Multiples Myelom

Zusammenfassung

Ergebnisse molekularbiologischer Untersuchungen mittels „Whole Genome Sequencing“ haben unser pathophysiologisches Verständnis des Multiplen Myeloms grundlegend verändert. Wir wissen heute, dass der maligne Plasmazellklon keiner linearen Entwicklung folgt, sondern bereits zu Beginn der Erkrankung multiple Klone vorhanden sind, die aufgrund ihrer individuellen Dynamik und Expansion die klonale Komposition und damit den Verlauf der Erkrankung bestimmen. Klinisch leitet sich aus dieser Erkenntnis die Notwendigkeit zur Durchführung von Kombinationstherapien mit synergistischen Wirkungsmechanismen ab, um Überleben und Wachstum möglichst vieler Klone zu verhindern. Der medizinische Fortschritt hat in den letzten Jahren zur Entwicklung und Zulassung vieler neuer Medikamente geführt, sodass eine Vielzahl derartiger Kombinationstherapien heutzutage möglich ist und diese auch bei guter Verträglichkeit und mit hoher Lebensqualität durchführbar sind. Die Effektivität der neuen Behandlungsmethoden – insbesondere der neuen Immuntherapien – ist dabei so hoch, dass erstmalig im Rezidiv der Erkrankung tiefe Remissionen ohne Nachweis von minimaler Resterkrankung möglich geworden sind. Diese Entwicklung schreitet unverändert voran, sodass sich auch in Zukunft das Überleben der Patienten weiter verbessern wird.

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