Diagnostik und Therapie des Multiplen Myelom

Zusammenfassung

Das Multiple Myelom ist eine maligne Erkrankung antikörperproduzierender Plasmazellen. Die Klinik ist charakterisiert durch Verdrängung der gesunden Hämatopoese, osteolytische Knochenkrankheit und Paraproteinämie/-urie. Letztere ist Ursache für Myelomnephropathie, Hyperviskositätssyndrome und Mangel an funktionsfähigen Antikörpern. In den letzten 30 bis 40 Jahren konnten enorme Forschritte bezüglich Therapieoptionen, Gesamtprognose und molekularer Pathophysiologie der Erkrankung erreicht werden. Daher wurden die Definitionen monoklonaler Gammopathien, die Stadieneinteilung, die Prognosefaktoren und die Kriterien für das Ansprechen neu definiert. Die Hochdosistherapie mit autologer Stammzelltransplantation ist heute Standardtherapie für die jüngeren Patienten. Ferner wurden neuartige Zytostatika zugelassen (z.B. Bortezomib, Lenalidomid), andere sind in klinischer Prüfung oder präklinischer Entwicklung. Dadurch sind auch bei älteren Patienten mit Komorbidität sichere und effektive Therapien möglich. Diese Übersichtsarbeit beschreibt die aktuellen Standards bezüglich Diagnose, Stadieneinteilung und Therapie des Multiplen Myelom.

Summary

Multiple Myeloma (MM) is a malignant disease of plasma cells which is characterized by hematopoietic insufficiency, bone destruction, and overproduction of monoclonal antibodies that cause renal failure, hyperviscosity, and immune deficiency. Over the past three to four decades tremendous progress was achieved concerning therapeutic options and overall prognosis but as well concerning the knowledge of the molecular basis of the disease. Therefore the definition of monoclonal gammopathies, the staging system of MM, the prognostic markers, and the response criteria needed to be revised. High-dose chemotherapy with autologous stem cell support has evolved to standard of care in younger patients. Additionally, novel therapeutic compounds have been approved (e.g. bortezomib, lenalidomide), others are in clinical testing or in preclinical development. Therefore, save and effective treatments can be offered also to elderly patients with comorbidity. The current standards for diagnosis, staging, and treatment of MM are summarized in this review.

Schlüsselwörter

Multiples Myelom - monoklonale Gammopathien - Prognosefaktoren - Diagnose - Therapie

Keywords

Multiple Myeloma - monoclonal gammopathies - prognostic markers - diagnosis - treatment

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