RESUMO
The past decade has seen significant progress in the development of new and effective therapies for multiple myeloma. Stem cell transplantation and the introduction of novel agents, such as thalidomide, lenalidomide, and bortezomib, have significantly improved outcomes of myeloma patients. In the current review, we analyzed the available data provided by published randomized clinical trials for the frontline therapy of myeloma patients. We attempted to assess the relative contribution and impact of these new therapies in the setting of both, transplant eligible and transplant ineligible patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/terapia , Transplante de Células-Tronco , Transplante de Medula Óssea , Ácidos Borônicos/uso terapêutico , Bortezomib , Humanos , Lenalidomida , Pirazinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Talidomida/análogos & derivados , Talidomida/uso terapêutico , Resultado do TratamentoRESUMO
Targeting the nuclear factor kappa B (NFκB) pathway is proposed as therapy for chronic lymphocytic leukemia (CLL). We hypothesized that an omega-3 fatty acids (n-3) supplement would suppress NFκB activation in lymphocytes of Rai Stage 0-1 CLL patients. The initial dose of 2.4 g n-3/day was gradually increased to 7.2 g n-3/day. After n-3 consumption: 1) plasma n-3 increased; 2) NFκB activation was suppressed in lymphocytes; 3) in vitro sensitivity of lymphocytes to doxorubicin was increased; and 4) expression of 32 genes in lymphocytes was significantly decreased.
Assuntos
Ácidos Graxos Ômega-3/administração & dosagem , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Linfocítica Crônica de Células B/metabolismo , Linfócitos/metabolismo , NF-kappa B/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Suplementos Nutricionais , Doxorrubicina/uso terapêutico , Ácidos Graxos Ômega-3/efeitos adversos , Ácidos Graxos Ômega-3/sangue , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Leucemia Linfocítica Crônica de Células B/sangue , Leucemia Linfocítica Crônica de Células B/genética , Linfócitos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , NF-kappa B/genética , NF-kappa B/metabolismo , RNA Mensageiro/genéticaRESUMO
Hematopoietic stem cell (HSC) transplantation may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. In some clinical settings, transplantation represents the only curative option. The feasibility and efficacy of this approach in older patients are undefined, since this population has been excluded from nearly all clinical trials. Advances in supportive care, HSC harvesting, and safer conditioning regimens have made this therapy available to patients well into their 6th and 7th decades of life. Recent evidence suggests that elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.
