ISSN (print) 1997-6933     ISSN (online) 2500-2139
Том 18 № 2 (2025), ЛИМФОИДНЫЕ ОПУХОЛИ
Том 18 № 2 (2025)
ЛИМФОИДНЫЕ ОПУХОЛИ

Современная стратегия и принципы лечения больных множественной миеломой (обзор литературы)

Опубликовано 01.04.2025
Александр Сергеевич Лучинин
ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 23, Москва, Российская Федерация, 115522
https://orcid.org/0009-0006-0020-3168
А.А. Семенова
ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 23, Москва, Российская Федерация, 115522
https://orcid.org/0000-0003-4951-3053
С.В. Семочкин
ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России, ул. Островитянова, д. 1, Москва, Российская Федерация, 117997; МНИОИ им. П.А. Герцена — филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2-й Боткинский пр-д, д. 3, Москва, Российская Федерация, 125284
https://orcid.org/0000-0002-8129-8114
2025-2
PDF_2025-18-2-153-162

Ключевые слова

множественная миелома
стратегия терапии

Как цитировать

Лучинин А.С., Семенова А.А., Семочкин С.В. Современная стратегия и принципы лечения больных множественной миеломой (обзор литературы). Клиническая онкогематология. 2025;(2):153–162. doi:10.21320/2500-2139-2025-18-2-153-162.
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Статистика

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Ключевые слова

Аннотация

Множественная миелома (ММ) за последние десятилетия трансформировалась из неизлечимой орфанной злокачественной опухоли в хроническое заболевание с существенно улучшенными возможностями лечения благодаря новым классам противоопухолевых препаратов. Понимание биологии ММ, а также разработка и внедрение в клиническую практику новых лекарственных средств привели к значительному улучшению показателей выживаемости. Стратификация больных ММ на группы риска с учетом результатов цитогенетического и молекулярно-генетического анализов в настоящее время рассматривается как ключевой подход, обеспечивающий выбор наиболее оптимальной лечебной тактики. У пациентов из группы высокого риска и с агрессивным течением ММ приоритетными признаются схемы комбинированной противоопухолевой терапии, включающие 3–5 препаратов, в т. ч. новые эффективные лекарственные средства различных классов (ингибиторы протеасом, иммуномодулирующие средства, моноклональные антитела и др.). Помимо оценки группы риска важным инструментом для принятия клинических решений становится мониторинг минимальной остаточной болезни (МОБ). Достижение МОБ-отрицательного результата ассоциируется с лучшими показателями выживаемости, что позволяет развивать ответ-адаптированные стратегии терапии. Перспективы прецизионного (персонализированного) лечения ММ пока остаются ограниченными из-за чрезвычайной гетерогенности молекулярно-генетического ландшафта опухоли. Требуются дальнейшие исследования для доказательства эффективности такого подхода. Таким образом, современная терапия ММ основывается на оценке параметров риска с использованием результатов стандартного цитогенетического и молекулярно-генетического исследований, мониторинге МОБ и персонализированном подходе, что позволяет добиваться существенного улучшения как непосредственных, так и отдаленных результатов лечения у пациентов с ММ.

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