CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题：Radiation for Multiple Myeloma in the Era of Novel Agents: Indications, Safety, and Dose Selection.
Radiation for Multiple Myeloma in the Era of Novel Agents: Indications, Safety, and Dose Selection.
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过去二十年，高效生物制剂的出现及部分患者采用自体干细胞移植（ASCT），显著改善了多发性骨髓瘤（MM）的生存结局。尽管如此，MM仍无法治愈，且每次复发后的缓解持续时间都会缩短。MM姑息性放疗（RT）可用于缓解疼痛、减轻压迫及预防骨折，疗效显著且通常耐受性良好。放疗可与生物制剂同时进行，但应谨慎考虑可能增加的血液学毒性，以免影响全身治疗；既往治疗线数较多、骨髓储备有限的患者尤其需要注意。本综述讨论放疗与生物制剂（蛋白酶体抑制剂、免疫调节剂和单克隆抗体）联合的安全性，回顾MM姑息性放疗适应证，并提出依据治疗目标、病灶是否复杂以及患者和病灶特征个体化放疗的框架。此外，文章讨论在嵌合抗原受体（CAR）T细胞治疗前进行桥接放疗的新兴作用。
Survival outcomes for multiple myeloma (MM) have drastically improved over the past two decades with the advent of highly effective biologic agents and integration of autologous stem cell transplant (ASCT) for select patients. Despite these advances, MM remains an incurable disease and duration of remission decreases with each relapse. Palliative radiotherapy (RT) for MM, including treatment of pain, relief of compression, and prevention of fracture, is highly effective and generally well tolerated.
Though RT can be delivered concurrently with biologic agents, caution should be exercised for potential added hematologic toxicity that may disrupt systemic therapy, especially in heavily pretreated patients, who have limited bone marrow reserve.
In this review, we discuss the safety of RT with biologic agents (proteasome inhibitors, immunomodulators, monoclonal antibodies), review indications for palliative RT in MM, and present a framework for how to personalize RT based on goals of treatment, classification of uncomplicated versus complicated lesions, and patient and lesion characteristics.
Additionally, we discuss the emerging role of bridging RT prior to chimeric antigen receptor (CAR) T-cell therapy.
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