2017梅奥多发性MM的治疗指南

 Life expectancy in patients with multiple myeloma is increasing because of the availability of an increasing number of novel agents with various mechanisms of action against the disease. However, the disease remains incurable in most patients because of the emergence of resistant clones, leading to repeated
relapses of the disease. In 2015, 5 novel agents were approved for therapy for relapsed multiple myeloma.This surfeit of novel agents renders management of relapsed multiple myeloma more complex because of the occurrence of multiple relapses, the risk of cumulative and emergent toxicity from previous therapies,as well as evolution of the disease during therapy. A group of physicians at Mayo Clinic with expertise in the care of patients with multiple myeloma regularly evaluates the evolving literature on the biology and therapy for multiple myeloma and issues guidelines on the optimal care of patients with this disease. In this article, the latest recommendations on the diagnostic evaluation of relapsed multiple myeloma and decision trees on how to treat patients at various stages of their relapse (off study) are provided together with the evidence to support them.

1. Hilights：

Major advances have occurred in the therapy of multiple myeloma with several new classes of agents approved in 2015.
Therapy of relapsed multiple myeloma is becoming more complex due to the development of such novel agents.
Restaging of myeloma and evaluation for disease evolution is important at the time of relapse.
Combination therapy that incorporates novel agents such as monoclonal antibodies is recommended.
Patients should be considered for stem cell transplant at time of relapse.
The disease can evolve to secondary plasma cell leukemia or extramedullary myeloma at any time.
Guidelines for therapy of first, second, or third relapse of the disease are provided.

2. 复发性MM的预后因素：

3. 复发性MM的分类：

4. 初次复发的治疗：

5. 二次及二次以上复发的治疗（非浆细胞白血病和髓外疾病）：

6. 四重难治性疾病的治疗：

7. 继发性浆细胞白血病和髓外疾病的治疗：