Take stock of domestic and foreign guides to see how to deal with the first relapse MM!
-
Last Update: 2020-07-18
-
Source: Internet
-
Author: User
Search more information of high quality chemicals, good prices and reliable suppliers, visit
www.echemi.com
Introduction for the first relapse of multiple myeloma, how to choose the treatment? By reviewing the domestic and foreign guidelines, to understand the second-generation oral proteasome inhibitor (PIs) isazomib protocol recommendations.multiple myeloma (mm) is a malignant disease with abnormal proliferation of clonal plasma cells. It is the second most common malignant tumor in the blood system in many countries. It occurs in the elderly and is still incurable at present.in clinical practice, all mm will inevitably relapse, and the treatment of recurrent mm has always been a hot issue for clinicians.in May 2020, the Chinese guidelines for the diagnosis and treatment of multiple myeloma (revised in 2020) was officially released [1]. The content of "first recurrence" added for the first time has aroused widespread discussion and concern among doctors.therefore, we reviewed the treatment principle and scheme selection of the first relapse mm in the clinical diagnosis and treatment guidelines at home and abroad, especially the scheme containing the second generation oral proteasome inhibitor (PIs) isazomib, to sort out the diagnosis and treatment ideas for everyone."first relapse mm" is defined as: the disease progresses or needs rescue treatment after previous treatment, and does not meet the criteria of primary refractory mm or relapsed refractory MM.among them, primary refractory refers to patients who have never achieved minimal remission (MR) or above for any treatment; relapse and refractory refers to patients who have no response to rescue treatment, or patients with MR or above remission have disease progression within 60 days of the last treatment [2].the first recurrence refers to the disease progression that occurs for the first time after first-line treatment, and further treatment plan is needed for it.guidelines at home and abroad on the treatment principles and recommended programs for the first relapse of mm. With the increase of relapse times or treatment lines of mm, the remission time of patients after treatment will be shorter and shorter, the progress of disease will be faster and faster, and the treatment will be more difficult.therefore, the choice of treatment for the first recurrence of MM is very important.What are the treatment principles and recommended regimens for the first relapse of mm in the guidelines at home and abroad? 1. The latest recommended treatment principles of Chinese guidelines: Chinese guidelines for the diagnosis and treatment of multiple myeloma (revised in 2020) [1] clearly pointed out that the treatment principles for the first relapse of MM are: to obtain the maximum degree of remission and prolong progression free survival (PFS); if the patients can tolerate it, 3-4 drugs containing proteasome inhibitors and immunomodulators should be selected; and The time of relapse should be considered in the treatment plan. If relapse occurs within 6 months, the drug combination with different mechanism should be used as far as possible.recommended regimens with oral PIs: 3-4 drug combination chemotherapy regimens include isazomib / lenalidomide / dexamethasone (IRD), dexamethasone / cyclophosphamide / etoposide / cisplatin ± bortezomib (DCEP ± b).2 ESMO guidelines for the first recurrence of MM recommended treatment principles: ESMO multiple myeloma diagnosis, treatment and follow-up clinical practice guidelines put forward [3-4]. For recurrent patients, the treatment choice should be based on the patient's age, general state, type, basic disease, effectiveness and tolerance of anterior line treatment, number of previous treatment lines, current available treatment options, and end-to-end treatment The time interval and recurrence type (i.e. biochemical recurrence or clinical recurrence; if biochemical recurrence, the treatment can be delayed).generally, PIs or lenalidomide is the most commonly used regimen.for the first relapse of mm, lenalidomide combined with dexamethasone, bortezomib alone or combined with polyethylene glycol liposome doxorubicin is recommended as class I a regimen.as the first oral PIs, isazomib combined with lenalidomide and dexamethasone is the recommended regimen for MM patients who have received at least one treatment regimen before, and IRD is the recommended regimen for the first relapse of mm after induction therapy with bortezomib regimen (Fig. 1).(RD: lenalidomide, low-dose dexamethasone; IRD: isazomib, lenalidomide, low-dose dexamethasone;) Fig. 1 The recommended regimen for the first relapse of mm after induction therapy with bortezomib regimen 3mayo's guidelines for the treatment of first relapsed mm: the treatment of recurrent multiple myeloma: Mayo myeloma stratification and treatment guidelines [5] shows that patients with MM may have relapse when receiving maintenance treatment or continuous treatment, or after induction therapy, or when expected observation without treatment Hair.for the first relapse of mm, it is necessary to judge the following points and then make the best choice: the overall health status of the patient; the nature of the recurrence, that is, whether it is inert or invasive; the quality (i.e., depth) and duration of remission of previous treatment drugs and response; and fluorescence in situ hybridization (FISH) data of recurrent bone marrow. Br / >in order to achieve a better overall quality of life after the first time of relapse, it is generally better to try to achieve the best overall quality of life after.in view of the advantages of triple therapy in the treatment of recurrent mm, triple therapy is the first choice for patients with recurrent mm when they can tolerate it.for patients with severe complications, double therapy can be selected.for patients with well controlled and well tolerated disease, escalation treatment is not usually performed.the recommended regimen with oral PIs: for patients with first relapse during maintenance treatment, the three drug regimen should be selected.IRD with isazomib can be used for patients with weakness or biological inertia who have received bortezomib in the front line (Fig. 2).if it is suitable for transplant patients, salvage or second ASCT can be considered.(type of evidence: I - III; recommendation level: b) for the first recurrence without treatment or maintenance treatment, mm: choose triple therapy.IRD regimen can be selected for patients with weakness or biological inertia (Fig. 2).if it is suitable for transplant patients, salvage or second ASCT can be considered.(evidence type: II; recommendation level: b) it is worth mentioning that IRD provides a convenient "all oral" regimen for patients with first relapse mm due to the oral dosage form of isazomib, which is especially favored by patients with weak or biological manifestations of inert recurrence [5].(a for some patients, ASCT is a treatment option; IRD: isazomib, lenalidomide and dexamethasone) Fig. 2. Summary of some recommended regimens containing isazomib in the treatment of first relapsed mm: individualized treatment should be based on the general condition, recurrence type and previous medication of patients with first relapse mm, Individualized treatment was performed.as mentioned above, in view of the advantages of "all oral" regimen (IRD) containing isazomib, which has the advantages of efficacy, compliance, safety and convenience, and isazomib has been approved for listing in China and included in the national health insurance catalog. It is believed that patients with relapsed mm for the first time can benefit from the "all oral" treatment scheme! References: [1] hematology branch of Chinese Medical Association, hematology branch of Chinese Medical Association, multiple myeloma Professional Committee of Chinese Medical Association. Chinese guidelines for diagnosis and treatment of multiple myeloma (revised in 2020) [J]. Chinese Journal of internal medicine. 2020; 59 (5): 341-6. [2] Rajkumar SV, harousseau JL, Durie B, et al. Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1[J]. Blood. 2011;117(18):4691-5.[3]Moreau P, San Miguel J, Sonneveld P, et al. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol. 2017;28(suppl_ 4) [5] Dingli D, ailawadhi s, Leif bergsgel P, et al. Therapy for relapsed multiple myeloma: guidelines from the Mayo stratiifcation for myeloma and risk adapted therapy [J]. Diagnostic theory and practice. 2017; 16 (5): 455-459. [5] Dingli D, ailawadhi s, Leif bergsgel P, et al. Therapy for relapsed multiple myeloma: guidelines from the Mayo stratification for myeloma and risk adapted therapy [J]. Mayo Clin proc. 2017; 92 (4): 578-598. Statement the purpose of this information is to help healthcare professionals better understand the latest developments in the field of related diseases.this website does not mean that we agree with the description and opinions of the published information, but only for providing more information. if copyright issues are involved, please contact us and we will deal with them as soon as possible. for medical and health professionals only. such information should not in any way replace professional medical guidance, nor should it be regarded as treatment advice. if such information is used for purposes other than understanding the information, neither the website nor the author shall be held responsible. vv-medcom-20615recommend recommended reading: viewing the advantages of the second generation PIs total oral regimen of isazomib from 2020 Chinese mm diagnosis and treatment guidelines. Let's make progress together
This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only.
This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of
the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed
description of the concern or complaint, to
service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content
will be removed immediately.