The regimen for multiple myeloma depends on whether or not it is newly diagnosed, age, general condition, and target organ damage. In the past decade, the first multiple myeloma has entered the era of new drugs, and new drugs represented by protease inhibitors (bortezomib, ixazomib, carfilzomib) and immunomodulators (thalidomide, lenalidomide, pomalidomide) have made a "qualitative" leap in the efficacy of multiple myeloma, and the toxicity and side effects are significantly reduced compared with traditional chemotherapy drugs.
Newly diagnosed patients are generally divided into patients who are suitable for transplantation and those who are not suitable for transplantation according to the age of 65 years, but the specific situation should be determined according to the patient's physical condition, and age is not an absolute cut-off line.
The "strong combination" of the new drug will bring better efficacy, and the overall response rate is about 80%, and it is currently believed that VRD (bortezomib lenalidomide dexamethasone) regimen is the best induction regimen for patients who are newly diagnosed and suitable for transplantation. 4 Autologous hematopoietic stem cell transplantation after 6 course of induction, although there are many new drugs now, but at present, the position of autologous hematopoietic stem cell transplantation in myeloma patients who are newly diagnosed and suitable for transplantation is still unshakable, which can significantly prolong the disease-free survival and overall survival rate of patients, and the best pretreatment scheme is still the classic melphalan pretreatment.
The ** regimen for patients who are not suitable for transplantation for the first time needs to fully consider the specific situation of the patient, comorbidities, etc., and be assessed as healthy, moderately healthy or frail according to the patient's physical condition.
For patients with healthy physical condition, a combination of three drugs can be chosen**;
Moderately healthy patients can choose a reduced three-drug induction regimen;
Frail patients may consider a two-drug regimen.
The choice of regimen for patients who are not transplant-friendly** is more important than that of patients who are not transplant-friendly.
With the continuous advent of new drugs, there are also "newer" drugs used in newly diagnosed patients, such as the second-generation protease inhibitor ixazomib, which has the advantage of convenient oral administration and low incidence of peripheral neuropathy; In addition, CD38 monoclonal antibody has also been tried more in the initial ** of high-risk patients.
The prognosis of patients with multiple myeloma depends on many factors, such as age, the disease itself, physical condition, and post-cure. Age is one of the important factors that determine the prognosis of patients with multiple myeloma.
The goal of young patients is to achieve long-term remission and achieve long-term survival through aggressiveness.
The primary goal of older patients is symptomatic relief and improving quality of life, while the secondary goal is to prolong survival.
Overall, in the era of new drugs, the survival rate of multiple myeloma patients has been extremely high, about 50% of myeloma patients have survived for more than 5 years, and with the advent of more new drugs, the efficacy of multiple myeloma will be further improved, and the quality of life of patients will be further improved.