Despite recent advances, multiple myeloma remains an incurable disease for most patients, and initial remission will be followed by relapses requiring therapy. For many, there will be several remissions and relapses until resistance develops to all available therapies. With the introduction of several new agents, myeloma treatment has changed drastically, and there are new options for the management of relapsed or refractory disease, including new drug classes with distinct mechanisms of action and cellular therapies. However, resistance to major drug classes used in first-line remains the most critical factor for the choice of treatment at relapse. Continuous lenalidomide-based therapy is used extensively at first-line, and resistance to lenalidomide has become the key factor for the choice of salvage therapy. Daratumumab is increasingly used in first-line, and soon patients that relapse while on daratumumab will become a common challenge. Three-drug regimens are the standard approach to manage relapsed disease. Adding drugs with new mechanisms of activity can improve outcomes and overcomes class resistance, but, until now, while biology is important, it can offer only limited guidance for the choice of therapy.

中文翻译：

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我如何治疗复发的多发性骨髓瘤。

尽管最近取得了进展，但对于大多数患者来说，多发性骨髓瘤仍然是一种无法治愈的疾病，最初的缓解之后会出现需要治疗的复发。对许多人来说，会出现几次缓解和复发，直到对所有可用疗法产生耐药性。随着几种新药物的推出，骨髓瘤治疗发生了巨大变化，复发或难治性疾病的管理有了新的选择，包括具有不同作用机制的新药物类别和细胞疗法。然而，对一线使用的主要药物类别的耐药性仍然是复发时选择治疗的最关键因素。以来那度胺为基础的持续治疗在一线广泛使用，来那度胺耐药已成为选择挽救治疗的关键因素。达雷妥尤单抗越来越多地用于一线治疗，很快在达雷妥尤单抗治疗期间复发的患者将成为一个共同的挑战。三药方案是治疗复发性疾病的标准方法。添加具有新活性机制的药物可以改善结果并克服类别耐药性，但直到现在，虽然生物学很重要，但它只能为治疗选择提供有限的指导。