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Current Hematologic Malignancy Reports Apr 2020As novel therapies are expanding the life expectancy of patients with multiple myeloma, appropriate supportive care has become critical in the management of these... (Review)
Review
PURPOSE OF REVIEW
As novel therapies are expanding the life expectancy of patients with multiple myeloma, appropriate supportive care has become critical in the management of these patients. This review aims to outline the key principles of supportive care of patients with myeloma, including management of bone disease, renal disease, anemia, peripheral neuropathy, infections, and venous thromboembolism.
RECENT FINDINGS
The results from large randomized, controlled trials on the use of high-cutoff hemodialysis in the removal of free light chains in renal disease and the use of levofloxacin in the prevention of infections have recently been published. These results, along with updated guidelines from professional societies on the use of bisphosphonates and erythropoietin stimulating agents, have provided guidance on more effective management strategies for myeloma patients. Integration of these updated guidelines and supportive care strategies into clinical practice will help to ensure quality of life for patients with myeloma.
Topics: Humans; Multiple Myeloma; Palliative Care; Quality of Life; Treatment Outcome
PubMed: 32172361
DOI: 10.1007/s11899-020-00570-9 -
Blood Cancer Journal Sep 2020The treatment of multiple myeloma (MM) continues to evolve rapidly with arrival of multiple new drugs, and emerging data from randomized trials to guide therapy. Along... (Review)
Review
The treatment of multiple myeloma (MM) continues to evolve rapidly with arrival of multiple new drugs, and emerging data from randomized trials to guide therapy. Along the disease course, the choice of specific therapy is affected by many variables including age, performance status, comorbidities, and eligibility for stem cell transplantation. In addition, another key variable that affects treatment strategy is risk stratification of patients into standard and high-risk MM. High-risk MM is defined by the presence of t(4;14), t(14;16), t(14;20), gain 1q, del(17p), or p53 mutation. In this paper, we provide algorithms for the treatment of newly diagnosed and relapsed MM based on the best available evidence. We have relied on data from randomized controlled trials whenever possible, and when appropriate trials to guide therapy are not available, our recommendations reflect best practices based on non-randomized data, and expert opinion. Each algorithm has been designed to facilitate easy decision-making for practicing clinicians. In all patients, clinical trials should be considered first, prior to resorting to the standard of care algorithms we outline.
Topics: Algorithms; Chromosome Aberrations; Chromosomes, Human; Clinical Decision-Making; Humans; Multiple Myeloma; Risk Assessment; Risk Factors
PubMed: 32989217
DOI: 10.1038/s41408-020-00359-2 -
Current Hematologic Malignancy Reports Apr 2021Over the last decade, the development of effective treatment approaches for multiple myeloma (MM) has been associated with higher response rates and longer survival. In... (Review)
Review
PURPOSE OF REVIEW
Over the last decade, the development of effective treatment approaches for multiple myeloma (MM) has been associated with higher response rates and longer survival. In patients who achieve complete response, several high sensitivity techniques have been studied to assess minimal residual disease (MRD) and detect residual neoplastic cells within the bone marrow (by flow cytometry or molecular biology techniques) or outside the bone marrow (by imaging or circulating disease markers in the peripheral blood). This is of utmost importance, since residual disease can drive clinical relapse. This review focuses on the progress made in the assessment of MRD in MM.
RECENT FINDINGS
The achievement of MRD negativity after therapy is considered prognostically important for MM patients, and data from clinical trials and meta-analyses have confirmed that it is strongly associated with better survival. Along with well-known techniques, such as next-generation sequencing (NGS), next-generation flow (NGF), and positron emission tomography/computed tomography (PET/CT), other methods such as mass spectrometry (MS) and circulating tumor cells are under study. Intensive treatment regimens at diagnosis can lead up to 70% of MRD negativity in MM patients, although the current proportion of curable patients is still unknown. Today, clinicians who treat MM deal with MRD assessment in routine clinical practice. Its appropriate use in therapeutic decision making may be the most fascinating and challenging issue to be addressed over the next few years.
Topics: Biomarkers, Tumor; Bone Marrow; Combined Modality Therapy; Disease Management; Disease Susceptibility; Flow Cytometry; High-Throughput Nucleotide Sequencing; Humans; Magnetic Resonance Imaging; Multiple Myeloma; Neoplasm, Residual; Positron Emission Tomography Computed Tomography; Prognosis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Treatment Outcome
PubMed: 33950462
DOI: 10.1007/s11899-021-00633-5 -
JAMA Feb 2022
Topics: Biopsy; Bone Marrow; Bortezomib; Dexamethasone; Drug Therapy, Combination; Hematopoietic Stem Cell Transplantation; Humans; Lenalidomide; Multiple Myeloma; United States
PubMed: 35103765
DOI: 10.1001/jama.2021.25306 -
Blood Cancer Journal May 2022Multiple myeloma (MM) is an acquired malignant plasma cell disorder that develops late in life. Although progression free and overall survival has improved across all... (Review)
Review
Multiple myeloma (MM) is an acquired malignant plasma cell disorder that develops late in life. Although progression free and overall survival has improved across all age, race, and ethnic groups, a subset of patients have suboptimal outcomes and are labeled as having high risk disease. A uniform approach to risk in NDMM remains elusive despite several validated risk stratification systems in clinical use. While we attempt to capture risk at diagnosis, the reality is that many important prognostic characteristics remain ill-defined as some patients relapse early who were defined as low risk based on their genomic profile at diagnosis. It is critical to establish a definition of high risk disease in order to move towards risk-adapted treatment approaches. Defining risk at diagnosis is important to both effectively design future clinical trials and guide which clinical data is needed in routine practice. The goal of this review paper is to summarize and compare the various established risk stratification systems, go beyond the R-ISS and international myeloma working group risk stratifications to evaluate specific molecular and cytogenetic abnormalities and how they impact prognosis independently. In addition, we explore the wealth of new genomic information from recent whole genome/exome sequencing as well as gene expression data and review known clinical factors affecting outcome such as disease burden and early relapse as well as patient related factors such as race. Finally, we provide an outlook on developing a new high risk model system and how we might make sense of co-occurrences, oncogenic dependencies, and mutually exclusive mutations.
Topics: Humans; Multiple Myeloma; Neoplasm Recurrence, Local; Neoplasm Staging; Paraproteinemias; Prognosis
PubMed: 35637223
DOI: 10.1038/s41408-022-00679-5 -
Journal of the National Comprehensive... Dec 2020Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the...
Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple myeloma, and newly diagnosed multiple myeloma.
Topics: Bone Marrow; Humans; Medical Oncology; Multiple Myeloma; Plasma Cells; Plasmacytoma
PubMed: 33285522
DOI: 10.6004/jnccn.2020.0057 -
Advances in Experimental Medicine and... 2020Multiple myeloma is a hematological malignancy. It is characterized by the abnormal clonal proliferation of malignant plasma cells in the bone marrow and the secretion... (Review)
Review
Multiple myeloma is a hematological malignancy. It is characterized by the abnormal clonal proliferation of malignant plasma cells in the bone marrow and the secretion of a large number of monoclonal immunoglobulins or light chains, causing bone destruction, elevated blood calcium levels, anemia, and renal dysfunction. Autophagy has a dual role in the autophagy of myeloma cells. On the one hand, autophagy eliminates abnormal proteins and organelles in cells, prevents gene damage, and inhibits tumorigenesis. On the other hand, once tumors are formed, tumor cells use autophagy to ensure their survival under nutrient-deficient and hypoxic conditions. Excessive autophagy promotes another form of death in tumor cells, autophagic cell death. Targeted autophagy is becoming another new myeloma treatment strategy.
Topics: Autophagy; Humans; Multiple Myeloma
PubMed: 32671780
DOI: 10.1007/978-981-15-4272-5_45 -
Home Healthcare NowMultiple myeloma (MM) is a cancer that arises from plasma cells in bone marrow. Approximately 35,730 Americans received a new diagnosis and MM will claim the lives of an... (Review)
Review
Multiple myeloma (MM) is a cancer that arises from plasma cells in bone marrow. Approximately 35,730 Americans received a new diagnosis and MM will claim the lives of an estimated 12,590 people in 2023. Complications of the disease process include anemia, leukopenia, thrombocytopenia, renal failure, severe pain, bone loss, and hypercalcemia. Patients with MM have a high risk for pathological fractures. For most forms of MM there are effective treatments that may result in long-term remission using multi-drug regimens. Although the medications approved in the United States to treat MM generally produce good outcomes, they have serious, and potentially life-threatening adverse effects. In addition, patients with specific genetic variations are at high risk for relapse. Communication with the oncology team and early intervention in the event of adverse effects of medications, complications of the disease process, or evidence of relapse are important to obtain the best possible outcome. Patients are easily overwhelmed with a three- to four-drug treatment regimen with some drugs given intravenously and/or subcutaneously at the clinic, and others taken orally at home on specific days of each 28-day cycle. Home care nursing is needed to assess for tolerance, adverse effects, and to address patient concerns. Medication management and teaching are very important in guiding patients to safely manage a schedule that changes daily. In addition, the high risk of pathological fractures and serious injury if the patient should fall supports the need for physical and occupational therapy fall prevention and safety education and exercise programs to help avert decline in functional status and combat cancer-related fatigue.
Topics: Humans; Multiple Myeloma; Antineoplastic Agents
PubMed: 38709580
DOI: 10.1097/NHH.0000000000001249 -
Hematology/oncology Clinics of North... Apr 2024This research indicates that monoclonal gammopathy of undetermined significance (MGUS) and myeloma may stem from chronic immune activation and inflammation, causing... (Review)
Review
This research indicates that monoclonal gammopathy of undetermined significance (MGUS) and myeloma may stem from chronic immune activation and inflammation, causing immune dysfunction and spatial immune exclusion. As the conditions progress, a shift toward myeloma involves ongoing immune impairment, affecting both innate and adaptive immunity. Intriguingly, even in advanced myeloma stages, susceptibility to immune effector cells persists. This insight highlights the intricate interplay between immune responses and the development of these conditions, paving the way for potential therapeutic interventions targeting immune modulation in the management of MGUS and myeloma.
Topics: Humans; Multiple Myeloma; Monoclonal Gammopathy of Undetermined Significance; Disease Progression
PubMed: 38195307
DOI: 10.1016/j.hoc.2023.12.011 -
Best Practice & Research. Clinical... Mar 2020
Topics: Antineoplastic Combined Chemotherapy Protocols; Biomedical Research; Bone Marrow; Early Detection of Cancer; High-Throughput Nucleotide Sequencing; Humans; Maintenance Chemotherapy; Multiple Myeloma; Neoplasm, Residual; Plasma Cells; Survival Analysis
PubMed: 32139007
DOI: 10.1016/j.beha.2020.101155