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Abstract(s)
Introdução: O mieloma mĂșltiplo Ă© a segunda neoplasia hematolĂłgica mais comum nos
paĂses desenvolvidos e a sua incidĂȘncia Ă© maior na faixa etĂĄria entre os 65 e os 75 anos.
Caracteriza-se pela proliferação monoclonal de plasmócitos, dando origem a lesÔes de
órgão-alvo, conhecidas por CRAB: hipercalcemia, lesão renal, anemia e lesÔes
osteolĂticas. O paradigma em relação ao tratamento aplicado nesta neoplasia tem
mudado de forma drĂĄstica ao longo dos Ășltimos anos e espera-se que nos prĂłximos anos
ainda evolua mais.
Objetivo: Perceber de que forma os tratamentos evoluĂram ao longo dos anos e o
impacto que tiveram no prognĂłstico dos doentes, principalmente ao nĂvel da sobrevida
global e da sobrevivĂȘncia livre de progressĂŁo, Ă© o objetivo primordial deste trabalho.
Método: Como metodologia para a realização desta monografia foi utilizado o motor de
busca PubMed, e foram, igualmente, retirados alguns artigos do Blood Cancer Journal.
Foram impostos limites temporais na pesquisa, à exceção dos artigos referenciados no
capĂtulo âAbordagem HistĂłrica, os quais nĂŁo obedeceram a nenhum limite temporal. A
prioridade foram sempre os artigos mais recentes e apenas em lĂngua inglesa.
Desenvolvimento: O mieloma mĂșltiplo Ă© resultado da evolução de uma gamapatia
monoclonal de significado indeterminado devido Ă influĂȘncia de alteraçÔes genĂ©ticas e
epigenĂ©ticas adquiridas ao longo do tempo. Ă uma neoplasia de difĂcil diagnĂłstico,
porque pode ser confundida clinicamente com muitas outras entidades, daĂ que o
prognóstico do doente também dependa muito da fase em que é diagnosticada.
Historicamente, o mieloma mĂșltiplo foi uma doença que durante muitas dĂ©cadas foi de
difĂcil controlo, porque atravĂ©s dos tratamentos utilizados nĂŁo se obtinham taxas de
resposta satisfatórias. Só a partir da década de 90 do século passado, com a aplicação do
transplante autólogo de progenitores hematopoiéticos e anos mais tarde com o
surgimento dos imunomoduladores, dos inibidores do proteossoma e dos anticorpos
monoclonais, Ă© que foi possĂvel melhorar muito o prognĂłstico dos doentes, tanto a nĂvel
da sobrevida global mĂ©dia que aumentou de 3 para 8 a 10 anos, nas Ășltimas duas dĂ©cadas,
como a nĂvel da qualidade de vida, devido Ă s remissĂ”es mais duradouras que os doentes
experienciam.
ConclusĂŁo: O mieloma mĂșltiplo Ă© atualmente considerado uma doença crĂłnica devido
ao impacto altamente positivo que as novas terapĂȘuticas tĂȘm apresentado ao nĂvel da
sobrevida global e da sobrevida livre de progressĂŁo. No entanto, sabe-se que as recaĂdas
sĂŁo inevitĂĄveis e que a doença desenvolve resistĂȘncias contra o tratamento. Por isso hĂĄ ainda muito para investigar, principalmente na ĂĄrea da imunoterapia, que pode
constituir a chave para a cura e/ou prevenção do mieloma mĂșltiplo.
Introduction: Multiple myeloma is the second most common haematological malignancy in developed countries, and its incidence is higher in the age range between 65 and 75 years old. It is characterized by the monoclonal proliferation of plasma cells, leading to end organ damage known as CRAB: hypercalcaemia, renal impairment, anaemia, and osteolytic bone lesions. The paradigm regarding treatment for this neoplasm has changed dramatically in recent years, and it is expected to continue evolving in the upcoming years. Objective: The main objective of this work is to understand how treatments have evolved over the years and the impact they have had on patient prognosis, especially in terms of overall survival and progression-free survival. Method: The PubMed search engine was used as the methodology for this monograph, and some articles were also retrieved from the Blood Cancer Journal. Time limits were imposed on the search, except for the articles referenced in the "Abordagem HistĂłrica" chapter, which did not follow any time limit. Priority was always given to the most recent articles and those only in English. Discussion: Multiple myeloma results from the evolution of a monoclonal gammopathy of undetermined significance due to the influence of genetic and epigenetic changes acquired over time. It is a neoplasm that is difficult to diagnose because it can be clinically similar to other diseases. Therefore, the patient's prognosis also depends on the stage at which it is diagnosed. Historically, multiple myeloma was a disease that was difficult to control because the treatments used did not produce deep response rates. Only from the 1990s, with the application of autologous hematopoietic stem cell transplantation, and later with the emergence of immunomodulatory agents, proteasome inhibitors, and monoclonal antibodies, it has been possible to significantly improve the prognosis of patients, both in terms of median overall survival, which has increased from 3 to 8-10 years in the last two decades, and in terms of quality of life due to more durable remissions experienced by patients. Conclusion: Multiple myeloma is currently considered a chronic disease due to the highly positive impact of new therapies on overall survival and progression-free survival. However, it is known that relapses are inevitable, and that the disease develops drug resistance. Therefore, there is still much to investigate, especially in the area of immunotherapy, which may hold the key to the cure and/or prevention of multiple myeloma.
Introduction: Multiple myeloma is the second most common haematological malignancy in developed countries, and its incidence is higher in the age range between 65 and 75 years old. It is characterized by the monoclonal proliferation of plasma cells, leading to end organ damage known as CRAB: hypercalcaemia, renal impairment, anaemia, and osteolytic bone lesions. The paradigm regarding treatment for this neoplasm has changed dramatically in recent years, and it is expected to continue evolving in the upcoming years. Objective: The main objective of this work is to understand how treatments have evolved over the years and the impact they have had on patient prognosis, especially in terms of overall survival and progression-free survival. Method: The PubMed search engine was used as the methodology for this monograph, and some articles were also retrieved from the Blood Cancer Journal. Time limits were imposed on the search, except for the articles referenced in the "Abordagem HistĂłrica" chapter, which did not follow any time limit. Priority was always given to the most recent articles and those only in English. Discussion: Multiple myeloma results from the evolution of a monoclonal gammopathy of undetermined significance due to the influence of genetic and epigenetic changes acquired over time. It is a neoplasm that is difficult to diagnose because it can be clinically similar to other diseases. Therefore, the patient's prognosis also depends on the stage at which it is diagnosed. Historically, multiple myeloma was a disease that was difficult to control because the treatments used did not produce deep response rates. Only from the 1990s, with the application of autologous hematopoietic stem cell transplantation, and later with the emergence of immunomodulatory agents, proteasome inhibitors, and monoclonal antibodies, it has been possible to significantly improve the prognosis of patients, both in terms of median overall survival, which has increased from 3 to 8-10 years in the last two decades, and in terms of quality of life due to more durable remissions experienced by patients. Conclusion: Multiple myeloma is currently considered a chronic disease due to the highly positive impact of new therapies on overall survival and progression-free survival. However, it is known that relapses are inevitable, and that the disease develops drug resistance. Therefore, there is still much to investigate, especially in the area of immunotherapy, which may hold the key to the cure and/or prevention of multiple myeloma.
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Keywords
Mieloma MĂșltiplo Novas TerapĂȘuticas Perspetiva HistĂłrica