Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion of plasma cells. The incidence of MM worldwide is increasing with greater than 140 000 people being diagnosed with MM per year. Whereas 5-year survival after a diagnosis of MM has improved from 28% in 1975 to 56% in 2012, the disease remains essentially incurable. In this review, we summarize our current understanding of MM including its epidemiology, genetics and biology. We will also provide an overview of MM management that has led to improvements in survival, including recent changes to diagnosis and therapies. Areas of unmet need include the management of patients with high-risk MM, those with reduced performance status and those refractory to standard therapies. Ongoing research into the biology and early detection of MM as well as the development of novel therapies, such as immunotherapies, has the potential to influence MM practice in the future.

• Klíčová slova
• clinical presentation, plasma cell disease, risks factors, survival, treatment,
• MeSH
• cyklin D1 genetika   MeSH
• exozom genetika   MeSH
• genetická predispozice k nemoci MeSH
• histondemethylasy genetika   MeSH
• imunoterapie metody   MeSH
• lidé MeSH
• míra přežití MeSH
• mnohočetný myelom diagnóza   epidemiologie   genetika   terapie   MeSH
• mutace MeSH
• nádorové biomarkery genetika   MeSH
• plazmatické buňky imunologie   patologie   MeSH
• represorové proteiny genetika   MeSH
• rizikové faktory MeSH
• transkripční elongační faktory genetika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• CCND1 protein, human MeSH Prohlížeč
• CDCA7L protein, human MeSH Prohlížeč
• cyklin D1 MeSH
• DIS3 protein, human MeSH Prohlížeč
• ELL2 protein, human MeSH Prohlížeč
• exozom MeSH
• histondemethylasy MeSH
• KDM1A protein, human MeSH Prohlížeč
• nádorové biomarkery MeSH
• represorové proteiny MeSH
• transkripční elongační faktory MeSH

During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved the treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drug classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.

• MeSH
• cílená molekulární terapie škodlivé účinky   MeSH
• hodnocení rizik MeSH
• incidence MeSH
• lidé MeSH
• management nemoci MeSH
• mnohočetný myelom komplikace   farmakoterapie   MeSH
• nežádoucí účinky léčiv diagnóza   epidemiologie   prevence a kontrola   terapie   MeSH
• protinádorové látky škodlivé účinky   terapeutické užití   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH
• přehledy MeSH
• Názvy látek
• protinádorové látky MeSH

Autologous stem cell transplantation (ASCT) is a standard treatment for eligible multiple myeloma (MM) patients, but many patients will relapse after ASCT and require subsequent therapy. The proteasome inhibitor carfilzomib is approved for relapsed or refractory MM (RRMM). In phase 3 trials, carfilzomib-based regimens (ASPIRE, carfilzomib-lenalidomide-dexamethasone; ENDEAVOR, carfilzomib-dexamethasone) demonstrated superior progression-free survival (PFS) compared with standard therapies for RRMM (ASPIRE: lenalidomide-dexamethasone; ENDEAVOR, bortezomib-dexamethasone). This subgroup analysis of ASPIRE and ENDEAVOR evaluated outcomes according to prior ASCT status. In total, 446 patients in ASPIRE and 538 in ENDEAVOR had prior ASCT. Median PFS was longer for carfilzomib-based regimens vs non-carfilzomib-based regimens for patients with prior ASCT (ASPIRE: 26.3 vs 17.8 months (hazard ratio (HR)=0.68); ENDEAVOR: not estimable vs 10.2 months (HR=0.61)), those with one prior line of therapy that included ASCT (ASPIRE: 29.7 vs 17.8 months (HR=0.70); ENDEAVOR: not estimable vs 11.2 months (HR=0.46)), and those without prior ASCT (ASPIRE: 26.4 vs 16.6 months (HR=0.76); ENDEAVOR: 17.7 vs 8.5 months (HR=0.43)). Overall response rates also favored the carfilzomib-based regimens. No new safety signals were detected. This analysis suggests that carfilzomib-based treatment may lead to improvement in PFS and response rates regardless of prior transplant status. Further evaluation is warranted.

• MeSH
• autologní transplantace MeSH
• dospělí MeSH
• Kaplanův-Meierův odhad MeSH
• lidé středního věku MeSH
• lidé MeSH
• mnohočetný myelom farmakoterapie   mortalita   patologie   terapie   MeSH
• oligopeptidy aplikace a dávkování   MeSH
• opakovaná terapie MeSH
• pooperační péče MeSH
• protokoly protinádorové kombinované chemoterapie škodlivé účinky   terapeutické užití   MeSH
• recidiva MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• transplantace hematopoetických kmenových buněk MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• carfilzomib MeSH Prohlížeč
• oligopeptidy MeSH