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Current Opinion in Oncology Nov 2020Immunotherapy is transforming treatment of multiple myeloma patients in all stages of their disease. This review will discuss recent developments in immunotherapy in... (Review)
Review
PURPOSE OF REVIEW
Immunotherapy is transforming treatment of multiple myeloma patients in all stages of their disease. This review will discuss recent developments in immunotherapy in multiple myeloma with a focus on antibodies, antibody-drug conjugates, and T-cell-redirection strategies.
RECENT FINDINGS
CD38-targeting antibodies have single agent activity in multiple myeloma, and especially when combined with other drugs, are improving the clinical outcome of patients with newly diagnosed or relapsed/refractory multiple myeloma. Also the SLAMF7-targeting antibody, elotuzumab, improves the survival of relapsed/refractory multiple myeloma patients, when it is combined with either lenalidomide or pomalidomide. Several novel immunotherapies, such as chimeric antigen receptor T cells, antibody-drug conjugates, and bispecific antibodies, are active in patients who developed resistance to all currently available antimultiple myeloma drugs, including immunomodulatory drugs, proteasome inhibitors, and CD38 antibodies. These new immunotherapeutic agents frequently target B-cell maturation antigen, which is highly and uniformly expressed on multiple myeloma cells. However, other targets, such as GPRC5D, are also being investigated.
SUMMARY
Immunotherapy is incorporated into first-line and relapse regimens, and is improving the survival of both newly diagnosed and relapsed/refractory multiple myeloma patients.
Topics: Clinical Trials, Phase III as Topic; Humans; Immunotherapy; Multiple Myeloma; Randomized Controlled Trials as Topic
PubMed: 32852308
DOI: 10.1097/CCO.0000000000000677 -
British Journal of Haematology Jul 2020
Topics: Aged; Female; Humans; Multiple Myeloma; Plasmacytoma
PubMed: 32301114
DOI: 10.1111/bjh.16646 -
Current Oncology (Toronto, Ont.) Apr 2023Multiple myeloma (MM) is a malignant clonal plasma cell disorder in the bone marrow and is the second-most common hematologic malignancy in adults. Although patients... (Review)
Review
Multiple myeloma (MM) is a malignant clonal plasma cell disorder in the bone marrow and is the second-most common hematologic malignancy in adults. Although patients with MM have a moderate life expectancy, it remains a heterogeneous disease that often requires multiple lines of chemotherapy for durable control and long-term survival. This review outlines current management strategies for both transplant-eligible and transplant-ineligible patients as well as for relapsed and refractory disease. Advances in drug therapies have widened management options and improved survival. In this paper, we also discuss implications for special populations and survivorship care.
Topics: Adult; Humans; Multiple Myeloma; General Practitioners; Hematologic Neoplasms
PubMed: 37232792
DOI: 10.3390/curroncol30050334 -
Current Hematologic Malignancy Reports Dec 2022Despite tremendous advances in multiple myeloma (MM) care, the disease maintains considerable morbidity and requires long-term treatment associated with significant... (Review)
Review
PURPOSE OF REVIEW
Despite tremendous advances in multiple myeloma (MM) care, the disease maintains considerable morbidity and requires long-term treatment associated with significant financial toxicity to patients and high costs to society. In this review, we explore why - despite treatment advances - value in MM treatment is largely a myth, then explain some ways the myth might become a reality.
RECENT FINDINGS
We discuss how value-based care in MM should include patient-centered outcomes such as financial toxicity and quality of life, which are heavily impacted by cost of drugs and the indefinite duration of therapy that is standard in MM treatment. We propose multiple paths to work toward reducing cost and augmenting value of care for patients with MM, including improving access to generic drugs, increasing federal funding for clinical trials, designing more patient-centric clinical trials, and exploring the utilization of minimal residual disease (MRD)-driven treatment de-escalation, among others. We remain optimistic that despite the challenges, we can work toward making progress in the realm of value-based care for patients with MM and make it a reality.
Topics: Humans; Multiple Myeloma; Quality of Life; Neoplasm, Residual
PubMed: 36040675
DOI: 10.1007/s11899-022-00669-1 -
Expert Review of Hematology 2023The importance of cancer staging is determined by how accurately it can predict prognosis, and how useful it is for treatment decisions. Compared to other malignancies,... (Review)
Review
INTRODUCTION
The importance of cancer staging is determined by how accurately it can predict prognosis, and how useful it is for treatment decisions. Compared to other malignancies, multiple myeloma (MM) staging proved more challenging because of unreliable prognostic factors and wide-ranging life expectancy. As traditional MM staging continues to evolve, it requires reassessment of its prognostic and predictive value.
AREAS COVERED
The studies that included prognostic and predictive value of MM stages from 1975 through 2023 were selected for this review using PubMed, MEDLINE platforms. The history and evolution of MM staging are revisited, including its role in predicting survival, treatment planning and potential practical implications for the future. The role of MM staging for oncological practice and patient counseling is discussed.
EXPERT OPINION
The utility of the traditional MM staging remains unsatisfactory because it lacks a strong connection with the disease biology, prognosis or treatment planning. Additionally, it demonstrates a modest value for patient counseling because individual prognosis is subject to under- or overestimation, and the median survival or survival rates are difficult concepts to grasp. Although the role of MM stages may change in the future, the current research upholds the notion that MM staging benefits more medical research and clinical trials than oncological practice.
Topics: Humans; Multiple Myeloma; Prognosis; Neoplasm Staging
PubMed: 37902242
DOI: 10.1080/17474086.2023.2277876 -
Hematology/oncology Clinics of North... Apr 2024Measurable (minimal) residual disease (MRD) has already proven to be one of the most important prognostic factors in multiple myeloma (MM). Each improvement in the depth... (Review)
Review
Measurable (minimal) residual disease (MRD) has already proven to be one of the most important prognostic factors in multiple myeloma (MM). Each improvement in the depth of MRD testing has led to superior discrimination of outcomes, and sustained MRD negativity seems to be paramount to durable responses. Peripheral blood assays to assess for MRD are still under investigation but hold promise as complementary tools to bone marrow MRD assays such as next-generation sequencing and flow cytometry. Herein, the authors explore the evidence and potential benefits and drawbacks of MRD-adapted clinical decision-making in MM.
Topics: Humans; Multiple Myeloma; Bone Marrow; Neoplasm, Residual; Flow Cytometry; High-Throughput Nucleotide Sequencing
PubMed: 38184470
DOI: 10.1016/j.hoc.2023.12.009 -
Haematologica May 2024
Topics: Humans; Multiple Myeloma
PubMed: 37981890
DOI: 10.3324/haematol.2023.284292 -
Journal of Veterinary Diagnostic... Jul 2022A 5-y-old spayed female Golden Retriever dog was referred because of severe normocytic normochromic nonregenerative anemia and thrombocytopenia. Serum analysis revealed...
A 5-y-old spayed female Golden Retriever dog was referred because of severe normocytic normochromic nonregenerative anemia and thrombocytopenia. Serum analysis revealed hyperproteinemia and monoclonal or oligoclonal gammopathy. Fine-needle aspiration of the spleen revealed a highly erythrophagocytic population of neoplastic round cells, morphologically suggestive of plasma cells. After euthanasia, histologic assessment of the spleen and liver revealed an erythrophagocytic round cell tumor. Immunohistochemical analysis of the tumor population was positive for MUM1p and negative for CD3, CD20, and Iba-1, confirming the plasma cell origin of the tumor. Erythrophagocytic multiple myeloma is a very rare neoplastic condition in dogs.
Topics: Animals; Dog Diseases; Dogs; Female; Liver; Multiple Myeloma; Spleen
PubMed: 35603564
DOI: 10.1177/10406387221092299 -
Clinical Cancer Research : An Official... Jun 2022The prognostic significance of minimal residual disease (MRD) detection in multiple myeloma is well established. Understanding factors that predict for MRD negativity,...
The prognostic significance of minimal residual disease (MRD) detection in multiple myeloma is well established. Understanding factors that predict for MRD negativity, such as tumor burden, cytogenetic, and immune-related biomarkers, may enable us to improve outcome prediction at diagnosis, and in the future move toward tailored treatment approaches. See related article by Guerrero et al., p. 2598.
Topics: Biomarkers; Humans; Machine Learning; Multiple Myeloma; Neoplasm, Residual; Prognosis
PubMed: 35357437
DOI: 10.1158/1078-0432.CCR-22-0219 -
Advances in Chronic Kidney Disease Mar 2022Cancer is a leading cause of death in patients with kidney transplantation. Patients with kidney transplants are 10- to 200-times more likely to develop cancers after... (Review)
Review
Cancer is a leading cause of death in patients with kidney transplantation. Patients with kidney transplants are 10- to 200-times more likely to develop cancers after transplant than the general population, depending on the cancer type. Recent advances in cancer therapies have dramatically improved survival outcomes; however, patients with kidney transplants face unique challenges of immunosuppression management, cancer screening, and recurrence of cancer after transplant. Patients with a history of cancer tend to be excluded from transplant candidacy or are required to have long cancer-free wait time before wait-listing. The strategy of pretransplant wait time management may need to be revisited as cancer therapies improve, which is most applicable to patients with a history of multiple myeloma. In this review, we discuss several important topics in transplant onconephrology: the current recommendations for pretransplant wait times for transplant candidates with cancer histories, cancer screening post-transplant, post-transplant lymphoproliferative disorder, strategies for transplant patients with a history of multiple myeloma, and novel therapies for patients with post-transplant malignancies. With emerging novel cancer treatments, it is critical to have multidisciplinary discussions involving patients, caregivers, transplant nephrologists, and oncologists to achieve patient-oriented goals.
Topics: Humans; Kidney Transplantation; Multiple Myeloma
PubMed: 35817526
DOI: 10.1053/j.ackd.2021.09.002