time is selected in the first-line treatment, the cost of repeated hospitalization can be greatly reduced, and even indirectly reduce the lost work cost caused by disease treatment, thereby reducing the overall treatment cost
.
Not only that, when the recurrence of the disease is prolonged after first-line treatment, it can also reduce the impact of disease-related symptoms on the patient's normal work and life, which can not only prolong the survival of patients, but also significantly improve the quality of life of
patients.
From the macro perspective of social benefits, it also reduces the adverse impact of disease treatment due to this part of the patient group on social and economic production, which is also one of the important reasons why the state actively includes new drugs in the scope of
medical insurance reimbursement.
brief summary
The approval of new myeloma drugs is based on its more reliable efficacy than the previous generation of drugs, patients should consider the whole course of treatment of the disease with holistic thinking in the initial stage of treatment, the choice of new drugs may have a higher initial treatment cost, but can effectively reduce the cost of later treatment, improve the quality of life throughout disease management, and significantly extend the overall survival
.
References: 1.
Blommestein, Hedwig M et al.
“Cost-effectiveness of Novel Treatment Sequences for Transplant-Ineligible Patients With Multiple Myeloma.
” JAMA network open vol.
4,3 e213497.
1 Mar.
2021
