诊断学理论与实践

诊断学理论与实践 ›› 2023, Vol. 22 ›› Issue (02): 121-126.doi: 10.16150/j.1671-2870.2023.02.003

• 指南解读 • 上一篇    下一篇

2023年美国国立综合癌症网络（NCCN）《多发性骨髓瘤指南》（第2版）更新解读

陶怡, 糜坚青()   

  1. 上海交通大学医学院附属瑞金医院上海血液学研究所，医学基因组学国家重点实验室，国家转化医学中心（上海），上海 200025
  • 收稿日期:2023-01-29 出版日期:2023-04-25 发布日期:2023-08-31
  • 通讯作者: 糜坚青　E-mail：jianqingmi@shsmu.edu.cn
  • 基金资助:
    国家自然科学基金(82070227);上海市申康促进市级医院临床技能与临床创新三年行动计划(SHDC2020CR2066B)

Interpretation of Multiple Myeloma Guidelines update (version 2， 2023) of National Comprehensive Cancer Network （NCCN）

TAO Yi, MI Jianqing()   

  1. Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Medical Genomics; National Research Center for Translational Medicine at Shanghai, Shanghai 200025, China
  • Received:2023-01-29 Online:2023-04-25 Published:2023-08-31

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摘要：

多发性骨髓瘤(multiple myeloma, MM)是血液系统第二大恶性肿瘤。随着新药的不断问世，MM患者的生存得到了明显改善，中位生存时间达7~10年，但高危MM患者的生存期仍不足3年，延长高危MM患者生存一直是该领域的研究热点。美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）最新发布了2023年第2版《多发性骨髓瘤指南》（以下简称2023.v2版指南）。该指南与2022年第5版比较，在诊断方面的更新主要体现在以表格形式对高危MM作了详细描述，既包括含有1q21获得/扩增的细胞遗传学高危因素，又包括如髓外病变、肾功能衰竭、虚弱等临床高危因素。在治疗方面，2023.v2版指南更新仍强调自体造血干细胞移植在新药时代的重要性，并认为判断患者是否适合移植，需根据初始治疗后患者的情况作动态调整。2023.v2版指南在MM初始诱导治疗中将新一代蛋白酶体抑制剂卡非佐米推荐升级，在维持治疗中将CD38单抗推荐升级；复发后的治疗选择也将这些新药和新一代免疫调节剂泊马度胺的组合列为首选方案。对高危MM的诊断技术和指南更新推荐的新药，目前在我国临床均已有应用，极大提高了临床医师对“临床治愈”MM的信心。全面解读2023.v2版指南更新，有望提升临床医师的诊治水平，进一步改善我国MM患者群体，尤其是高危MM患者的预后。

关键词: 多发性骨髓瘤, 指南解读, 高危因素

Abstract:

Multiple myeloma (MM) is the second most common hematological malignancy. With the continuous advent of new drugs, the survival of MM patients has been significantly improved, with a median survival of 7-10 years. However, the overall survival of high-risk MM patients is still less than 3 years, and extending the survival of high-risk MM has always been a hot topic in this field. The National Comprehensive Cancer Network (NCCN) released the 2nd version of the MM guidelines for 2023 (2023. v2). Compared with the 5th edition of the MM guidelines for 2022, the update of this guideline in diagnosis is mainly reflected in the detailed description of high-risk MM in tabular form, including both cytogenetic high-risk factors containing 1q21 gain/amplification and clinical high-risk factors, such as extramedullary disease, renal failure and weakness. In terms of treatment, the updated guideline still emphasizes the importance of autologous hematopoietic stem cell transplantation in the era of new drugs, and indicates that the judgment of whether patients are suitable for transplantation needs to be dynamically adjusted based on the patients’ condition after initial treatment. 2023. v2 upgrades the recommendation of the new generation proteasome inhibitor carfilzomib in initial induction and CD38 monoclonal antibody in maintenance therapy. The combinations of these new drugs with immunomodulatory drug pomalidomide are also listed as the preferred regimens in relapsed patients. The diagnostic techniques for distinguishing high-risk MM and new drugs recommended in the updated guideline are currently available in China, Which greatly enhanc our confidence in the “clinical cure” of MM. A comprehensive interpretation of the 2023. v2 of the guidelines is expected to improve the diagnostic and therapeutic level of clinicians, and further improve the prognosis of China’s MM patient population, especially high-risk patients.

Key words: Multiple myeloma, Interpretation of guideline, Risk factor

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