多发性骨髓瘤(MM)是第二常见的浆细胞恶性血液病,以溶骨性骨病变为特征,贫血,高钙血症,肾功能衰竭,和恶性浆细胞的积累。MM的发病机制涉及MM细胞通过可溶性细胞因子和细胞粘附分子与骨髓微环境相互作用,激活各种信号通路,如PI3K/AKT/mTOR,RAS/MAPK,JAK/STAT,Wnt/β-catenin,和NF-κB通路。这些途径的异常激活有助于增殖,生存,迁移,和骨髓瘤细胞的耐药性,使它们成为有吸引力的治疗干预目标。目前,在MM中针对这些信号通路的批准药物是有限的,许多抑制剂和诱导剂仍处于临床前或临床研究阶段。MM的治疗选择包括非靶向药物,如烷化剂,皮质类固醇,免疫调节药物,蛋白酶体抑制剂,和组蛋白脱乙酰酶抑制剂。此外,靶向药物如单克隆抗体,嵌合抗原受体T细胞,双特异性T细胞衔接者,和双特异性抗体正在用于MM治疗。尽管在MM治疗方面取得了重大进展,这种疾病仍然无法治愈,强调需要根据新兴的理论知识开发新的或联合的靶向疗法,技术,和平台。在这次审查中,我们强调了信号通路在MM的恶性进展和治疗中的关键作用,探索靶向治疗和潜在治疗的进展,为改善MM管理和结局提供进一步的见解。
Multiple myeloma (MM) is the second most common hematological malignancy of plasma cells, characterized by osteolytic bone lesions, anemia, hypercalcemia, renal failure, and the accumulation of malignant plasma cells. The pathogenesis of MM involves the interaction between MM cells and the bone marrow microenvironment through soluble cytokines and cell adhesion molecules, which activate various signaling pathways such as PI3K/AKT/mTOR, RAS/MAPK, JAK/STAT, Wnt/β-catenin, and NF-κB pathways. Aberrant activation of these pathways contributes to the proliferation, survival, migration, and drug resistance of myeloma cells, making them attractive targets for therapeutic intervention. Currently, approved drugs targeting these signaling pathways in MM are limited, with many inhibitors and inducers still in preclinical or clinical research stages. Therapeutic options for MM include non-targeted drugs like alkylating agents, corticosteroids, immunomodulatory drugs, proteasome inhibitors, and histone deacetylase inhibitors. Additionally, targeted drugs such as monoclonal antibodies, chimeric antigen receptor T cells, bispecific T-cell engagers, and bispecific antibodies are being used in MM treatment. Despite significant advancements in MM treatment, the disease remains incurable, emphasizing the need for the development of novel or combined targeted therapies based on emerging theoretical knowledge, technologies, and platforms. In this review, we highlight the key role of signaling pathways in the malignant progression and treatment of MM, exploring advances in targeted therapy and potential treatments to offer further insights for improving MM management and outcomes.