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InFo Onkologie

, Volume 21, Issue 6, pp 35–43 | Cite as

Welche Faktoren sind zu berücksichtigen?

Therapie des multiplen Myeloms bei älteren Patienten

  • Charlotte Weyermann
  • Sven Thorspecken
  • Christian Straka
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Zusammenfassung

Das multiple Myelom ist eine Erkrankung, die typischerweise ältere Patienten betrifft. Obwohl sich durch die Hochdosistherapie mit autologer Stammzelltransplantation die Prognoese deutlich verbessert hat, ist diese Form der Therapie nicht für alle älteren Patienten sinnvoll. Bei ihnen müssen eine Vielzahl von Faktoren für die Therapieentscheidung berücksichtigt werden.

Literatur

  1. 1.
    Wörmann et al. Onkopedia Leitlinie Multiples Myelom. (Stand Mai 2018); https://www.onkopedia.com/de/onkopedia/guidelines/multiples-myelom/@@view/html/index.html abgerufen am 12.09.2018
  2. 2.
    Gesellschaft der epidemiologischen Krebsregister e. V. (GEKID) und Zentrum für Krebsregisterdaten (ZfKD) im Robert Koch-Institut. Krebs in Deutschland für 2013/2014; https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/krebs_in_deutschland_node.html abgerufen am 12.09.2018Google Scholar
  3. 3.
    Larocca et al. Patient-centered practice in elderly myeloma patients: An overview and consensus from the European Myeloma Network (EMN). Leukemia. 2018; http://doi.org/10.1038/s41375-018-0142-9.CrossRefGoogle Scholar
  4. 4.
    Engelhardt M et al. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma. Haematologica. 2014;99(2):23–42.CrossRefGoogle Scholar
  5. 5.
    Palumbo A et al. International Myeloma Working Group Consensus Statement for the Management, Treatment, and Supportive Care of Patients With Myeloma Not Eligible for Standard Autologous Stem-Cell Transplantation. J Clin Oncol. 2014;32(6):587–600.CrossRefGoogle Scholar
  6. 6.
    Pawlyn C et al. Nuances in the Management of Older Patients With Multiple Myeloma. Curr Hematol Malig Rep. 2016;11(3):241–51.CrossRefGoogle Scholar
  7. 7.
    Palumbo A et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 2015;125(13):2068–74.CrossRefGoogle Scholar
  8. 8.
    Engelhardt M et al. Geriatric assessment in multiple myeloma patients: validation of the International Myeloma Working Group (IMWG) score and comparison with other common comorbidity scores. Haematologica. 2016;101(9):1110–9.CrossRefGoogle Scholar
  9. 9.
    Auner HW et al. Trends in autologous hematopoietic cell transplantation for multiple myeloma in Europe: increased use and improved outcomes in elderly patients in recent years. Bone Marrow Transplant. 2015;50(2):209–15.CrossRefGoogle Scholar
  10. 10.
    Merz M et al. Survival of elderly patients with multiple myeloma—Effect of upfront autologous stem cell transplantation. Eur J Cancer. 2016;62:1–8.CrossRefGoogle Scholar
  11. 11.
    Merz M et al. Autologous stem cell transplantation for elderly patients with newly diagnosed multiple myeloma in the era of novel agents. Ann Oncol. 2014;25(1):189–95.CrossRefGoogle Scholar
  12. 12.
    Auner HW et al. Melphalan 140mg/m2 or 200mg/m2 for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica. 2018;103(3):514–21.CrossRefGoogle Scholar
  13. 13.
    Gay F et al. Bortezomib induction, reduced-intensity transplantation, and lenalidomide consolidation-maintenance for myeloma: updated results. Blood. 2013;122(8):1376–83.CrossRefGoogle Scholar
  14. 14.
    Gay F et al. From transplant to novel cellular therapies in multiple myeloma: European Myeloma Network guidelines and future perspectives. Haematologica. 2018;103(2):197–211.CrossRefGoogle Scholar
  15. 15.
    Straka C et al. Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial. Haematologica. 2016;101(11):1398–406.CrossRefGoogle Scholar
  16. 16.
    McCarthy PL et al. Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis. J Clin Oncol. 2017;35(29):3279–89.CrossRefGoogle Scholar
  17. 17.
    Palumbo A et al. Safety of thalidomide in newly diagnosed elderly myeloma patients: a meta-analysis of data from individual patients in six randomized trials. Haematologica. 2013;98(1):87–94.CrossRefGoogle Scholar
  18. 18.
    Fayers PM et al. Thalidomide for previously untreated elderly patients with multiple myeloma: meta-analysis of 1685 individual patient data from 6 randomized clinical trials. Blood. 2011;118(5):1239–47.CrossRefGoogle Scholar
  19. 19.
    Benboubker L et al. Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med. 2014;371(10):906–17.CrossRefGoogle Scholar
  20. 20.
    Facon T et al. Final analysis of survival outcomes in the phase 3 FIRST trial of up-front treatment for multiple myeloma. Blood. 2018;131(3):301–10.CrossRefGoogle Scholar
  21. 21.
    San Miguel JF et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008;359(9):906–17.CrossRefGoogle Scholar
  22. 22.
    San Miguel JF et al. Persistent Overall Survival Benefit and No Increased Risk of Second Malignancies With Bortezomib-Melphalan-Prednisone Versus Melphalan-Prednisone in Patients With Previously Untreated Multiple Myeloma. J Clin Oncol. 2013;31(4):448–55.CrossRefGoogle Scholar
  23. 23.
    Bringhen S et al. Efficacy and safety of once-weekly bortezomib in multiple myeloma patients. Blood. 2010;116(23):4745–53.CrossRefGoogle Scholar
  24. 24.
    Moreau P et al. Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study. Lancet Oncol. 2011;12(5):431–40.CrossRefGoogle Scholar
  25. 25.
    Niesvizky R et al. Community-Based Phase IIIB Trial of Three UPFRONT Bortezomib-Based Myeloma Regimens. J Clin Oncol. 2015;33(33):3921–9.CrossRefGoogle Scholar
  26. 26.
    Magarotto V et al. Triplet vs doublet lenalidomide-containing regimens for the treatment of elderly patients with newly diagnosed multiple myeloma. Blood. 2016;127(9):1102–8.CrossRefGoogle Scholar
  27. 27.
    Bringhen S et al. Long Term Outcome of Lenalidomide-Dexamethasone (Rd) Vs Melphalan-Lenalidomide-Prednisone (MPR) Vs Cyclophosphamide-Prednisone-Lenalidomide (CPR) As Induction Followed By Lenalidomide-Prednisone (RP) Vs Lenalidomide (R) As Maintenance in a Community-Based Newly Diagnosed Myeloma Population: Updated Analysis of EMN01 Phase III Study. Blood. 2017;130(Suppl 1):901.Google Scholar
  28. 28.
    Stewart AK et al. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myelomaN Engl J Med. 2015;372(2):142–52.CrossRefGoogle Scholar
  29. 29.
    Dimopoulos MA et al. Carfilzomib, lenalidomide, and dexamethasone in patients with relapsed multiple myeloma categorised by age: secondary analysis from the phase 3 ASPIRE study. Br J Haematol. 2017;177(3):404–13.CrossRefGoogle Scholar
  30. 30.
    Dimopoulos MA et al. Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre study. Lancet Oncol. 2016;17(1):27–38.CrossRefGoogle Scholar
  31. 31.
    Moreau P et al. Oral Ixazomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med. 2016;374(17):1621–34.CrossRefGoogle Scholar
  32. 32.
    San-Miguel JF et al. Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: a multicentre, randomised, double-blind phase 3 trial. Lancet Oncol. 2014;15(11):1195–206.CrossRefGoogle Scholar
  33. 33.
    Richardson PG et al. Panobinostat plus bortezomib and dexamethasone in previously treated multiple myeloma: outcomes by prior treatment. Blood. 2016;127(6):713–21.CrossRefGoogle Scholar
  34. 34.
    San-Miguel JF et al. Overall survival of patients with relapsed multiple myeloma treated with panobinostat or placebo plus bortezomib and dexamethasone (the PANORAMA 1 trial): a randomised, placebo-controlled, phase 3 trial. Lancet Haematol. 2016;3(11):e506–e515.CrossRefGoogle Scholar
  35. 35.
    Lokhorst HM et al. Targeting CD38 with Daratumumab Monotherapy in Multiple Myeloma. N Engl J Med. 2015;373(13):1207–19.CrossRefGoogle Scholar
  36. 36.
    Lonial S et al. Daratumumab monotherapy in patients with treatment-refractory multiple myeloma (SIRIUS): an open-label, randomised, phase 2 trial. Lancet. 2016;387(10027):1551–60.CrossRefGoogle Scholar
  37. 37.
    Palumbo A et al. Daratumumab, Bortezomib, and Dexamethasone for Multiple Myeloma. N Engl J Med. 2016;375(8):754–66.CrossRefGoogle Scholar
  38. 38.
    Dimopoulos MA et al. Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med. 2016;375(14):1319–31.CrossRefGoogle Scholar
  39. 39.
    Lonial S et al. Elotuzumab Therapy for Relapsed or Refractory Multiple Myeloma. N Engl J Med. 2015;373(7):621–31.CrossRefGoogle Scholar
  40. 40.
    Miguel JS et al. Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013;14(11):1055–66.CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Charlotte Weyermann
    • 1
  • Sven Thorspecken
    • 1
  • Christian Straka
    • 1
  1. 1.Klinik für Hämatologie, Onkologie und Stammzelltransplantation am Klinikum SchwabingMünchenDeutschland

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