Treatment of Patients in Third Relapse and Beyond Including Double-Refractory Disease

摘要: With the continued arrival of new agents, treatment options for multiply relapsed and double-refractory myeloma have expanded considerably. Important factors to guide choice therapy are prior drug exposures, comorbidities including in particular renal impairment, performance status, rapidity relapse. Data on currently approved therapies—carfilzomib, pomalidomide, panobinostat, daratumumab, elotuzumab, salvage transplant—are reviewed. Additionally, promising therapies development—novel proteasome inhibitors (marizomib), HDAC6 (ricolinostat), cell cycle (filanesib), apoptosis inducers (selinexor), protein kinase (ibrutinib, dinaciclib, afuresertib, LGH447), monoclonal antibodies (isatuximab, indatuximab), tumor vaccines, allogeneic transplant, immune modulators (pembrolizumab, CAR-T cells)—are discussed.