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55% пациентов с эпилепсией никогда не обращаются к специалисту. Как правильно диагностировать эпилептические приступы?
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Советы молодым</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="air-pollution-and-heart-disease-how-to-lower-your-risks-9" data-product-id="7374935031964" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374935031964 small--hide" title=" Quick shop " data-handle="air-pollution-and-heart-disease-how-to-lower-your-risks-9"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/how-to/products/air-pollution-and-heart-disease-how-to-lower-your-risks-9" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="150px" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Загрязнение воздуха и сердечно-сосудистые заболевания. Как снизить риски? Часть 9. 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title=" Quick shop " data-handle="alpha-ketoglutarate-and-longevity-how-to-use-it-with-vitamins-to-slow-aging-9"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/how-to/products/alpha-ketoglutarate-and-longevity-how-to-use-it-with-vitamins-to-slow-aging-9" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; 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> <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/womens-health" class="slide-nav__link"> <span>Women's Health. 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7</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div> <div class="grid__item one-whole"> <div class="product-summary--wide"> <div class="dd-article-summary rte"> <p>Leading expert in multiple myeloma, Dr. Nikhil Munshi, MD, explains how treatment has evolved. He details the shift from two-drug to three and four-drug combinations. These new regimens achieve near 100% response rates. The treatment goal is now minimal residual disease (MRD) negativity. Advanced technologies detect one cancer cell in a million. This allows for deeper response assessment. Four-drug combinations are becoming the new standard for induction therapy.</p> </div> </div> </div></div> </div> </section> <script type="application/ld+json"> {"@context":"http:\/\/schema.org\/","@id":"\/products\/how-to-select-drug-combinations-for-multiple-myeloma-treatment-7#product","@type":"Product","brand":{"@type":"Brand","name":"DiagnosticDetectives.Com"},"category":"","description":"Optimizing Multiple Myeloma Treatment with Advanced Drug Combinations\n\nJump To Section\n\nTreatment Evolution in Myeloma\nMRD Negativity as the New Goal\nAdvanced Detection Technologies\nThree-Drug vs. Two-Drug Regimens\nFour-Drug Combination Therapy\nFuture Treatment Directions\nFull Transcript\n\n\nTreatment Evolution in Myeloma\nDr. Nikhil Munshi, MD, highlights a significant shift in multiple myeloma treatment. At least six new medicines received approval in the last five years. Two-drug regimens are now largely replaced by three or four-drug combinations. This evolution has dramatically improved patient outcomes. Dr. Anton Titov, MD, discusses these advances with Dr. Nikhil Munshi, MD. Response rates now approach 100% in many cases.\n\nMRD Negativity as the New Goal\nThe treatment objective has moved beyond complete remission. The new benchmark is minimal residual disease (MRD) negativity. Dr. Nikhil Munshi, MD, explains that complete remission was historically defined by bone marrow examination. This method could detect roughly one myeloma cell in 100 cells. Achieving MRD negativity signifies a much deeper response. It is a critical predictor of long-term treatment success.\n\nAdvanced Detection Technologies\nAdvanced technologies are crucial for defining MRD negativity. Dr. Nikhil Munshi, MD, describes two primary methods. Next-generation sequencing offers extremely high sensitivity. Multicolor flow cytometry, using 10 to 12 colors, is another powerful tool. These technologies can identify one myeloma cell in a million normal cells. This represents a 10,000-fold increase in detection sensitivity over older methods.\n\nThree-Drug vs. Two-Drug Regimens\nClinical studies clearly demonstrate the superiority of three-drug regimens. Dr. Nikhil Munshi, MD, notes these typically combine a steroid with two key drug classes. A proteasome inhibitor and an immunomodulatory drug form the backbone. This combination has proven significantly better than two-drug therapies. The improved efficacy is measured in both response rates and progression-free survival.\n\nFour-Drug Combination Therapy\nThe next frontier involves adding a fourth drug to the regimen. Dr. Nikhil Munshi, MD, identifies CD38-targeting monoclonal antibodies as this fourth agent. These antibodies attach to a specific protein on myeloma cells. Studies show four-drug combinations provide better responses than three-drug regimens. They achieve MRD negativity in approximately 50% of patients. This represents the current gold standard in induction therapy.\n\nFuture Treatment Directions\nOngoing research continues to refine multiple myeloma treatment. Dr. Nikhil Munshi, MD, mentions numerous studies across different countries. These trials compare various permutations of the available drug classes. The optimal combination likely includes a proteasome inhibitor, an immunomodulatory drug, a steroid, and a CD38 antibody. Dr. Anton Titov, MD, explores these future directions with Dr. Nikhil Munshi, MD. The goal remains achieving the deepest possible response for every patient.\nFull Transcript\nDr. Nikhil Munshi, MD: At least six new medicines for multiple myeloma were approved in the last five years. Two-drug regimens have now been replaced by three- or four-drug combinations, and response rates, as you mentioned, are close to 100%, with complete remission happening in over 50% of multiple myeloma patients.\n\nSo how do we identify the most efficient combination of new drugs for multiple myeloma in treatment induction and also in maintenance treatment regimens? It's a good problem—a problem of success—that a lot of treatments are giving us 100% response rates.\n\nBecause we get 100% response rates, we are beginning to move on to determining what is called minimal residual disease negativity. To simply describe MRD: when we currently—or until the recent past—determined response and called it complete response, we did a bone marrow test to see if there were no myeloma cells in the bone marrow. That was one of the requirements to call someone in complete remission.\n\nThat determination of bone marrow negativity was based on regular pathological examination under a microscope, and our ability to find myeloma cells in that setting was around one cell in 100. So if there was one myeloma cell in the bone marrow among 100 cells, we might be able to find it by doing the staining we use. That was our standard until recently.\n\nNow, newer technologies—sequencing-based technology and also doing multicolor, 10- and 12-color flow cytometry—have allowed us to identify one myeloma cell in a million. That’s 10,000 times deeper estimation of myeloma cell presence.\n\nUtilizing such a very sensitive method, we are redefining response. Our aim now is not just to get complete remission alone, but to get MRD negativity, which doesn't happen in 100% of patients yet—it happens in around 50%.\n\nUsing such methodologies, we are beginning to compare multiple drug combinations. We have clearly shown in many studies that three drugs are better than two drugs. The three drugs usually involve one steroid, but the main two drugs end up being a proteasome inhibitor and an immunomodulating drug. That’s very clear.\n\nNow, we are all greedy—we want to get more and more. We want 100% of patients to have the best response. So what we began to do is combine a fourth drug, which is an antibody that targets a cell surface molecule called CD38.\n\nThese CD38 antibodies have become an important component of four-drug regimens: three that are described, plus the fourth antibody. Now there are multiple studies showing that four drugs provide better responses and progression-free survival compared to three drugs.\n\nSo four drugs are becoming better. But because there are multiple permutations and combinations available, there are many studies ongoing simultaneously in different countries and regions, asking which one may be better.\n\nMost likely, general analysis would be that a proteasome inhibitor, a CD38 antibody, and one immunomodulatory drug with steroid—those four drugs provide currently the best induction response, usually around 50% MRD negativity and overall 100% response rates.","image":"https:\/\/diagnosticdetectives.ru\/cdn\/shop\/products\/Dr_Nikhil_Munshi_Multiple_Myeloma_Treatment_Expert_Second_Opinion_Diagnostic_Detectives_Network.007.jpg?v=1680502605\u0026width=1920","name":"How to select drug combinations for multiple myeloma treatment? 7","offers":{"@id":"\/products\/how-to-select-drug-combinations-for-multiple-myeloma-treatment-7?variant=42432618299548#offer","@type":"Offer","availability":"http:\/\/schema.org\/InStock","price":"0.00","priceCurrency":"RUB","url":"https:\/\/diagnosticdetectives.ru\/products\/how-to-select-drug-combinations-for-multiple-myeloma-treatment-7?variant=42432618299548"},"url":"https:\/\/diagnosticdetectives.ru\/products\/how-to-select-drug-combinations-for-multiple-myeloma-treatment-7"} </script> </div><section id="shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q" class="shopify-section index-section"> <section class="section section--tight" data-section-id="template--18622507942044__product_expert_masterclass_teaser_GQjD4Q"> <div class="page-width"><div class="emc"> <a href="/pages/expert-masterclass/dr-nikhil-munshi" class="emc__media" style="--emc-max-w: 960px; 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display:block; width:100%; max-width: var(--emc-max-w, 960px); margin-left:0; margin-right:auto; border-radius: 1rem; overflow:hidden; box-shadow: 0 10px 30px rgba(0,0,0,.25); } /* Image */ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__img{ display:block; width:100%; height:auto; aspect-ratio:16/9; object-fit:cover; transform:translateZ(0); } #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__img--placeholder{ background:#111; aspect-ratio:16/9; } /* Optional dim to help CTA (driven by slider) */ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__overlay{ position:absolute; inset:0; pointer-events:none; background:#000; /* solid black */ opacity: var(--emc-dim, .35) !important; /* slider value 0..1 */ z-index: 1; /* sits above image */ transition: opacity .2s ease; /* smooth when slider changes */ } /* Keep CTA above the overlay */ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__cta--center{ position:absolute; 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background: rgba(0,0,0,.42); } #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__media:hover .emc__img{ transform: scale(1.01); transition: transform .35s ease; } } /* Icon circle + large red triangle */ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__icon{ display:inline-grid; place-items:center; width: clamp(2.75rem, 2rem + 1.8vw, 3.25rem); height: clamp(2.75rem, 2rem + 1.8vw, 3.25rem); border-radius:9999px; background: rgba(0,0,0,.35); border: 1px solid rgba(255,255,255,.75); color:#fff; /* outer circle stroke */ flex: 0 0 auto; } #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__icon-svg{ width: 80%; height: 80%; } /* CTA text scales: mobile → desktop */ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__cta-text{ font-weight:600; letter-spacing:.01em; font-size: clamp(1rem, .9rem + .95vw, 1.6rem); text-shadow: 0 1px 2px rgba(0,0,0,.5); } /* Mobile uses full width; desktop capped by setting */ @media (max-width: 989px){ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__media{ max-width: 100%; } } /* Mobile uses full width; desktop capped by setting */ @media (max-width: 989px){ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__media{ max-width: 100%; } } /* ↓ Smaller CTA on phones, allow wrapping */ @media (max-width: 749px){ #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__cta-btn{ gap: .4rem; padding: .4rem .7rem; /* even tighter padding */ flex-wrap: wrap; /* allow two lines */ line-height: 1.2; } #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__cta-text{ font-size: .85rem; /* smaller text */ text-align: center; /* center text when wrapping */ } #shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q .emc__icon{ width: 1.8rem; /* smaller circle */ height: 1.8rem; 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if(!holders.length) return true; var id = findVimeoId(r); if(!id){ log('EMC: no Vimeo ID yet'); return false; } // Try best-quality candidates; safely fall back to what already works fetchBestVimeoThumb(id).then(function(thumbUrl){ if(!thumbUrl){ // one last guard using your previous single vumbnail path if (ALLOW_VIMBNAIL) thumbUrl = vumbnailUrl(id); } if(!thumbUrl){ log('EMC: no thumbnail URL available'); return; } for(var i=0;i<holders.length;i++){ upgradeThumb(holders[i], thumbUrl); } }); return true; } function start(){ if(runOnce()) return; // Poll up to MAX_WAIT_MS for lazy iframes to appear var elapsed = 0; var interval = setInterval(function(){ elapsed += POLL_EVERY_MS; if(runOnce() || elapsed >= MAX_WAIT_MS){ clearInterval(interval); } }, POLL_EVERY_MS); // React instantly to DOM insertions var obs = new MutationObserver(function(){ runOnce(); }); try { obs.observe(document.body, { childList:true, subtree:true }); } catch(e){} setTimeout(function(){ try{ obs.disconnect(); }catch(e){} }, MAX_WAIT_MS + 500); 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padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="30vw" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">55% пациентов с эпилепсией никогда не обращаются к специалисту. Как правильно диагностировать эпилептические приступы?</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="advice-to-young-neurosurgeons-how-to-become-a-skilled-surgeon-8" data-product-id="7374949220508" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374949220508 small--hide" title=" Quick shop " data-handle="advice-to-young-neurosurgeons-how-to-become-a-skilled-surgeon-8"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/how-to/products/advice-to-young-neurosurgeons-how-to-become-a-skilled-surgeon-8" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; 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padding-bottom: 41.666666666666664%;" > <is-land on:visible data-image-type="photoswipe"> <img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1080" alt="Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю." srcset="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1080 1080w" width="1080" height="450.0" loading="eager" class=" image-element" data-photoswipe-src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1800" data-photoswipe-width="1920" data-photoswipe-height="800" data-index="1" sizes=" (min-width: 769px) 50vw, 75vw" data-animate="none"> </is-land> </div><div class="product__video-wrapper"> <is-land on:idle> <div class="video-media aspect-ratio--16-9" data-background="false" ><video-media defer-hydration > <video playsinline="true" controls="controls" preload="metadata" aria-label="Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю." poster="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002_500x.jpg?v=1666367638"><source src="//diagnosticdetectives.ru/cdn/shop/videos/c/vp/a22b0d50e4c64d9c8b0a558888197f4a/a22b0d50e4c64d9c8b0a558888197f4a.HD-720p-4.5Mbps-8813343.mp4?v=0" type="video/mp4"><img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002_500x.jpg?v=1666367638"></video> </video-media></div> <template data-island> <script type="module"> import 'components/video-media' </script> </template> </is-land> </div></div> </div> </div></div> <div data-product-thumbs class="product__thumbs product__thumbs--beside product__thumbs-placement--left medium-up--hide small--hide" data-position="beside" data-arrows="false" ><div class="product__thumbs--scroller"></div></div> </div> <script type="application/json" data-current-variant-json>{"id":41852130001052,"title":"Default Title","option1":"Default Title","option2":null,"option3":null,"sku":"","requires_shipping":false,"taxable":false,"featured_image":null,"available":true,"name":"Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю.","public_title":null,"options":["Default Title"],"price":0,"weight":0,"compare_at_price":null,"inventory_management":null,"barcode":"","requires_selling_plan":false,"selling_plan_allocations":[]}</script> <script type="application/json" data-product-options-json>["Title"]</script> </product-images> <script type="module"> import 'components/product-images' </script> <script type="application/json" id="ModelJson-template--18622507942044__featured_product_LHGeFD"> [] </script><div class="localized-video-iframe-container" style="margin-top: 1.5rem;"> <div id="language-selector-wrapper"> <label for="language-selector">🎧 Select dubbed video language:</label> <select id="language-selector"> <option value="">Choose dubbed language</option> <option value="de" >Deutsch</option> <option value="fr" >Français</option> <option value="ru" selected>Русский</option> <option value="it" >Italiano</option> <option value="es" >Español</option> <option value="pt" >Português</option> <option value="ar" >العربية</option> <option value="zh" >中文</option> <option value="ja" >日本語</option> <option value="ko" >한국어</option> </select> </div> <iframe id="localized-video-iframe" src="https://player.vimeo.com/video/1113043591?autoplay=0&title=0&byline=0&portrait=0" data-selected-lang="ru" frameborder="0" allow="autoplay; fullscreen" allowfullscreen loading="lazy" style="width:100%; aspect-ratio:16/9; margin-top: 0.5rem;"> </iframe> </div></div><div class="product-grid__content product--description product-single__sticky grid__item medium-up--one-half"> <div class="product-single__meta"> <div class="product-block" data-section-id="template--18622507942044__featured_product_LHGeFD" > <h1 class="h2 product-single__title">Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю.</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div></div> </div> </section> <script> document.addEventListener("DOMContentLoaded", function () { const selector = document.getElementById("language-selector"); const iframe = document.getElementById("localized-video-iframe"); if (!selector || !iframe) return; // 🧠 Detect the language used in video (via data attribute from Liquid) const loadedLang = iframe.getAttribute("data-selected-lang"); if (loadedLang) { selector.value = loadedLang; } // 🧠 On dropdown change, switch video selector.addEventListener("change", function () { const lang = selector.value; if (!lang) return; const metafieldUrl = {"vimeo_url_ar":"https:\/\/player.vimeo.com\/video\/1113042680","vimeo_url_de":"https:\/\/player.vimeo.com\/video\/1113042888","vimeo_url_es":"https:\/\/player.vimeo.com\/video\/1113043009","vimeo_url_fr":"https:\/\/player.vimeo.com\/video\/1113043115","vimeo_url_it":"https:\/\/player.vimeo.com\/video\/1113043209","vimeo_url_ja":"https:\/\/player.vimeo.com\/video\/1113043318","vimeo_url_ko":"https:\/\/player.vimeo.com\/video\/1113043403","vimeo_url_pt":"https:\/\/player.vimeo.com\/video\/1113043502","vimeo_url_ru":"https:\/\/player.vimeo.com\/video\/1113043591","vimeo_url_zh":"https:\/\/player.vimeo.com\/video\/1113042779"}; const urlKey = "vimeo_url_" + lang; const newUrl = metafieldUrl[urlKey]; if (newUrl) { iframe.src = newUrl + "?autoplay=0&title=0&byline=0&portrait=0"; } }); }); </script> </div><div id="shopify-section-template--18622507942044__featured_product_ik9hhY" class="shopify-section index-section"> <section class="page-content page-content--product page-content--partial" data-section-id="template--18622507942044__featured_product_ik9hhY" data-product-id="7374955151516" > <div class="page-width"> <div class="product-grid__container product--images float-grid grid--product-images-right grid--product-images--partial clearfix"><div class="product-grid__content product--description product-single__sticky grid__item medium-up--one-half"> <div class="product-single__meta"> <div class="product-block" data-section-id="template--18622507942044__featured_product_ik9hhY" > <h1 class="h2 product-single__title">Подбор идеальных хирургов или медицинских специалистов для проведения вашего лечения.</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; 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const iframe = document.getElementById("localized-video-iframe"); if (!selector || !iframe) return; // 🧠 Detect the language used in video (via data attribute from Liquid) const loadedLang = iframe.getAttribute("data-selected-lang"); if (loadedLang) { selector.value = loadedLang; } // 🧠 On dropdown change, switch video selector.addEventListener("change", function () { const lang = selector.value; if (!lang) return; const metafieldUrl = {}; const urlKey = "vimeo_url_" + lang; const newUrl = metafieldUrl[urlKey]; if (newUrl) { iframe.src = newUrl + "?autoplay=0&title=0&byline=0&portrait=0"; } }); }); </script> </div><div id="shopify-section-template--18622507942044__sub" class="shopify-section product-full-width"> <div class="page-width page-width--narrow"> <div class="product-block" > <at-rte class="at-rte rte clearfix"> <h1>Optimizing Multiple Myeloma Treatment with Advanced Drug Combinations</h1> <h3>Jump To Section</h3> <ul> <li><a href="#treatment-evolution-myeloma">Treatment Evolution in Myeloma</a></li> <li><a href="#mrd-negativity-goal">MRD Negativity as the New Goal</a></li> <li><a href="#advanced-detection-technologies">Advanced Detection Technologies</a></li> <li><a href="#three-drug-vs-two-drug">Three-Drug vs. Two-Drug Regimens</a></li> <li><a href="#four-drug-combination-therapy">Four-Drug Combination Therapy</a></li> <li><a href="#future-treatment-directions">Future Treatment Directions</a></li> <li><a href="#full-transcript">Full Transcript</a></li> </ul> <h2 id="treatment-evolution-myeloma">Treatment Evolution in Myeloma</h2> <p>Dr. Nikhil Munshi, MD, highlights a significant shift in multiple myeloma treatment. At least six new medicines received approval in the last five years. Two-drug regimens are now largely replaced by three or four-drug combinations. This evolution has dramatically improved patient outcomes. Dr. Anton Titov, MD, discusses these advances with Dr. Nikhil Munshi, MD. Response rates now approach 100% in many cases.</p> <h2 id="mrd-negativity-goal">MRD Negativity as the New Goal</h2> <p>The treatment objective has moved beyond complete remission. The new benchmark is minimal residual disease (MRD) negativity. Dr. Nikhil Munshi, MD, explains that complete remission was historically defined by bone marrow examination. This method could detect roughly one myeloma cell in 100 cells. Achieving MRD negativity signifies a much deeper response. It is a critical predictor of long-term treatment success.</p> <h2 id="advanced-detection-technologies">Advanced Detection Technologies</h2> <p>Advanced technologies are crucial for defining MRD negativity. Dr. Nikhil Munshi, MD, describes two primary methods. Next-generation sequencing offers extremely high sensitivity. Multicolor flow cytometry, using 10 to 12 colors, is another powerful tool. These technologies can identify one myeloma cell in a million normal cells. This represents a 10,000-fold increase in detection sensitivity over older methods.</p> <h2 id="three-drug-vs-two-drug">Three-Drug vs. Two-Drug Regimens</h2> <p>Clinical studies clearly demonstrate the superiority of three-drug regimens. Dr. Nikhil Munshi, MD, notes these typically combine a steroid with two key drug classes. A proteasome inhibitor and an immunomodulatory drug form the backbone. This combination has proven significantly better than two-drug therapies. The improved efficacy is measured in both response rates and progression-free survival.</p> <h2 id="four-drug-combination-therapy">Four-Drug Combination Therapy</h2> <p>The next frontier involves adding a fourth drug to the regimen. Dr. Nikhil Munshi, MD, identifies CD38-targeting monoclonal antibodies as this fourth agent. These antibodies attach to a specific protein on myeloma cells. Studies show four-drug combinations provide better responses than three-drug regimens. They achieve MRD negativity in approximately 50% of patients. This represents the current gold standard in induction therapy.</p> <h2 id="future-treatment-directions">Future Treatment Directions</h2> <p>Ongoing research continues to refine multiple myeloma treatment. Dr. Nikhil Munshi, MD, mentions numerous studies across different countries. These trials compare various permutations of the available drug classes. The optimal combination likely includes a proteasome inhibitor, an immunomodulatory drug, a steroid, and a CD38 antibody. Dr. Anton Titov, MD, explores these future directions with Dr. Nikhil Munshi, MD. The goal remains achieving the deepest possible response for every patient.</p> <h2 id="full-transcript">Full Transcript</h2> <p><strong>Dr. Nikhil Munshi, MD:</strong> At least six new medicines for multiple myeloma were approved in the last five years. Two-drug regimens have now been replaced by three- or four-drug combinations, and response rates, as you mentioned, are close to 100%, with complete remission happening in over 50% of multiple myeloma patients.</p> <p>So how do we identify the most efficient combination of new drugs for multiple myeloma in treatment induction and also in maintenance treatment regimens? It's a good problem—a problem of success—that a lot of treatments are giving us 100% response rates.</p> <p>Because we get 100% response rates, we are beginning to move on to determining what is called minimal residual disease negativity. To simply describe MRD: when we currently—or until the recent past—determined response and called it complete response, we did a bone marrow test to see if there were no myeloma cells in the bone marrow. That was one of the requirements to call someone in complete remission.</p> <p>That determination of bone marrow negativity was based on regular pathological examination under a microscope, and our ability to find myeloma cells in that setting was around one cell in 100. So if there was one myeloma cell in the bone marrow among 100 cells, we might be able to find it by doing the staining we use. That was our standard until recently.</p> <p>Now, newer technologies—sequencing-based technology and also doing multicolor, 10- and 12-color flow cytometry—have allowed us to identify one myeloma cell in a million. That’s 10,000 times deeper estimation of myeloma cell presence.</p> <p>Utilizing such a very sensitive method, we are redefining response. Our aim now is not just to get complete remission alone, but to get MRD negativity, which doesn't happen in 100% of patients yet—it happens in around 50%.</p> <p>Using such methodologies, we are beginning to compare multiple drug combinations. We have clearly shown in many studies that three drugs are better than two drugs. The three drugs usually involve one steroid, but the main two drugs end up being a proteasome inhibitor and an immunomodulating drug. That’s very clear.</p> <p>Now, we are all greedy—we want to get more and more. We want 100% of patients to have the best response. So what we began to do is combine a fourth drug, which is an antibody that targets a cell surface molecule called CD38.</p> <p>These CD38 antibodies have become an important component of four-drug regimens: three that are described, plus the fourth antibody. Now there are multiple studies showing that four drugs provide better responses and progression-free survival compared to three drugs.</p> <p>So four drugs are becoming better. But because there are multiple permutations and combinations available, there are many studies ongoing simultaneously in different countries and regions, asking which one may be better.</p> <p>Most likely, general analysis would be that a proteasome inhibitor, a CD38 antibody, and one immunomodulatory drug with steroid—those four drugs provide currently the best induction response, usually around 50% MRD negativity and overall 100% response rates.</p> </at-rte> <script type="module"> import 'components/rte' </script> </div> </div> </div> </main><!-- BEGIN sections: footer-group --> <div id="shopify-section-sections--18523926593692__footer" class="shopify-section shopify-section-group-footer-group"> <div class="footer__section footer__section--border"> <div class="page-width"> <div class="footer__newsletter"><div class="footer__subscribe rte rte--nomargin clearfix"> <p><strong>Get high-impact health ideas [1x month]</strong></p> </div> <form method="post" action="/contact#newsletter-sections--18523926593692__footer" id="newsletter-sections--18523926593692__footer" accept-charset="UTF-8" class="contact-form"><input type="hidden" name="form_type" value="customer" /><input type="hidden" name="utf8" value="✓" /> <label for="Email-sections--18523926593692__footer" class="visually-hidden"> Enter your email </label> <label for="newsletter-form-submit-sections--18523926593692__footer" class="visually-hidden"> Subscribe </label> <input type="hidden" name="contact[tags]" value="prospect,newsletter"> <input type="hidden" name="contact[context]" value="footer"> <div class="input-group newsletter__input-group"> <input type="email" value="" placeholder=" Enter your email " name="contact[email]" id="Email-sections--18523926593692__footer" class="input-group-field newsletter__input" autocorrect="off" autocapitalize="off" required > <div class="input-group-btn"> <button type="submit" id="newsletter-form-submit-sections--18523926593692__footer" class="btn" name="commit" aria-label=" Subscribe " > <span class="form__submit--large"> Subscribe </span> <span class="form__submit--small"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon--wide icon-arrow-right" viewbox="0 0 50 15" fill="currentColor" width="20" height="20" > <path d="M0 9.63V5.38h35V0l15 7.5L35 15V9.63Z" /> </svg> </span> </button> </div> </div></form> </div> </div> </div> <div id="FooterMobileNavWrap" class="footer__section footer__section--border medium-up--hide"> <div id="FooterMobileNav" class="page-width"></div> </div><is-land on:visible> <footer-section class="site-footer" data-section-id="sections--18523926593692__footer" data-section-type="footer-section"> <div id="FooterMenus" class="footer__section footer__section--menus " > <div class="page-width"> <div class="footer__blocks"><div class="footer__block footer__block--menu" data-type="menu" > <h2 class="footer__title h4"> About us </h2> <ul class="footer__menu"><li> <a href="/pages/our-mission-story">About us. 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