Vai trò của kháng thể đơn dòng Daratumumab trong điều trị đa u tủy

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Tác giả: Hồng Anh Châu, Nguyễn Phương Dung Cồ, Quốc Tuấn Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.5

Bộ sưu tập: Metadata

ID: 339331

Thêm vào giỏ Liên kết toàn văn

Đa u tủy là một bệnh lý gây tổn thương tủy xương và nhiều cơ quan ngoài xương do sự tăng sinh ác tính của dòng tương bào. Chiến lược điều trị trong đa u tủy đã đạt được nhiều tiến bộ, đặc biệt là sự phát triển của các thuốc điều hòa miễn dịch, thuốc ức chế proteasome và phương pháp cấy ghép tế bào gốc tạo máu tự thân. Tuy nhiên, phần lớn bệnh vẫn không thể chữa khỏi và hầu hết bệnh nhân đều tái phát. Trong những năm gần đây, sự ra đời của Daratumumab, một kháng thể đơn dòng chống lại CD38 đã mở ra một tương lai đầy hứa hẹn cho bệnh nhân đa u tủy. Daratumumab chống lại tế bào đa u tủy thông qua các cơ chế tác động miễn dịch phụ thuộc Fc, gây hiện tượng apoptosis thông qua liên kết chéo và tác động biến đổi hoạt tính enzyme của CD38. Hiệu quả của Daratumumab đã được chứng minh thông qua nhiều thử nghiệm lâm sàng. Vào tháng 11 năm 2016, kết quả từ nghiên cứu CASTOR và POLLUX đã dẫn đến việc FDA phê duyệt Daratumumab với Vd hoặc Rd cho những bệnh nhân đa u tủy tái phát/kháng trị. Thêm vào đó, FDA và EMA cũng đã phê duyệt 2 phác đồ Daratumumab với VMP và Daratumumab với Rd cho bệnh nhân đa u tủy mới chẩn đoán không đủ điều kiện cấy ghép thông qua kết quả từ 2 thử nghiệm ngẫu nhiên ALCYONE và MAIA. Ngoài ra, kết quả của thử nghiệm CASSIOPEIA cũng đã tạo cơ sở cho FDA chấp thuận Daratumumab kết hợp VTd ở bệnh nhân đa u tủy mới chẩn đoán đủ điều kiện cấy ghép. Daratumumab đã cải thiện đáng kể kết quả điều trị ở bệnh nhân đa u tủy tái phát/kháng trị cũng như bệnh nhân đa u tủy mới chẩn đoán. Chính vì vậy mà ngày nay Daratumumab ngày càng được ứng dụng rộng rãi hơn trong thực hành lâm sàng.Abstract Multiple myeloma is a disease that damages the bone marrow and many extra-skeletal organs due to malignant proliferation of plasma cells. Therapeutic strategies for multiple myeloma have made great progress, especially with the development of immunomodulatory drugs, proteasome inhibitors and autologous hematopoietic stem cell transplantation. However, the majority of the disease remains incurable and most patients relapse. In recent years, introduction of Daratumumab, an anti-CD38 monoclonal antibody, has opened up a promising future for patients with multiple myeloma. Daratumumab acts against multiple myeloma cells through Fc-dependent immunomodulatory mechanisms, induces apoptosis through cross-linking and modifies CD38 enzymatic activity. The effectiveness of Daratumumab has been demonstrated through numerous clinical trials. In November 2016, results from the CASTOR and POLLUX studies led to FDA approval of Daratumumab with Vd or Rd for patients with relapsed/refractory multiple myeloma. Further, the FDA and EMA also approved two regimens of Daratumumab with VMP and Daratumumab with Rd for transplant-ineligible newly diagnosed multiple myeloma patients through results from two randomized trials, ALCYONE and MAIA. In addition, the results of the CASSIOPEIA trial also provided the basis for FDA approval of Daratumumab plus VTd in transplant-eligible newly diagnosed multiple myeloma patients. Daratumumab has significantly improved treatment outcomes in patients with relapsed/refractory multiple myeloma as well as in patients with newly diagnosed multiple myeloma. Therefore, Daratumumab is more and more widely applied in clinical practice today. DOI: 10.59715/pntjmp.1.3.1

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