3931-1-5712-1-10-20121128-dikonversi - Copy.docx - Tinjauan...

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Terapi Terkini Multiple Myeloma Ketut Suega, Yunny Sripurnama Sjah 1 Tinjauan pustaka TERAPI TERKINI MULTIPLE MYELOMA Ketut Suega, Yunny Sripurnama Sjah Bagian/SMF Ilmu Penyakit Dalam FK Unud/ RS Sanglah, Denpasar Email: [email protected] ABSTRACT Management strategies for Multiple Myeloma (MM) have continued to evolve as the result of innovative treatment modalities and efficacy data used in establishing new standard of care. In 2004, multiple myeloma was diagnosed in more than 15.000 people in the United States and will account for approximately 20% of deaths due to hematologic malignancies. Most commonly diagnosed in the growing elderly population. Until recently, few effective treatment existed. The use of alkylating agents and corticosteroid had remained the treatment of choice for almost four decades. On a cellular level, the disease is characterized by complex interactions between tumor cells and the surrounding bone marrow microenvironment. Understanding of the relationship between malignant plasma cells and the microenvironment has sparked ongoing efforts to develop targeted therapeutic agents for treatment of this disease. Recent advances in its treatment including using of the immunomodulatory drugs such as thalidomide and lenalidomide as well as the proteasome inhibitor bortezomib. Each of these agents is undergoing extensive clinical evaluation in combination with other therapies to produce unprecedented response rates in newly diagnosed and relapsed MM. They have each improved the response to therapy, but they are expensive. In recent years, evidence supporting a survival benefit for three new drugs have resulted in their inclusion, in combination with older drugs, in the management of younger and older patients. Each of these new drugs has multiple mechanisms of action, targeting both intracellular signaling pathways and tumor microenvironment. This review focus on the newer agents such as thalidomide, bortezomib, and lenalidomide in treatment of patient with newly diagnosed MM and relapsed MM, treatment-related side effect, and future using of these agent including new combination therapy. Keywords: multiple myeloma, thalidomide, bortezomib, lenalidomide, combination therapy PENDAHULUAN Strategi manajemen untuk MM terus berkembang sesuai dengan modalitas pengobatan yang inovatif, dan pengertian yang terus berkembang dari patogenesis penyakit. Data efikasi menunjukan hasil pengobatan standar yang baru termasuk terapi kombinasi yang baru. Penyakit ini paling sering didiagnosa pada kelompok usia lanjut, dan MM tetap merupakan salah satu penyakit keganasan yang mahal karena membutuhkan transplantasi sumsum tulang pengobatan yang digunakan pada awal penyakit dan timbulnya
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2 J Peny Dalam, Volume 10 Nomor 3 September 2009 stadium relaps maupun komplikasi dalam pengobatan suportif. 1 MM adalah keganasan sel B dari sel plasma neoplastik yang memproduksi protein imunoglobulin monoklonal, ditandai oleh ekspansi monoklonal dan akumulasi abnormal sel plasma di dalam kompartemen sumsum tulang 2-4
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