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Seminars in Oncology Nursing Aug 2017To understand the role of the genetic changes and bone marrow microenvironment on the development, progression, and staging of multiple myeloma (MM). (Review)
Review
OBJECTIVE
To understand the role of the genetic changes and bone marrow microenvironment on the development, progression, and staging of multiple myeloma (MM).
DATA SOURCES
Peer-reviewed articles and clinical guidelines.
CONCLUSION
The acquisition of genetic changes and the bone marrow microenvironment in which myeloma cells develop both influence the pathogenic potential of these malignant cells and is reflected in staging of the disease, risk of progression, and predicted response to treatment.
IMPLICATIONS FOR NURSING PRACTICE
Treatment of multiple myeloma is largely dependent on risk factors in which specific genetic alterations play a large role. Clinicians should be aware of these genetic changes and how they may influence the individual treatment plan for each patient.
Topics: Disease Progression; Epigenesis, Genetic; Humans; Multiple Myeloma; Neoplasm Staging; Treatment Outcome; Tumor Microenvironment
PubMed: 28688533
DOI: 10.1016/j.soncn.2017.05.012 -
Cancer Treatment Reviews Nov 2021Despite significant advances in the treatment of multiple myeloma which had led to unprecedented rates of response and survival, patients still relapse, and cure remains... (Review)
Review
Despite significant advances in the treatment of multiple myeloma which had led to unprecedented rates of response and survival, patients still relapse, and cure remains elusive. We propose in this review a roadmap to achieve the dream of cure for multiple myeloma based on five complementary strategies. First, to increase knowledge about disease pathogenesis with a focus on the biology of circulating tumor cells, responsible for dissemination and extramedullary disease, and minimal residual disease clones who represent the reservoir of clonal evolution and disease recurrence. Second, to consider undetectable measurable residual disease (MRD), defined by high-sensitive techniques, as the new endpoint of therapy. Third, to treat disease causation instead of symptomatology through early detection and intervention. Thereby, by treating high-risk smoldering myeloma patients early, we may not only contribute to delay disease progression into active disease but also to increase the cure rates. Fourth, to use the most active scheme in standard-risk patients if the cure is in the horizon. Fifth, to investigate experimental therapies in newly diagnosed patients with high-risk MM, implementing early rescue intervention strategies with the goal of eradicating all tumor clones, and achieving minimal residual disease negativity.
Topics: Humans; Multiple Myeloma
PubMed: 34597912
DOI: 10.1016/j.ctrv.2021.102284 -
Blood Mar 2008Multiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of all hematologic cancers. In this paper, we present a historically focused... (Review)
Review
Multiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of all hematologic cancers. In this paper, we present a historically focused review of the disease, from the description of the first case in 1844 to the present. The evolution of drug therapy and stem-cell transplantation for the treatment of myeloma, as well as the development of new agents, is discussed. We also provide an update on current concepts of diagnosis and therapy, with an emphasis on how treatments have emerged from a historical perspective after certain important discoveries and the results of experimental studies.
Topics: Animals; Biomarkers, Tumor; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Multiple Myeloma; Randomized Controlled Trials as Topic; Risk Factors; Stem Cell Transplantation
PubMed: 18332230
DOI: 10.1182/blood-2007-10-078022 -
Hematological Oncology Jun 2019The treatment of myeloma is rapidly evolving. This article reviews the current diagnostic criteria, risk stratification, and approach to treatment of multiple myeloma.... (Review)
Review
The treatment of myeloma is rapidly evolving. This article reviews the current diagnostic criteria, risk stratification, and approach to treatment of multiple myeloma. Treatment approach for both newly diagnosed and relapsed disease are discussed.
Topics: Clinical Decision-Making; Combined Modality Therapy; Disease Management; Humans; Multiple Myeloma; Recurrence; Retreatment; Treatment Outcome
PubMed: 31187526
DOI: 10.1002/hon.2586 -
Seminars in Oncology Dec 2016Multiple myeloma (MM), although a rare disease, is the second most common hematologic malignancy. It is found in the spectrum of plasma cell dyscrasias, which begins... (Review)
Review
Multiple myeloma (MM), although a rare disease, is the second most common hematologic malignancy. It is found in the spectrum of plasma cell dyscrasias, which begins with monoclonal gammopathy of unknown significance (MGUS) to overt plasma cell leukemia and extramedullary myeloma. MM is associated with significant morbidity due to its end-organ destruction. It is a disease of the older population and its incidence in the African American population is twice that of the European American population. Improvements in the treatment of MM in the past couple of decades, beginning with the use of autologous stem cell transplantation followed by availability of novel treatments such as immunomodulatory drugs (ImIDs) and proteasome inhibitors (PIs) has transformed the natural history of the disease leading to longer survival times. Advancements in the diagnosis, monitoring, and treatment of MM are of the utmost importance as the general population lives longer due to other improvements in health care. The recent introduction of novel therapies has been paralleled by advancements in the monitoring of MM, namely, by the availability exquisitely sensitive techniques in detecting minimal residual disease. As drug development and technology continues to improve, it will be important to design rationale clinical trials enrolling patient populations that represent the overall population, including racial minorities and the elderly, so that trial results can be appropriately extrapolated. Herein, the changing epidemiology, improvements in survival, and the health disparity observed in important subgroups of MM are reviewed.
Topics: Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Multiple Myeloma; Time Factors
PubMed: 28061985
DOI: 10.1053/j.seminoncol.2016.11.004 -
Clinical Medicine (London, England) Jan 2019
Review
Topics: Bone Marrow; Humans; Multiple Myeloma
PubMed: 30651246
DOI: 10.7861/clinmedicine.19-1-58 -
Annals of Oncology : Official Journal... Mar 2021
Topics: Follow-Up Studies; Humans; Multiple Myeloma; Societies, Medical
PubMed: 33549387
DOI: 10.1016/j.annonc.2020.11.014 -
Nature Dec 2011
Topics: Humans; Multiple Myeloma; Neoplastic Stem Cells; Precancerous Conditions; Survival Analysis; Tumor Microenvironment
PubMed: 22169796
DOI: 10.1038/480S33a -
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 May 2015Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder. SMM is distinguished from monoclonal gammopathy of undetermined significance by a much... (Review)
Review
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder. SMM is distinguished from monoclonal gammopathy of undetermined significance by a much higher risk of progression to multiple myeloma (MM). There have been major advances in the diagnosis, prognosis, and management of SMM in the last few years. These include a revised disease definition, identification of several new prognostic factors, a classification based on underlying cytogenetic changes, and new treatment options. Importantly, a subset of patients previously considered SMM is now reclassified as MM on the basis of biomarkers identifying patients with an ≥80% risk of progression within 2 years. SMM has assumed greater significance on the basis of recent trials showing that early therapy can be potentially beneficial to patients. As a result, there is a need to accurately diagnose and risk-stratify patients with SMM, including routine incorporation of modern imaging and laboratory techniques. In this review, we outline current concepts in diagnosis and risk stratification of SMM, and provide specific recommendations on the management of SMM.
Topics: Asymptomatic Diseases; Clonal Evolution; Disease Management; Disease Progression; Humans; Multiple Myeloma; Risk Factors
PubMed: 25838344
DOI: 10.1182/blood-2014-09-568899