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Multiple myeloma is a clonal plasma cell dyscrasia with clinical heterogeneity. As of now, two key questions need to be answered before starting to treat a newly diagnosed myeloma patient. One is whether the patient is a candidate for high-dose chemotherapy with stem cell support and the other is risk stratification. As novel therapeutics have emerged, it is increasingly important to introduce a risk-adapted approach. The heterogeneity of the disease is established, for the most part, by disease biology, predominantly genetics. Cytogenetic analysis by either banding technique or fluorescent in situ hybridization is able to identify high-risk subpopulations. The new international staging system based on beta2-microglobulin and albumin levels in serum is also very helpful in defining the high-risk group (stage 3). This group of patients may not respond well to high-dose chemotherapy and require early introduction of newer treatments such as the bortezomib-containing regimen. The main factor in determining the eligibility for stem cell transplants is age. Based on the current literature and situation in Taiwan, we suggest stem cell transplantation if the patient is younger than 55 years of age. Each case should be considered individually if the age of the patient is between 55 and 70 years. Finally, we have also reviewed the status and the treatment of multiple myeloma in Taiwan. Fortunately, there has been an improvement in awareness, diagnosis and treatment. Cytogenetic studies have been applied in risk evaluations, but are limited in a few centers due to lack of availability. With the exception of the agent lenalidomide, new novel agents are available for treating of myeloma in Taiwan. |
