Optimizing high dose melphalan

IF 6.9 2区医学 Q1 HEMATOLOGY Blood Reviews Pub Date : 2024-03-01 DOI:10.1016/j.blre.2023.101162

Gunjan Shah, Sergio Giralt, Parastoo Dahi

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Abstract

Melphalan, has been a major component of myeloma therapy since the 1950s. In the context of hematopoietic cell transplantation (HCT), high dose melphalan (HDM) is the most common conditioning regimen used due to its potent anti-myeloma effects and manageable toxicities. Common toxicities associated with HDM include myelosuppression, gastrointestinal issues, and mucositis. Established approaches to reduce these toxicities encompass dose modification, nausea prophylaxis with 5HT3 receptor antagonists, cryotherapy, amifostine use, and growth factors. Optimization of melphalan exposure through personalized dosing and its combination with other agents like busulfan, or bendamustine show promise. Propylene glycol-free melphalan (Evomela) represents a novel formulation aiming to enhance drug stability and reduce adverse effects. This review explores strategies to enhance the efficacy and mitigate the toxicity of HDM in multiple myeloma. Future directions involve exploring these strategies in clinical trials to improve the safety and efficacy of HDM, thereby enhancing outcomes for multiple myeloma patients undergoing autologous HCT.

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优化大剂量美法仑

自20世纪50年代以来，美法仑一直是骨髓瘤治疗的主要成分。在造血细胞移植（HCT）中，大剂量美法仑（HDM）是最常用的治疗方案，因为它具有强大的抗骨髓瘤作用，而且毒性可控。与 HDM 相关的常见毒性包括骨髓抑制、胃肠道问题和粘膜炎。减少这些毒性的既有方法包括剂量调整、使用 5HT3 受体拮抗剂预防恶心、冷冻疗法、使用阿米福斯汀和生长因子。通过个性化剂量优化美法仑的暴露量，并将其与其他药物（如丁螺环素或苯达莫司汀）联合使用，也显示出了良好的前景。不含丙二醇的美法仑（Evomela）是一种新型制剂，旨在提高药物稳定性并减少不良反应。本综述探讨了提高 HDM 在多发性骨髓瘤中的疗效并减轻其毒性的策略。未来的方向包括在临床试验中探索这些策略，以提高 HDM 的安全性和疗效，从而改善接受自体 HCT 的多发性骨髓瘤患者的治疗效果。

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来源期刊

Blood Reviews 医学-血液学

CiteScore

13.80

自引率

1.40%

发文量

期刊介绍： Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.