2009-11-01 梅奥诊所 Mayo Clin Proc. 2009;84(12):1095–1110
Management of Newly Diagnosed Symptomatic Multiple Myeloma:Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines 2009
Multiple myeloma is a malignant plasma cell neoplasm that affectsmore than 20,000 people each year and is the secondmost common hematologic malignancy. It is part of a spectrumof monoclonal plasma cell disorders, many of which do not requireactive therapy. During the past decade, considerable progresshas been made in our understanding of the disease processand factors that influence outcome, along with development ofnew drugs that are highly effective in controlling the disease andprolonging survival without compromising quality of life. Identificationof well-defined and reproducible prognostic factors andintroduction of new therapies with unique modes of action andimpact on disease outcome have for the first time opened up theopportunity to develop risk-adapted strategies for managing thisdisease. Although these risk-adapted strategies have not beenprospectively validated, enough evidence can be gathered fromexisting randomized trials, subgroup analyses, and retrospectivestudies to develop a working framework. This set of recommendationsrepresents such an effort—the development of a set ofconsensus guidelines by a group of experts to manage patientswith newly diagnosed disease based on an interpretation of thebest available evidence.