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Song GY, Jung SH, Kim K, Kim SJ, Yoon SE, Lee HS, Kim M, Ahn SY, Ahn JS, Yang DH, Kim HJ, Lee JJ. Endothelial activation and stress index (EASIX) is a reliable predictor for overall survival in patients with multiple myeloma. BMC Cancer 2020; 20:803. [PMID: 32831058 PMCID: PMC7446202 DOI: 10.1186/s12885-020-07317-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recently, the endothelial Activation and Stress Index (EASIX) score has been reported to predict overall survival (OS) after allogeneic stem cell transplantation. This study evaluated the prognostic role of EASIX score in patients with newly diagnosed multiple myeloma (MM). METHODS This retrospective study analyzed the records of 1177 patients with newly diagnosed MM between February 2003 and December 2017 from three institutions in the Republic of Korea. Serum lactate dehydrogenase (LDH), creatinine, and platelet count at diagnosis were measured in all included patients. EASIX scores were calculated using the formula-LDH (U/L) × Creatinine (mg/dL) / platelet count (109/L) and were evaluated based on log2 transformed values. RESULTS The median age of patients was 63 years (range, 22-92), and 495 patients (42.1%) underwent autologous stem cell transplantation (ASCT). The median log2 EASIX score at diagnosis was 1.1 (IQR 0.3-2.3). Using maximally selected log-rank statistics, the optimal EASIX cutoff value for OS was 1.87 on the log2 scale (95% CI 0.562-0.619, p < 0.001). After median follow-up for 50.0 months (range, 0.3-184.1), the median OS was 58.2 months (95% CI 53.644-62.674). Overall, 372 patients (31.6%) showed high EASIX scores at diagnosis, and had significantly inferior OS compared to those with low EASIX (log2 EASIX ≤1.87) (39.1 months vs. 67.2 months, p < 0.001). In multivariate Cox analysis, high EASIX was significantly associated with poor OS (HR 1.444, 95% CI 1.170-1.780, p = 0.001). In the subgroup analysis of patients who underwent ASCT, patients with high EASIX showed significantly inferior OS compared to those with low EASIX (52.8 months vs. 87.0 months, p < 0.001). In addition, in each group of ISS I, II, and III, high EASIX was associated with significantly inferior OS (ISS 1, 45.2 months vs. 76.0 months, p = 0.001; ISS 2, 42.3 months vs. 66.5 months, p = 0.002; ISS 3, 36.8 months vs. 55.1 months, p = 0.001). CONCLUSION EASIX score at diagnosis is a simple and strong predictor for OS in patients with newly diagnosed MM.
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Affiliation(s)
- Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea.
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
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Atkin C, Iqbal G, Planche T, Pratt G, Yong K, Wood J, Raynes K, Low E, Higgins H, Neal RD, Dunn J, Drayson MT, Bowcock S. Diagnostic pathways in multiple myeloma and their relationship to end organ damage: an analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) trial. Br J Haematol 2020; 192:997-1005. [PMID: 32798327 DOI: 10.1111/bjh.17044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/26/2020] [Indexed: 11/27/2022]
Abstract
Multiple myeloma is associated with significant early morbidity and mortality, with considerable end organ damage often present at diagnosis. The Tackling EArly Morbidity and Mortality in Multiple Myeloma (TEAMM) trial was used to evaluate routes to diagnosis in patients with myeloma and the relationship between diagnostic pathways, time to diagnosis and disease severity. A total of 915 participants were included in the study. Fifty-one per cent were diagnosed by direct referral from primary care to haematology; 29% were diagnosed via acute services and 20% were referred via other secondary care specialties. Patients diagnosed via other secondary care specialties had a longer diagnostic interval (median 120 days vs. 59 days) without an increase in features of severe disease, suggesting they had a relatively indolent disease. Marked intrahospital delay suggests possible scope for improvement. A quarter of those diagnosed through acute services reported >30 days from initial hospital consultation to haematology assessment. Participants diagnosed through acute services had poorer performance status (P < 0·0001) and higher burden of end organ damage (P < 0·0001) with no difference in the overall length of diagnostic pathway compared to those diagnosed by direct referral (median 59 days). This suggests that advanced disease in patients presenting through acute services predominantly reflects disease aggression.
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Affiliation(s)
- Catherine Atkin
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tim Planche
- St George's University Hospitals NHS Trust, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kwee Yong
- UCL Cancer Institute, University College London, London, UK
| | - Jill Wood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kerry Raynes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Helen Higgins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Richard D Neal
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Stella Bowcock
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, UK
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103
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Qureshi A, Tariq MJ, Shah Z, Abu Zar M, Aslam S, Rafae A, Shafqat M, Malik MN, Faisal MS, Anwer F. Evidence-based supportive care in multiple myeloma. J Community Hosp Intern Med Perspect 2020; 10:313-317. [PMID: 32850087 PMCID: PMC7427456 DOI: 10.1080/20009666.2020.1771124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy characterized by an abnormal clone of plasma cells in the bone marrow. MM and its therapy increase the risk of complications like anemia, osteolytic lesions, pain, infections, and renal abnormalities in MM patients. Supportive care for MM patients improves the quality of life. Treatment with bisphosphonates decreases skeletal-related events. Vertebroplasty and kyphoplasty are done in cases of vertebral compression fractures. Prophylactic antibiotics and antivirals can decrease infections related to morbidity. Plasmapheresis in patients with renal dysfunctions decreases dialysis dependency and improve quality of life.
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Affiliation(s)
- Anum Qureshi
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA.,Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Muhammad Junaid Tariq
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Zunairah Shah
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Muhammad Abu Zar
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Shehroz Aslam
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Abdul Rafae
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Madeeha Shafqat
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Mustafa Nadeem Malik
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | | | - Faiz Anwer
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA.,Taussig Cancer Center, Cleveland Clinic, Department of Hematology, Medical Oncology, Cleveland, OH, USA
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104
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Rasch S, Lund T, Asmussen JT, Lerberg Nielsen A, Faebo Larsen R, Østerheden Andersen M, Abildgaard N. Multiple Myeloma Associated Bone Disease. Cancers (Basel) 2020; 12:E2113. [PMID: 32751464 PMCID: PMC7465468 DOI: 10.3390/cancers12082113] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023] Open
Abstract
The lytic bone disease is a hallmark of multiple myeloma, being present in about 80% of patients with newly diagnosed MM, and in more during the disease course. The myeloma associated bone disease (MBD) severely affects the morbidity and quality of life of the patients. MBD defines treatment demanding MM. In recent years, knowledge of the underlying pathophysiology has increased, and novel imaging technologies, medical and non-pharmaceutical treatments have improved. In this review, we highlight the major achievements in understanding, diagnosing and treating MBD. For diagnosing MBD, low-dose whole-body CT is now recommended over conventional skeletal survey, but also more advanced functional imaging modalities, such as diffusion-weighted MRI and PET/CT are increasingly important in the assessment and monitoring of MBD. Bisphosphonates have, for many years, played a key role in management of MBD, but denosumab is now an alternative to bisphosphonates, especially in patients with renal impairment. Radiotherapy is used for uncontrolled pain, for impeding fractures and in treatment of impeding or symptomatic spinal cord compression. Cement augmentation has been shown to reduce pain from vertebral compression fractures. Cautious exercise programs are safe and feasible and may have the potential to improve the status of patients with MM.
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Affiliation(s)
- Stine Rasch
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Department of Internal Medicine, Division of Haematology, Sydvestjysk Sygehus, Finsensgade 35, DK-6700 Esbjerg, Denmark
| | - Thomas Lund
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Haematology Research Unit, Department of Clinical Research, University of Southern Denmark, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark
| | - Jon Thor Asmussen
- Department of Clinical Radiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark;
| | - Anne Lerberg Nielsen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark;
| | - Rikke Faebo Larsen
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
| | - Mikkel Østerheden Andersen
- Center for Spine Surgery & Research, Lillebaelt Hospital, Østre Hougvel 55, DK-5500 Middelfart, Denmark;
| | - Niels Abildgaard
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Haematology Research Unit, Department of Clinical Research, University of Southern Denmark, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark
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105
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Chen X, Luo X, Zu Y, Issa HA, Li L, Ye H, Yang T, Hu J, Wei L. Severe renal impairment as an adverse prognostic factor for survival in newly diagnosed multiple myeloma patients. J Clin Lab Anal 2020; 34:e23416. [PMID: 32710448 PMCID: PMC7521223 DOI: 10.1002/jcla.23416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Renal impairment (RI) is associated with poor survival in newly diagnosed multiple myeloma (MM) patients. Renal function recovery has been one of the main therapeutic goals in those patients. Methods The records from 393 newly diagnosed MM patients in our hospital between January 2012 and December 2016 were retrospectively analyzed. RI was defined as an eGFR < 40 mL/min according to the novel IMWG criteria. RI patients were categorized based on their renal function at diagnosis: severe RI: eGFR < 30 mL/min, and mild RI: 30 mL/min ≤ eGFR <40 mL/min. We explored whether RI, and particularly severe RI, was an adverse prognostic factor for survival, and investigated the impact of renal function recovery on survival. Results Severe RI, hemoglobin <100 g/L, LDH ≥ 245 U/L, hyperuricemia, 1q21 amplification, and lack of novel agent treatment were associated with decreased overall survival (OS). Severe RI patients with renal response had a median OS of 27 months compared with 18 months for those patients without renal response (P = .030), but their median OS was still significantly lower than that for patients without severe RI, which was 51 months. In severe RI patients, the overall renal response rate in bortezomib‐based regimens was significantly higher than that in nonbortezomib‐based regimens. Conclusion Our results suggest that severe RI is an adverse prognostic factor for survival in newly diagnosed MM patients, restoration of renal function may improve survival, and bortezomib‐based regimens may be the preferred treatment in patients with severe RI.
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Affiliation(s)
- Xuduan Chen
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaofeng Luo
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanping Zu
- Department of Nephrology, Fujian Provincial Hospital Jinshan Branch, Fuzhou, China
| | - Hajji Ally Issa
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Linlin Li
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Ye
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting Yang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianda Hu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lixin Wei
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
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106
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Mai EK, Miah K, Bertsch U, Dürig J, Scheid C, Weisel KC, Kunz C, Munder M, Lindemann HW, Merz M, Hose D, Jauch A, Seckinger A, Luntz S, Sauer S, Fuhrmann S, Brossart P, Elmaagacli A, Goerner M, Bernhard H, Hoffmann M, Raab MS, Blau IW, Hänel M, Benner A, Salwender HJ, Goldschmidt H. Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age. Leukemia 2020; 35:809-822. [PMID: 32684633 PMCID: PMC8318883 DOI: 10.1038/s41375-020-0976-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/03/2023]
Abstract
Intensive upfront therapy in newly-diagnosed multiple myeloma (MM) including induction therapy (IT), high-dose melphalan (MEL200), and autologous blood stem cell transplantation (ASCT) followed by consolidation and/or maintenance is mostly restricted to patients up to 65 years of age. Prospective phase III trial data in the era of novel agents for patients up to 70 years of age are not available. The GMMG-MM5 trial included 601 patients between 18 and 70 years of age, divided in three groups for the present analysis: ≤60 years (S1, n = 353), 61–65 years (S2, n = 107) and 66–70 years (S3, n = 141). Treatment consisted of a bortezomib-containing IT, MEL200/ASCT, consolidation, and maintenance with lenalidomide. Adherence to treatment was similar among patients of the three age groups. Overall toxicity during all treatment phases was increased in S2 and S3 compared to S1 (any adverse event/any serious adverse event: S1:81.7/41.8% vs. S2:90.7/56.5% vs. S3:87.2/68.1%, p = 0.05/<0.001). With respect to progression-free survival (log-rank p = 0.73), overall survival (log-rank p = 0.54) as well as time-to-progression (Gray’s p = 0.83) and non-relapse mortality (Gray’s p = 0.25), no differences were found between the three age groups. Our results imply that an intensive upfront therapy with a bortezomib-containing IT, MEL200/ASCT, lenalidomide consolidation, and maintenance should be applied to transplant-eligible MM patients up to 70 years of age.
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Affiliation(s)
- Elias K Mai
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Kaya Miah
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uta Bertsch
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Jan Dürig
- Department of Hematology, University Clinic Essen, Essen, Germany
| | - Christof Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Katja C Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Hematology, Oncology and Immunology, University Hospital Tübingen, Tübingen, Germany
| | - Christina Kunz
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Child Nutrition, Max Rubner Institute, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany
| | - Markus Munder
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Hans-Walter Lindemann
- Department of Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany
| | - Maximilian Merz
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Anja Seckinger
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Steffen Luntz
- Coordination Centre for Clinical Trials, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Sauer
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Fuhrmann
- Department of Hematology and Oncology, Helios Hospital Berlin Buch, Berlin, Germany
| | | | - Ahmet Elmaagacli
- Department of Hematology and Oncology, Asklepios Hospital Hamburg St. Georg, Hamburg, Germany
| | - Martin Goerner
- Department of Hematology, Oncology and Palliative Care, Klinikum Bielefeld, Bielefeld, Germany
| | - Helga Bernhard
- Department of Internal Medicine V, Klinikum Darmstadt, Darmstadt, Germany
| | - Martin Hoffmann
- Medical Clinic A, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Marc S Raab
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Igor W Blau
- Medical Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans J Salwender
- Department of Hematology and Oncology, Asklepios Hospital Hamburg Altona, Hamburg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.
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Monoclonal Gammopathy of Undetermined Significance (MGUS)-Not So Asymptomatic after All. Cancers (Basel) 2020; 12:cancers12061554. [PMID: 32545521 PMCID: PMC7352603 DOI: 10.3390/cancers12061554] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is considered to be a benign precursor condition that may progress to a lymphoproliferative disease or multiple myeloma. Most patients do not progress to an overt condition, but nevertheless, MGUS is associated with a shortened life expectancy and, in a minority of cases, a number of co-morbid conditions that include an increased fracture risk, renal impairment, peripheral neuropathy, secondary immunodeficiency, and cardiovascular disease. This review aims to consolidate current evidence for the significance of these co-morbidities before considering how best to approach these symptoms and signs, which are often encountered in primary care or within a number of specialties in secondary care.
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108
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Prognostic Potential of Electrocardiographic Parameters in Patients with Multiple Myeloma: A Retrospective Analysis of the Multiple Myeloma Population. Adv Ther 2020; 37:2946-2955. [PMID: 32337646 DOI: 10.1007/s12325-020-01343-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients with multiple myeloma (MM) can develop cardiac abnormalities, predisposing them to the development of heart failure, arrhythmias, or infarction with poor prognosis. The purpose of this study is to evaluate the prognostic potential of electrocardiographic (ECG) parameters in patients with MM. METHODS This study retrospectively included patients with MM from January 2010 to December 2018 in the First Affiliated Hospital of Xi'an Jiao Tong University. Univariate and multivariate Cox proportional hazard models were conducted to evaluate the relationship between ECG parameters and all-cause mortality in patients with MM. RESULTS A total of 409 patients were included (mean age 61.3 ± 9.7 years, 59.2% male). The relationship between ECG parameters (including PR interval, voltage, QRS axis, QRS duration, and QTc interval) and all-cause mortality in patients with MM was evaluated. Overall, patients with QTc interval ≥ 400 ms have a significantly higher all-cause mortality compared to those with QTc interval < 400 ms (P < 0.001). When stratified by the International Staging System (ISS), this relationship was true for stages II and III (P < 0.01), but not stage I (P > 0.05). Patients with MM and QRS duration ≥ 120 ms had a higher all-cause mortality compared to those with QRS duration < 120 ms for women (P < 0.01) but not for men (P > 0.05). PR interval, voltage, and QRS axis did not predict mortality. CONCLUSION QTc interval was independently associated with all-cause mortality in patients with MM, especially when QTc interval was more than 400 ms in more advanced stages II and III. ECG parameters may provide prognostic potential in patients with MM and aid risk stratification of these patients.
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109
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Kobayashi H, Terao T, Tsushima T, Abe Y, Miura D, Narita K, Kitadate A, Takeuchi M, Matsue K. Association between serum erythropoietin levels and renal reversibility in patients with renal impairment from multiple myeloma. Cancer Med 2020; 9:4460-4466. [PMID: 32311841 PMCID: PMC7300410 DOI: 10.1002/cam4.3050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/13/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
Renal impairment (RI) is a common clinical presentation in patients with multiple myeloma (MM). Despite treatment with novel agents or management strategies that focus on the disease response, some patients develop irreversible RI. This study aimed to determine the influencing, clinical variables of renal reversibility in patients with RI treated with novel drugs. We analyzed 244 patients newly diagnosed with MM retrospectively. Maximum renal response was assessed according to the criteria for the definition of renal response proposed by the International Myeloma Working Group. Major renal response was defined as the occurrence of complete renal response or partial renal response. RI (a glomerular filtration rate < 50 mL/min/1.73 m2) was observed in 110 patients (45%). In total, 56 patients (51%) achieved a major renal response. Serum erythropoietin (EPO) levels >25 mIU/mL (P < .001) and a percentage of urinary albumin excretion ≤25% (P < .001) were both significant factors that influenced the occurrence of major renal responses. Both remained significant factors associated with renal reversibility in the multivariate analysis. Patients were assigned a score of 1 each for EPO >25 mIU/mL and urinary albumin ≤25%. The estimated 6‐month rates of major renal responses of patients with scores of 2, 1, and 0 were 78.6%, 30.6%, and 0%, respectively (P < .001). In conclusion, a serum EPO level >25 mIU/mL is an independent predictive factor for major renal response and may predict renal reversibility more accurately when urinary albumin level is congruently ≤25%.
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Affiliation(s)
- Hiroki Kobayashi
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Toshiki Terao
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Takafumi Tsushima
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Yoshiaki Abe
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Daisuke Miura
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Kentaro Narita
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Akihiro Kitadate
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
| | - Kosei Matsue
- Division of Hematology/Oncology Department of Medicine Kameda Medical Center Kamogawa‐shi Chiba‐Ken Japan
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110
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Chaidos A, Katsarou A, Mustafa C, Milojkovic D, Karadimitris A. Interleukin 6-blockade treatment for severe COVID-19 in two patients with multiple myeloma. Br J Haematol 2020; 190:e9-e11. [PMID: 32369612 DOI: 10.1111/bjh.16787] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Aristeidis Chaidos
- Centre for Haematology, Department of Immunology & Inflammation, Hugh and Josseline Langmuir Centre for Myeloma Research, Imperial College, London, UK.,Department of Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Alexia Katsarou
- Centre for Haematology, Department of Immunology & Inflammation, Hugh and Josseline Langmuir Centre for Myeloma Research, Imperial College, London, UK.,Department of Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Chira Mustafa
- Centre for Haematology, Department of Immunology & Inflammation, Hugh and Josseline Langmuir Centre for Myeloma Research, Imperial College, London, UK.,Department of Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Dragana Milojkovic
- Department of Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Anastasios Karadimitris
- Centre for Haematology, Department of Immunology & Inflammation, Hugh and Josseline Langmuir Centre for Myeloma Research, Imperial College, London, UK.,Department of Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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111
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Stoma I, Karpov I, Iskrov I, Lendina I, Uss A. Clinical efficacy of pneumococcal vaccination in multiple myeloma patients on novel agents: Results of a prospective clinical study. Vaccine 2020; 38:4713-4716. [PMID: 32418789 DOI: 10.1016/j.vaccine.2020.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Among the high risk groups, patients with multiple myeloma (MM) have one of the highest incidence of invasive pneumococcal disease, mainly pneumonias. Recent changes in MM treatment have now led to an increase of survival, while the infection-related mortality remains high. The question of efficacy of pneumococcal vaccination in patients receiving novel target agents has not been clinically investigated before. PATIENTS AND METHODS We have introduced the 3-dose vaccination regimen by 13-valent pneumococcal conjugate (PCV13) vaccine between the treatment courses with novel target agents (bortezomib, lenalidomide, ixazomib) with a minimum of 1 month interval. The incidence of pneumonias during the one-year observation period was taken as a primary outcome in this registered clinical trial. RESULTS From 2017 to 2020, we have prospectively included 18 adult patients who were vaccinated by PCV13 along with 18 patients of a control matched group. No adverse effects of vaccination were registered in the study. We have observed an independent effect of PCV13 vaccination on the incidence of pneumonias. The absolute risk reduction of pneumonias in patients received PCV13 vaccination was 33.3%. Number needed to treat for PCV13 vaccination in multiple myeloma patients receiving novel agents was 3.0; (95% CI 1.61-22.1; p = 0.0571). CONCLUSION Therefore, we have shown the clinical effectiveness of PCV13 vaccination schedule based on 3 doses given with a minimum 1 month interval between the courses of novel agents in multiple myeloma patients, despite the expected decrease in immunological response to vaccination during target and immunotherapy. ClinicalTrials.gov Identifier: NCT03619252.
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Affiliation(s)
- Igor Stoma
- Department of Infectious Diseases, Belarusian State Medical University, Minsk, Belarus; Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Belarus.
| | - Igor Karpov
- Department of Infectious Diseases, Belarusian State Medical University, Minsk, Belarus
| | - Igor Iskrov
- Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Belarus
| | - Irina Lendina
- Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Belarus
| | - Anatoly Uss
- Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Belarus
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112
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Wongsaengsak S, Kopel J, Behera TR, Chakraborty R, Ball S. Infection risk with carfilzomib in multiple myeloma: a systematic review and meta-analysis of randomised controlled trials. Br J Haematol 2020; 190:e95-e97. [PMID: 32400886 DOI: 10.1111/bjh.16735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sariya Wongsaengsak
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Tapas R Behera
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Rajshekhar Chakraborty
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Somedeb Ball
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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113
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Aqsa A, Droubi S, Glaser A. Aspergillus and Rhizopus Fungal Coinfection in a Patient With Multiple Myeloma. Cureus 2020; 12:e8050. [PMID: 32537269 PMCID: PMC7286591 DOI: 10.7759/cureus.8050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Opportunistic fungal infections are rare but life-threatening in immunocompromised patients. We discuss a case of an immunocompromised patient with multiple myeloma who presented with shortness of breath, fever, ocular palsy, and hemiplegia. She was found to have influenza A respiratory tract infection complicated by invasive aspergillosis and mucormycosis. Investigation revealed invasive fungal sinusitis and cerebritis. Serum biomarkers, beta-d-glucan, and galactomannan failed to detect fungal disease. We believe that our case is unique as there is limited data available regarding the occurrence of invasive fungal infections after Influenza infections. Furthermore, it highlights the hurdles in the diagnosis of disseminated fungal infection.
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Affiliation(s)
- Anum Aqsa
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Sami Droubi
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Allison Glaser
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
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114
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Safety Analysis of Five Randomized Controlled Studies of Daratumumab in Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e579-e589. [PMID: 32409106 DOI: 10.1016/j.clml.2020.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple studies have demonstrated the efficacy and safety of daratumumab for relapsed/refractory multiple myeloma (MM) and primary treatment for transplant-eligible and -ineligible patients. MATERIALS AND METHODS We conducted an integrated safety analysis to characterize the frequency, severity, natural history, and outcomes of adverse events (AEs) with daratumumab versus comparators. Data were pooled from 5 completed phase III randomized controlled studies that had included 1798 daratumumab-treated and 1797 comparator-treated patients with MM as a first line in both transplant-eligible and transplant-ineligible patients and for relapsed/refractory disease. Safety analyses included reporting of AEs using crude and exposure-adjusted incidence rates. RESULTS The median follow-up duration was 16.84 months (range, 7.4-28 months) for both daratumumab-treated and comparator-treated patients. Discontinuation for any reason occurred less often with daratumumab (22% vs. 33.9%), although discontinuation because of AEs occurred at similar rates (25% vs. 26%) as did deaths owing to AEs (2.25% vs. 1.84%). When adjusted for exposure, neutropenia, lymphopenia, diarrhea, fatigue, dyspnea, pneumonia, and hypertension were the only common grade 3/4 AEs reported more often with daratumumab than with the comparators. The prevalence of common grade 3/4 AEs with daratumumab were < 7% apart from neutropenia, lymphopenia, and pneumonia (45.9% vs. 32.3%, 13% vs. 7.5%, and 10.6% vs. 7.2%, respectively). Grade 3/4 daratumumab infusion-related reactions happened in 3.8% of patients. The majority of infusion-related reactions occurred after the first infusion. CONCLUSIONS These results from an integrated analysis support a favorable benefit/risk profile of daratumumab in patients with MM.
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115
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Bone complications in patients with multiple myeloma in five European countries: a retrospective patient chart review. BMC Cancer 2020; 20:170. [PMID: 32126974 PMCID: PMC7055060 DOI: 10.1186/s12885-020-6596-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 01/31/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Bone complications (pathologic fracture, spinal cord compression, surgery to bone and radiation to bone) are a common problem in patients with multiple myeloma (MM). We set out to provide insights into the real-world burden of bone complications in patients with newly diagnosed MM (NDMM). METHODS We conducted a retrospective review of medical charts of patients with NDMM whose disease had progressed following first-line treatment in the 3 months before data collection in 2016 in five European countries (France, Germany, Italy, Spain and the United Kingdom). RESULTS The aggregated study population included 813 patients. Bone pain commonly led to MM diagnosis (63%) and 74% of all patients had two or more bone lesions at initiation of first-line treatment. Furthermore, 26% of patients experienced a new bone complication between MM diagnosis and disease progression following first-line treatment, despite 75% of individuals receiving bisphosphonates. Most bone complications (52%) occurred in the period before initiation of first-line treatment (mean duration: 2.3 months) and more than half of patients (56%) who experienced a new bone complication were hospitalised. Analgesics were used more frequently in patients with bone complications than in those without them (76% vs 50%, respectively). Furthermore, 51% of patients had renal impairment by the time first-line treatment was started. Overall, 25% of patients did not receive bisphosphonates for prevention of bone complications and one in four of those with renal impairment at initiation of first-line treatment did not receive bisphosphonates. CONCLUSIONS Bone complications are common in patients with NDMM. They are frequently associated with hospitalization and analgesic use. Data from this study, conducted in the era of novel anti-myeloma therapies and before the approval of denosumab for use in patients with MM, suggest that although most patients (75%) received bisphosphonates, use of anti-resorptive therapy for prevention of bone complications may be suboptimal in patients with NDMM, irrespective of renal function.
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116
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Yadav P, Sathick IJ, Leung N, Brown EE, Cook M, Sanders PW, Cockwell P. Serum free light chain level at diagnosis in myeloma cast nephropathy-a multicentre study. Blood Cancer J 2020; 10:28. [PMID: 32127527 PMCID: PMC7054310 DOI: 10.1038/s41408-020-0295-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/29/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
Myeloma cast nephropathy (MCN) is a common cause of severe renal impairment in multiple myeloma (MM). The level of free light chain (FLC) that causes MCN varies substantially and there is uncertainty about the threshold level that should be used to inform clinical practice. In a multicentre cohort study of 103 patients with a diagnosis of MM and biopsy-confirmed MCN made between 2002–2014, we report prospectively measured levels of serum FLC at diagnosis obtained using a single nephelometric assay (Freelite®) and we explore the relationship between serum FLC level at diagnosis with renal outcome and patient survival. Using a landmark approach, overall survival (OS) was compared between patients who achieved independence from dialysis compared to those who remained dialysis dependent at 3-month, 6-month, 9-month, and 12-month time points. The median serum FLC level at diagnosis was 7531 mg/L (range 107–114600). Serum creatinine was 535 μmol/L (range 168–2993) and eGFR 7 ml/min/1.73 m2 (range 1–34). Six patients (5.8%) had an FLC level <1500 mg/L, which is the International Myeloma Working Group threshold for MCN and two patients were below the International Kidney and Monoclonal Gammopathy working group threshold of 500 mg/L; one was hypercalcaemic, and one had high-normal serum calcium level and had received a non-steroidal anti-inflammatory agent. Sixty-nine (67%) patients required haemodialysis treatment of whom 36 (52.1%) recovered independent renal function. Sixty-six (64%) patients died with a median OS of 2.5 years (95% CI 1.8–3.3). A landmark analysis revealed that independence from dialysis was associated with improved survival at 3-months (P = 0.003), 6-months (P = 0.035) and 9-months (P = 0.014); there was no survival benefit observed beyond 12 months (P = 0.146). Serum FLC level at diagnosis was neither associated with renal function recovery nor with OS. This is the largest reported cohort of patients with biopsy-confirmed MCN and prospectively measured serum FLC levels. These results indicate that a serum monoclonal FLC > 500 mg/L should be considered the threshold level associated with the development of MCN.
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Affiliation(s)
- Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | | | - Elizabeth E Brown
- Department of Pathology, University of Alabama at Birmingham, Birmingham AL, USA
| | - Mark Cook
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul W Sanders
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. .,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
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117
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Mohyuddin GR, Aziz M, McClune B, Abdallah AO, Qazilbash M. Antibiotic prophylaxis for patients with newly diagnosed multiple myeloma: Systematic review and meta-analysis. Eur J Haematol 2020; 104:420-426. [PMID: 31880853 DOI: 10.1111/ejh.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Ascertain the benefit of prophylactic antibiotics for patients with newly diagnosed multiple myeloma (MM), given that clinical trials evaluating this have had conflicting results. METHODS We performed a systematic review and meta-analysis evaluating the use of prophylactic antibiotics in patients with MM and its impact on infection risk and mortality. RESULTS Across three included studies, a total of 664 patients received antibiotics and 650 patients received no antibiotics. The overall incidence of infection within 3 months was lower for antibiotic group compared to placebo (18.4% vs 23.4%, RR: 0.79, 95% CI 0.62-1.00, P = .05, I2 = 6.5%). There was no difference in mortality in the first 3 months (1.5% vs 3.5%, RR: 0.47, 95% CI 0.17-1.27, P = .60, I2 = 28.1%). CONCLUSION Antibiotic prophylaxis for a finite duration can decrease the overall incidence of infection within the first 3 months following diagnosis. This does not lead to a decrease in mortality. Further data on antibiotic resistance patterns, toxicity, healthcare expenditures, and the impact of antibiotics on subsequent therapies can assist providers in helping make decisions on prophylactic antibiotics with their patients.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Brian McClune
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, Kansas
| | - Al-Ola Abdallah
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, Kansas
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas, MD Anderson Cancer Center, Houston, Texas
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118
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Soekojo CY, Low JZ, Oh J, Ooi M, De Mel S, Chng WJ. Bacterial Infection Among Patients With Multiple Myeloma Treated With Bortezomib-based Induction Therapy: Real-World Experience in an Asian Cancer Center. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e165-e170. [PMID: 32019731 DOI: 10.1016/j.clml.2019.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/26/2019] [Accepted: 12/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment landscape for multiple myeloma (MM) has progressed significantly, and over the past decade, bortezomib-based induction therapy has been a standard of care. However, the practice of antibacterial prophylaxis during induction therapy has been diverse. The aim of our study is to evaluate the proportion of patients with febrile episodes and bacteremia among patients with MM, during the first 12 weeks of bortezomib-based induction therapy, without routine fluoroquinolone prophylaxis, but with routine Pneumocystis Carinii prophylaxis (mostly with trimethoprim-sulfamethoxazole), in a region with high fluoroquinolone resistance rate. Of note, these patients have direct access to health care facilities and timely supportive care. PATIENTS AND METHODS We evaluated newly diagnosed MM patients from 2014 to 2018 receiving bortezomib-based induction therapy for the proportion of patients who had febrile episodes and bacteremia in the first 12 weeks of bortezomib-based induction therapy. We also evaluated if there were factors associated with increased febrile episodes including age, absolute neutrophil count, creatinine clearance, M-band level at diagnosis, nadir platelet count, International Staging System, and Revised International Staging System. RESULTS Of the 108 evaluable patients, there were a total of 25 (23.1%) patients who had febrile episodes, and 1 (0.9%) patient who had bacteremia during the first 12 weeks of bortezomib-based induction therapy. All patients recovered well. No deaths were seen. Febrile episodes were associated with lower absolute neutrophil count (P = .036), renal impairment (P = .013), and ISS stage (P = .026). CONCLUSION The proportion of patients with significant bacterial infection during the first 12 weeks of bortezomib-based induction therapy without routine fluoroquinolone prophylaxis, but with routine Pneumocystis Carinii prophylaxis (mostly with trimethoprim-sulfamethoxazole), is low in a population with adequate access to health care facilities and timely supportive care.
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Affiliation(s)
| | - Jia Zhen Low
- National University Cancer Institute, National University Health System, Singapore
| | - Jaslyn Oh
- National University Cancer Institute, National University Health System, Singapore
| | - Melissa Ooi
- National University Cancer Institute, National University Health System, Singapore
| | - Sanjay De Mel
- National University Cancer Institute, National University Health System, Singapore
| | - Wee Joo Chng
- National University Cancer Institute, National University Health System, Singapore.
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119
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Romano A, Parrinello NL, Simeon V, Puglisi F, La Cava P, Bellofiore C, Giallongo C, Camiolo G, D'Auria F, Grieco V, Larocca F, Barbato A, Cambria D, La Spina E, Tibullo D, Palumbo GA, Conticello C, Musto P, Di Raimondo F. High-density neutrophils in MGUS and multiple myeloma are dysfunctional and immune-suppressive due to increased STAT3 downstream signaling. Sci Rep 2020; 10:1983. [PMID: 32029833 PMCID: PMC7005058 DOI: 10.1038/s41598-020-58859-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
To understand neutrophil impairment in the progression from MGUS through active MM, we investigated the function of mature, high-density neutrophils (HDNs), isolated from peripheral blood. In 7 MM, 3 MGUS and 3 healthy subjects by gene expression profile, we identified a total of 551 upregulated and 343 downregulated genes in MM-HDN, involved in chemokine signaling pathway and FC-gamma receptor mediated phagocytosis conveying in the activation of STAT proteins. In a series of 60 newly diagnosed MM and 30 MGUS patients, by flow-cytometry we found that HDN from MM, and to a lesser extend MGUS, had an up-regulation of the inducible FcγRI (also known as CD64) and a down-regulation of the constitutive FcγRIIIa (also known as CD16) together with a reduced phagocytic activity and oxidative burst, associated to increased immune-suppression that could be reverted by arginase inhibitors in co-culture with lymphocytes. In 43 consecutive newly-diagnosed MM patients, who received first-line treatment based on bortezomib, thalidomide and dexamethasone, high CD64 could identify at diagnosis patients with inferior median overall survival (39.5 versus 86.7 months, p = 0.04). Thus, HDNs are significantly different among healthy, MGUS and MM subjects. In both MGUS and MM neutrophils may play a role in supporting both the increased susceptibility to infection and the immunological dysfunction that leads to tumor progression.
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Affiliation(s)
- A Romano
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - N L Parrinello
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - V Simeon
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
- Department of Mental Health and Preventive Medicine, Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Puglisi
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - P La Cava
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - C Bellofiore
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - C Giallongo
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - G Camiolo
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - F D'Auria
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
| | - V Grieco
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
| | - F Larocca
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
| | - A Barbato
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - D Cambria
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - E La Spina
- Biometec, Dipartimento di Scienze Biomediche e Biotecnologiche, University of Catania, Catania, Italy
| | - D Tibullo
- Biometec, Dipartimento di Scienze Biomediche e Biotecnologiche, University of Catania, Catania, Italy
| | - G A Palumbo
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - C Conticello
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy
| | - P Musto
- Laboratory of Pre-Clinical Research and Advanced Diagnostics, IRCCS-CROB, Rionero in Vulture (Pz), Potenza, Italy
- Chair and Unit of Hematology and Stem Cell Transplantation, Aldo Moro University, Bari, Italy
| | - F Di Raimondo
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy.
- Division of Hematology, Azienda Ospedaliera Policlinico e Vittorio Emanuele di Catania, Catania, Italy.
- Department of Mental Health and Preventive Medicine, Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
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120
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Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, Dunn JA. Levofloxacin prophylaxis in patients with myeloma - Authors' reply. Lancet Oncol 2020; 21:e69. [PMID: 32007200 DOI: 10.1016/s1470-2045(20)30020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Mark T Drayson
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK.
| | | | - Tim Planche
- Department of Medical Microbiology, St George's, University of London, London, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, London, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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121
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Liu CJ, Hong YC, Kuan AS, Yeh CM, Tsai CK, Liu YC, Hsiao LT, Wang HY, Ko PS, Chen PM, Liu JH, Gau JP. The risk of early mortality in elderly patients with newly diagnosed acute myeloid leukemia. Cancer Med 2020; 9:1572-1580. [PMID: 31902138 PMCID: PMC7013048 DOI: 10.1002/cam4.2740] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/01/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a common hematologic neoplasm with high incidence and mortality in the elderly. Our aims were to explore risk factors for early mortality in elderly AML patients and develop a new prognostic score. Methods We enrolled newly diagnosed AML patients age 60 and above at Taipei Veterans General Hospital between July 2008 and May 2017. The primary endpoint was early mortality, defined as death within two months after AML diagnosis. A multivariate Cox proportional hazards model was used to build a risk‐scoring system incorporating significant risk factors for AML. Results The final cohort included 277 elderly AML patients. The median age was 74 (range 60‐96), and 61.7% were male. The two‐month mortality rate was 29.9%. Age ≥ 80 (adjusted HR 1.88), myocardial infarction (adjusted HR 1.87), ECOG ≥ 2 (adjusted HR 2.10), complex karyotype (adjusted HR 3.21), bone marrow blasts ≥ 70% (adjusted HR 1.88), WBC ≥ 100 × 109/L (adjusted HR 3.31), and estimated glomerular filtration rate (eGFR) < 45 (adjusted HR 2.60) were identified as independent predictors for early mortality in the multivariate analysis. A simplified score incorporating the seven factors was developed with good predictive ability measured by Harrell's C statistic [0.72 (95% CI 0.66‐0.78)]. Conclusions We identified seven potential risk factors for early mortality and built up a new prognostic score for elderly AML patients. The new score may help clinicians stratify patients and initiate appropriate management. Further validation of our findings on other cohorts is warranted.
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Affiliation(s)
- Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ai Seon Kuan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Division of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Kuang Tsai
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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What the Intensivists Need to Know About Critically Ill Myeloma Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7121630 DOI: 10.1007/978-3-319-74588-6_98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy characterized by an increase in aberrant plasma cells in the bone marrow leading to rising monoclonal protein in serum and urine. With the introduction of novel therapies with manageable side effects, this incurable disease has evolved into a chronic disease with an acceptable quality of life for the majority of patients. Accordingly, management of acute complications is fundamental in reducing the morbidity and mortality in MM. MM emergencies include symptoms and signs related directly to the disease and/or to the treatment; many organs may be involved including, but not limited to, renal, cardiovascular, neurologic, hematologic, and infectious complications. This review will focus on the numerous approaches that are aimed at managing these complications.
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Peña C, Schutz NP, Riva E, Valjalo R, Majlis A, López‐Vidal H, Lois V, Zamora D, Ochoa P, Shanley C, Gonzalez JT, Fantl D, Correa G, Ramirez J, Mur P, Silva G, Verri V, Rojas C, Escobar K, Glavic G, Méndez GP. Epidemiological and clinical characteristics and outcome of monoclonal gammopathy of renal significance‐related lesions in Latin America. Nephrology (Carlton) 2019; 25:442-449. [DOI: 10.1111/nep.13685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/20/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Camila Peña
- Department of HematologyHospital del Salvador Santiago de Chile
| | - Natalia P. Schutz
- Department of HematologyHospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Eloísa Riva
- Department of HematologyCátedra de Hematología, Hospital de Clínicas, Facultad de Medicina Montevideo Uruguay
- Department of HematologyHospital Británico Montevideo Uruguay
| | - Ricardo Valjalo
- Department of NephrologyHospital del Salvador Santiago de Chile
| | - Alejandro Majlis
- Department of Hematology, Hemato‐Oncology DepartmentClínica Las Condes Santiago de Chile
| | | | - Vivianne Lois
- Department of HematologyHospital Barros Luco Trudeau Santiago de Chile
| | - Daniela Zamora
- Department of NephrologyHospital Barros Luco Trudeau Santiago de Chile
| | - Paola Ochoa
- Department of HematologyInstituto Alexander Fleming Buenos Aires Argentina
| | - Claudia Shanley
- Department of HematologyHospital Británico Buenos Aires Argentina
| | | | - Dorotea Fantl
- Department of HematologyHospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Gonzalo Correa
- Department of NephrologyHospital del Salvador Santiago de Chile
| | | | - Paola Mur
- Department of NephrologyHospital San Juan de Dios Santiago de Chile
| | | | - Verónica Verri
- Department of HematologyInstituto de Investigaciones Médicas Alfredo Lanari – UBA Buenos Aires Argentina
| | - Christine Rojas
- Department of HematologyHospital Gustavo Fricke Viña del Mar Chile
| | - Karen Escobar
- Department of HematologyHospital Gustavo Fricke Viña del Mar Chile
| | - Gustavo Glavic
- Department of NephrologyHospital Sótero del Río Santiago de Chile
| | - Gonzalo P. Méndez
- Department of Pathology, Facultad de MedicinaPontificia Universidad Católica de Chile Santiago de Chile
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Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, Wood J, Raynes K, Higgins H, Dawkins B, Meads D, Hulme CT, Monahan I, Karunanithi K, Dignum H, Belsham E, Neilson J, Harrison B, Lokare A, Campbell G, Hamblin M, Hawkey P, Whittaker AC, Low E, Dunn JA. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Oncol 2019; 20:1760-1772. [PMID: 31668592 PMCID: PMC6891230 DOI: 10.1016/s1470-2045(19)30506-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Myeloma causes profound immunodeficiency and recurrent, serious infections. Around 5500 new cases of myeloma are diagnosed per year in the UK, and a quarter of patients will have a serious infection within 3 months of diagnosis. We aimed to assess whether patients newly diagnosed with myeloma benefit from antibiotic prophylaxis to prevent infection, and to investigate the effect on antibiotic-resistant organism carriage and health care-associated infections in patients with newly diagnosed myeloma. METHODS TEAMM was a prospective, multicentre, double-blind, placebo-controlled randomised trial in patients aged 21 years and older with newly diagnosed myeloma in 93 UK hospitals. All enrolled patients were within 14 days of starting active myeloma treatment. We randomly assigned patients (1:1) to levofloxacin or placebo with a computerised minimisation algorithm. Allocation was stratified by centre, estimated glomerular filtration rate, and intention to proceed to high-dose chemotherapy with autologous stem cell transplantation. All investigators, patients, laboratory, and trial co-ordination staff were masked to the treatment allocation. Patients were given 500 mg of levofloxacin (two 250 mg tablets), orally once daily for 12 weeks, or placebo tablets (two tablets, orally once daily for 12 weeks), with dose reduction according to estimated glomerular filtration rate every 4 weeks. Follow-up visits occurred every 4 weeks up to week 16, and at 1 year. The primary outcome was time to first febrile episode or death from all causes within the first 12 weeks of trial treatment. All randomised patients were included in an intention-to-treat analysis of the primary endpoint. This study is registered with the ISRCTN registry, number ISRCTN51731976, and the EU Clinical Trials Register, number 2011-000366-35. FINDINGS Between Aug 15, 2012, and April 29, 2016, we enrolled and randomly assigned 977 patients to receive levofloxacin prophylaxis (489 patients) or placebo (488 patients). Median follow-up was 12 months (IQR 8-13). 95 (19%) first febrile episodes or deaths occurred in 489 patients in the levofloxacin group versus 134 (27%) in 488 patients in the placebo group (hazard ratio 0·66, 95% CI 0·51-0·86; p=0·0018. 597 serious adverse events were reported up to 16 weeks from the start of trial treatment (308 [52%] of which were in the levofloxacin group and 289 [48%] of which were in the placebo group). Serious adverse events were similar between the two groups except for five episodes (1%) of mostly reversible tendonitis in the levofloxacin group. INTERPRETATION Addition of prophylactic levofloxacin to active myeloma treatment during the first 12 weeks of therapy significantly reduced febrile episodes and deaths compared with placebo without increasing health care-associated infections. These results suggest that prophylactic levofloxacin could be used for patients with newly diagnosed myeloma undergoing anti-myeloma therapy. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Mark T Drayson
- School of Immunity and Infection, University of Birmingham, Birmingham, UK.
| | | | - Tim Planche
- Department of Medical Microbiology, St George's, University of London, London, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, London, UK
| | - Jill Wood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kerry Raynes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Helen Higgins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Claire T Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Irene Monahan
- Department of Medical Microbiology, St George's, University of London, London, UK
| | | | | | | | - Jeff Neilson
- The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
| | - Beth Harrison
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Anand Lokare
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gavin Campbell
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Michael Hamblin
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Peter Hawkey
- West Midlands Public Health Laboratory, Heart of England NHS Trust, Birmingham, UK
| | - Anna C Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Eric Low
- Patient Advocacy, Myeloma UK, Edinburgh UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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125
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Autologous Stem Cell Transplantation in Multiple Myeloma with Renal Failure: Friend or Foe? Stem Cells Int 2019; 2019:9401717. [PMID: 31781250 PMCID: PMC6875020 DOI: 10.1155/2019/9401717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Autologous stem cell transplantation (ASCT) is a standard treatment for multiple myeloma (MM), but the clinical response and renal curative effect in MM patients with renal failure (RF) remain controversial. The myeloma kidney disease has different types, and most are due to the direct toxic effects of light chain. Although ASCT can effectively clear the light chain, the data of renal function improvement are still limited. We reviewed the published literatures, focusing on the prospective studies, the retrospective analysis studies, and the case reports. RF patients who received ASCT displayed a low survival rate (OS: HR 1.95, 95% CI 1.020 to 3.720; I2 = 64.9%, P = 0.014) and a shorter EFS/PFS (EFS/PFS: HR 1.53, 95% CI 1.090 to 2.140; I2 = 0%, P = 0.669). However, ASCT was feasible and could have the similar clinical response outcomes compared with the normal renal function (CR: OR 1.013, 95% CI 0.569 to 1.804; I2 = 48.5%, P = 0.101; PR: OR 1.013, 95% CI 0.342 to 1.226; I2 = 46.3%, P = 0.144). Moreover, MM with RF after ASCT had a good improvement of renal function and melphalan is still an important factor affecting the treatment of ASCT.
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van Bentum R, Nieken J, de Waal E, Hoogendoorn M. Native aortic valve endocarditis with Morganella morganii in a patient with multiple myeloma and valvular amyloidosis: a case report. BMC Infect Dis 2019; 19:957. [PMID: 31707976 PMCID: PMC6842506 DOI: 10.1186/s12879-019-4511-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/24/2019] [Indexed: 11/11/2022] Open
Abstract
Background Patients with multiple myeloma (MM) are known to be immune incompetent and experience higher incidences of infectious diseases. However, infective endocarditis (IE) is rarely observed in patients with MM and Morganella morganii (M. morganii) has rarely been associated with IE. Case presentation A 72-year-old female receiving 4th line treatment for MM presented with fever and concomitant confusion. Urinary culture revealed growth of Escherichia coli, wherefore broadspectrum penicillin and high-dose corticosteroids were initiated. However, blood cultures showed growth of M. morganii. Fluoroquinolone was added due to penicillin-resistance of the Morganella species. Two days after admission, the patient acutely deteriorated with hemodynamic instability. Gentamicin and high dose corticosteroids were added. Echocardiography showed marked aortic valve vegetation with severe aortic valve regurgitation, leading to the diagnosis of bacterial endocarditis of the native aortic valve. Shortly after diagnosis, the patient died. At autopsy, vegetation with gram-negative rods in the native aortic valve was observed, confirming the diagnosis of M. morganii-endocarditis. Additional staining for amyloid confirmed advanced light-chain (AL) amyloidosis with extensive amyloid depositions of the aortic valve and valvular damage as complications of her MM. Conclusions Our case suggests that IE with M. morganii was facilitated by the combination of the cardiac amyloidosis with valvular impairment and the profound immune deficiency caused by the several chemo-immunomodulatory treatment lines and the MM itself. This case further illustrates that awareness for rare opportunistic infections in an era with growing potential of combined chemoimmunotherapy is warranted.
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Affiliation(s)
- Renée van Bentum
- Department of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
| | - Judith Nieken
- Pathologie Friesland, Center for Pathology, Jelsumerstraat 6a, 8917 EN, Leeuwarden, The Netherlands
| | - Esther de Waal
- Department of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Mels Hoogendoorn
- Department of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
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127
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Reducing infection-related morbidity and mortality in patients with myeloma. Lancet Oncol 2019; 20:1633-1635. [PMID: 31668593 DOI: 10.1016/s1470-2045(19)30649-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
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128
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Lee SR, Choi H, Lee BH, Kang KW, Yu ES, Kim DS, Park Y, Choi CW, Kim BS, Sung HJ. Modified dose of melphalan-prednisone in multiple myeloma patients receiving bortezomib plus melphalan-prednisone treatment. Korean J Intern Med 2019; 34:1333-1346. [PMID: 30360024 PMCID: PMC6823557 DOI: 10.3904/kjim.2018.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Bortezomib plus melphalan-prednisone (VMP) is a standard treatment for multiple myeloma, particularly for patients who are ineligible for high-dose therapy. However, early discontinuation or treatment modification is often needed owing to adverse events. The aim of this study was to investigate the clinical outcomes of modifying the dose of melphalan-prednisone (MP) in patients receiving VMP. METHODS We examined 67 patients who received a modified dose of MP, and 38 patients who received the regularly planned dose of MP. We then analyzed clinical differences between the groups. RESULTS Although there was no difference in the proportion of discontinuation due to adverse events between dose groups, more patients in the planned-dose group experienced earlier discontinuation in general. The overall response rate (ORR) was 81.0% and complete response (CR) rate was 30.5%. After a median 15.7 months of follow-up, the median progression-free survival (PFS) and overall survival (OS) were 25.0 and 47.8 months, respectively. There was no significant difference in the ORR, CR, PFS, and OS of the two dose groups. A median of four cycles were delivered, and the median cumulative bortezomib dose was 41.6 mg/m2 . The median PFS in patients with doses ≥ 41.6 mg/m2 was longer than that in patients with doses < 41.6 mg/m2 (35.1 months vs. 9.6 months). However, when MP was < 50% of the planned dose, PFS and OS were poor. CONCLUSION Modifying the dose of MP might be a feasible and effective therapeutic approach for multiple myeloma patients receiving VMP treatment.
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Affiliation(s)
- Se Ryeon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hojoon Choi
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Hyun Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ka-Won Kang
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Sang Yu
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Sik Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yong Park
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chul Won Choi
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Soo Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hwa Jung Sung
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Correspondence to Hwa Jung Sung, M.D. Division of Hematology and Oncology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea Tel: +82-31-412-6549 Fax: +82-31-412-5984 E-mail:
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Kormann R, Pouteil-Noble C, Muller C, Arnulf B, Viglietti D, Sberro R, Sayegh J, Durrbach A, Dantal J, Girerd S, Pernin V, Albano L, Rondeau E, Peltier J. Kidney transplantation for active multiple myeloma or smoldering myeloma: a case- control study. Clin Kidney J 2019; 14:156-166. [PMID: 33564414 PMCID: PMC7857822 DOI: 10.1093/ckj/sfz128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background The increased survival of patients with multiple myeloma (MM) raises the question of kidney transplantation (KT) in patients with end-stage renal disease (ESRD). Methods We included 13 patients with MM or smoldering myeloma (SMM) and ESRD transplanted between 2007 and 2015, including 7 MM with cast nephropathy, 3 with MM-associated amyloid light chain amyloidosis or light chain deposition disease and 3 SMM and compared them with 65 control-matched kidney-transplanted patients. Nine of the MM patients with KT were also compared with 63 matched MM patients on haemodialysis. Results Pre-transplantation parameters were comparable, except for the duration of renal replacement therapy (57.8 versus 37.0 months; P = 0.029) in MM versus control patients, respectively. The median follow-up post-KT was 44.4 versus 36.4 months (P = 0.40). The median MM graft and patient survival were 80.1 and 117.2 months, respectively, and were not significantly different from control patients, although mortality tended to be higher in the 10 symptomatic MM patients (P = 0.059). MM patients had significantly more viral and fungal infections and immunosuppressive maintenance therapy modifications while they received lower induction therapy. Two MM patients relapsed and two SMM cases evolved to MM after KT. Three cast nephropathies occurred, two of them leading to ESRD. Moreover, survival of MM with KT increased relative to control haemodialysed patients (P = 0.002). Conclusions Selected MM patients may benefit from KT but need careful surveillance in the case of KT complications and MM evolution.
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Affiliation(s)
- Raphaël Kormann
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie, Paris, France
- Correspondence and offprint requests to: Raphaël Kormann; E-mail:
| | - Claire Pouteil-Noble
- Service de Transplantation-Néphrologie, Hôpital Edouard Herriot and Université Lyon 1, Lyon, France
| | - Clotilde Muller
- Néphrologie-Transplantation, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Bertrand Arnulf
- Service d’Immuno-hématologie, Hôpital Saint Louis, Université Denis Diderot-Paris VII AP-HP, Paris, France
| | - Denis Viglietti
- Service de Néphrologie, Hôpital Saint Louis, Université Denis Diderot-Paris VII AP-HP, Paris, France
| | - Rebecca Sberro
- Service de Transplantation, Hôpital Necker, Université Paris Descartes AP-HP, Paris, France
| | - Johnny Sayegh
- Service de Néphrologie–Dialyse–Transplantation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Antoine Durrbach
- Service de Néphrologie, Hôpital Bicêtre, AP-HP, Inserm UMRS 1197, Université Paris Sud, Paris, France
| | - Jacques Dantal
- Service de Néphrologie et d'Immunologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-Les-Nancy, France
| | - Vincent Pernin
- Département de Néphrologie et Transplantation Rénale, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Laetitia Albano
- Service de Néphrologie et Transplantation Rénale, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Eric Rondeau
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie, Paris, France
- Néphrologie-Transplantation, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Julie Peltier
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie, Paris, France
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Pasiarski M, Sosnowska-Pasiarska B, Grywalska E, Stelmach-Gołdyś A, Kowalik A, Góźdź S, Roliński J. Immunogenicity And Safety Of The 13-Valent Pneumococcal Conjugate Vaccine In Patients With Monoclonal Gammopathy Of Undetermined Significance - Relationship With Selected Immune And Clinical Parameters. Clin Interv Aging 2019; 14:1741-1749. [PMID: 31631993 PMCID: PMC6790629 DOI: 10.2147/cia.s220423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose Patients with monoclonal gammopathy of undetermined significance (MGUS) have an increased risk of developing infections. Streptococcus pneumoniae vaccinations are recommended for immunocompromised patients, including patients with lymphoproliferative disorders such as MGUS. The objective of the study was to assess the immune response to the 13-valent pneumococcal conjugate vaccine (PCV13) in treatment-naive MGUS patients versus healthy subjects. All study groups were evaluated for the levels of specific pneumococcal antibodies, the levels of IgG and IgG subclasses, and selected peripheral blood lymphocyte subpopulations, including the proportion of plasmablasts before and after immunization. Patients and methods A total of 22 previously untreated patients with MGUS and 15 healthy age- and sex-matched volunteers were included in the study. All participants were immunized with PCV13 Prevenar13 (Pfizer). The following parameters were assessed: 1) serum-specific pneumococcal antibody titers before and 30 days after vaccination, 2) percentage of plasmablasts, defined as CD19+/IgD-/CD27++, before and 7 days after vaccination, 3) serum total IgG and IgG1, IgG2, IgG3, IgG4 levels before and 30 days after vaccination. Results and conclusion PCV13 vaccination in MGUS patients is safe and effectively protects against S. pneumoniae infection. In unvaccinated individuals, vaccination should be carried out as soon as possible after diagnosis. It can protect patients against serious infectious complications, which can contribute to extending the time to progression and transformation into more aggressive diseases. PCV13 vaccination is more effective in MGUS patients with a lower concentration of M protein. Serum M protein concentration in patients diagnosed with MGUS may be a useful predictor of the effectiveness of vaccination.
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Affiliation(s)
- Marcin Pasiarski
- Department of Hematology, Holycross Cancer Center, Kielce, Poland.,Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland.,Clinical Immunology Department, St. John's Cancer Center, Lublin, Poland
| | | | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland
| | - Stanisław Góźdź
- Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland.,Department of Oncology, Holycross Cancer Center, Kielce, Poland
| | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland.,Clinical Immunology Department, St. John's Cancer Center, Lublin, Poland
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131
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Bird SA, Boyd K. Multiple myeloma: an overview of management. Palliat Care Soc Pract 2019; 13:1178224219868235. [PMID: 32215370 PMCID: PMC7065505 DOI: 10.1177/1178224219868235] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022] Open
Abstract
Multiple myeloma represents 2% of all new cancer diagnoses in the United Kingdom and accounts for 2% of all cancer deaths. In the past few decades, there have been huge improvements in life expectancy which have been driven by novel therapeutic agents, autologous stem cell transplants and intensified supportive care. This review will discuss the pathogenesis of multiple myeloma, current management approaches and the direction of future treatments. In addition, this review will highlight the high burden of symptoms that patients experience and therefore the great benefits that can be gained from specialist palliative care input.
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Zahid MF, Ali N, Nasir M, Baig MH, Iftikhar M, Bin Mahmood SU, Malik A, Atif S, Beg MA. Infections in patients with multiple myeloma treated with conventional chemotherapy: a single-center, 10-year experience in Pakistan. Hematol Transfus Cell Ther 2019; 41:292-297. [PMID: 31412989 PMCID: PMC6978542 DOI: 10.1016/j.htct.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/03/2019] [Accepted: 02/27/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality. Objective We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period. Method and results Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients. Conclusion Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy.
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Affiliation(s)
| | - Natasha Ali
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan; Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Myra Nasir
- Medical Graduate, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Arhama Malik
- Medical Graduate, Aga Khan University, Karachi, Pakistan
| | - Sara Atif
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Mohammad Asim Beg
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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133
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Lin CH, Yang CF, Yang HC, Fay LY, Yeh CM, Kuan AS, Wang HY, Gau JP, Hsiao LT, Chiou TJ, Chen PM, Liu YC, Ko PS, Liu JH, Liu CJ. Risk Prediction for Early Mortality in Patients with Newly Diagnosed Primary CNS Lymphoma. J Cancer 2019; 10:3958-3966. [PMID: 31417640 PMCID: PMC6692612 DOI: 10.7150/jca.32467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Overall survival of patients with primary CNS lymphoma (PCNSL) has improved since the introduction of immunochemotherapy. However, up to 10-15% of PCNSL patients still die shortly after diagnosis. In the present study, we aimed to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with PCNSL. Methods: We included newly diagnosed PCNSL patients in a tertiary medical center in Taiwan between January 1, 2002 and May 31, 2018. Clinical risk factors were collected and compared between PCNSL patients who had and did not have early mortality. Results: A total of 133 consecutive patients with PCNSL were included in this study. Approximately 9.8% of the PCNSL patients had early mortality. In multivariate analysis, age ≥ 80 (adjusted hazard ratio [HR] 3.34, 95% confidence interval [CI] 1.01-11.04, p = 0.048) and involvement of the basal ganglia (adjusted HR 4.85, 95% CI 1.47-15.95, p = 0.009) were identified as independent risk factors of early mortality. Use of MTX-based chemotherapy served as an independent protective factor for early mortality (adjusted HR 0.19, 95% CI 0.05-0.67, p = 0.010). Infection and tumor-associated mass effect contributed most to early mortality. Conclusion: Early mortality is not uncommon in patients with PCNSL. Identification of patients with higher risk may help clinicians with initiating appropriate surveillance and management.
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Affiliation(s)
- Chia-Hsin Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Fen Yang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Taipei Veterans General Hospital.,Institute of Brain Science, National Yang-Ming University
| | - Li-Yu Fay
- Department of Neurosurgery, Taipei Veterans General Hospital
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ai-Seon Kuan
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Hao-Yuan Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Min Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Chung Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Shen Ko
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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134
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Nador G, Ramasamy K, Panitsas F, Pratt G, Sadler R, Javaid MK. Testing and management for monoclonal gammopathy of uncertain significance and myeloma patients presenting with osteoporosis and fragility fractures. Rheumatology (Oxford) 2019; 58:1142-1153. [PMID: 31225884 DOI: 10.1093/rheumatology/kez127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/03/2019] [Indexed: 12/19/2022] Open
Abstract
Multiple myeloma, the second most frequent blood cancer, and its precursor, monoclonal gammopathy of uncertain significance, are associated with an increased risk of fragility fractures. However, current guidelines fail to offer explicit indications for healthcare professionals in terms of testing and thresholds for onward referral. The purpose of this review is to present the association of these conditions and metabolic bone disease and to highlight the importance of considering a diagnosis of monoclonal gammopathy of uncertain significance and myeloma in the context of a secondary fracture prevention assessment and of a multidisciplinary approach in managing these patients.
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Affiliation(s)
- Guido Nador
- Department of Clinical Haematology, Oxford University Hospitals, Oxford, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals, Oxford, UK.,NIHR, BRC Blood Theme, Oxford, UK
| | - Fotios Panitsas
- Haematology Department, Larissa University Hospital, Larissa, Greece
| | - Guy Pratt
- Haematology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Ross Sadler
- Department of Immunology, Oxford University Hospitals, Oxford
| | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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135
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Renaud L, Schraen S, Fouquet G, Guidez S, Demarquette H, Nudel M, Cayssials E, Bories C, Herbaux C, Systchenko T, Faucompré JL, Machet A, Sabirou F, Levy A, Bobin A, Richez V, Moya N, Gruchet C, Desmier D, van de Wyngaert Z, Carpentier B, Manier S, Facon T, Harding S, Leleu X. Response to pneumococcal vaccination in multiple myeloma. Cancer Med 2019; 8:3822-3830. [PMID: 31145552 PMCID: PMC6639194 DOI: 10.1002/cam4.2253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background Streptococcus pneumoniae infection causes morbidity and mortality in multiple myeloma patients. Pneumococcal vaccination is commonly given to immunocompromised myeloma patients; however response data are sparse. Here, we present longitudinal response data to pneumococcal vaccination in multiple myeloma patients. Method Twenty‐eight multiple myeloma patients were included, 25 of whom were newly diagnosed. All the patients received two vaccines Prevnar13® and Pneumo23®. Serotype‐specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline, and then sequentially at different time points postvaccination until treatment ended. Response to vaccination is available for 20 patients. The primary endpoint was the incidence rate of patients who obtained an isotype response serum concentration after vaccination. Secondary endpoints included detailed isotype increase, time to first increase, further assessment of a decreased anti‐pneumococcal serum concentrations following treatment including autologous stem cell transplantation (ASCT), rate of infection with a special attention to pneumococcal infection. Results The median age was 66 years and the male to female ratio was 0.6. Anti‐pneumococcal capsular polysaccharide (anti‐PCP23) IgG, IgG2, IgA, and IgM responses were detected within 1 week postvaccination. Response to at least one subtype of antibody was obtained in 85% (n = 17) of patients, for at least two subtypes in 65% (n = 13), for at least three subtypes in 55% (n = 11), and 2 patients responded to all four subtypes. The median increase in the concentration of anti‐PCP23 isotypes was threefold following vaccination, with the highest increase observed when Pneumo23® was given more than 30 days after Prevnar13®. The anti‐pneumococcal geometric mean concentration decreased significantly for all subtypes over time independently of treatment approaches. Conclusion Myeloma has the ability to demonstrate a response to pneumococcal vaccine, independently of preexisting hypogammaglobulinemia and possibly of treatment‐induced immunodepression. We also observed a drop in the serum response overtime and following autologous transplantation. Further studies in larger sample are needed to understand the benefit of vaccination strategies in these patients.
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Affiliation(s)
- Loïc Renaud
- Department of Hematology, CHU Lille, Lille, France
| | | | | | - Stephanie Guidez
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | | | - Thomas Systchenko
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Antoine Machet
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Florence Sabirou
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Antony Levy
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Arthur Bobin
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Niels Moya
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Cécile Gruchet
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Deborah Desmier
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | | | - Xavier Leleu
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
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136
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Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e415-e424. [PMID: 31208889 DOI: 10.1016/j.clml.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/14/2019] [Accepted: 05/12/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Renal impairment (RI) is a common complication of multiple myeloma (MM) and remains a poor prognostic factor despite improved survival with newer therapies. PATIENTS AND METHODS We evaluated baseline characteristics, treatment, and outcomes of newly diagnosed MM patients with RI at diagnosis in the Australia and New Zealand Myeloma and Related Diseases Registry over 5 years to April 2018; we compared patients with RI (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) with those with eGFR ≥60. In autologous stem cell transplantation (ASCT) analyses, patients aged 70 years and younger and ≥1 year from diagnosis were included. RESULTS Overall, 36% of patients with newly diagnosed MM had RI; they were older, had more advanced disease and comorbidities, and worse performance status. Bortezomib-based induction therapy was most commonly used, although administered to fewer RI patients, despite similar response rates. Patients with RI were less likely to receive ASCT; however, recipients had longer progression-free survival (PFS) and overall survival (OS). Patients with RI had shorter OS and PFS after adjusting for age. In ASCT recipients with RI versus no RI, there was no difference in PFS and OS. CONCLUSION Our findings in "real world" MM patients with RI confirm that patient-, disease-, and treatment-related factors (such as suboptimal bortezomib and ASCT use), and delays in commencing therapy, might contribute to poorer outcomes, and support the use of ASCT in patients with RI.
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137
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Chen J, Liu H, Li L, Liu Z, Song J, Wang G, Wang H, Ruan E, Ding K, Shao Z, Fu R. Clinical features and treatment outcome of elderly multiple myeloma patients with impaired renal function. J Clin Lab Anal 2019; 33:e22888. [PMID: 31004381 PMCID: PMC6595344 DOI: 10.1002/jcla.22888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/10/2019] [Accepted: 03/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Renal impairment (RI) is a most common complication of multiple myeloma (MM), which is associated with an increased risk of early death and worse survival. Methods We retrospectively analyzed clinical features and outcomes of 77 MM patients over 70 years old and compared the differences between with and without RI groups. Results The percentage of elder MM patients with RI was 61%. Hemoglobin level was a protective factor (OR = 0.954, P = 0.033), while creatinine and hypertension were hazards (OR = 1.288, P < 0.001 and OR = 30.12, P = 0.008). And the percentages of patients with mild‐to‐moderate RI and moderate‐to‐severe RI were 40.4% and 59.6%. Complete remission (CR) rate was higher in patients treated with bortezomib (33.3%) than those with non‐bortezomib treatment (3.33%) (P = 0.007). Meanwhile, CRrenal was higher in patients with bortezomib (58.3%) than non‐bortezomib treatment (22.2%) (P = 0.025). The median OS of the patients with RI treated with bortezomib was longer than those with non‐bortezomib regimens (15.0 vs 6.0 months, P = 0.001). The same result was observed in the patients with moderate‐to‐severe RI (13.0 vs 6.0 months, P = 0.007). The median OS of the patients with RI receiving the bortezomib regimens (15 months) was longer than those with non‐bortezomib regimens (6.0 months) (P = 0.001). Conclusion Hemoglobin is a protective factor in elder patients with RI, while creatinine and hypertension were hazards. The median OS of elderly patients with RI was worse, and bortezomib can improve the CR rate in these patients.
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Affiliation(s)
- Jin Chen
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lijuan Li
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jia Song
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guojin Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huaquan Wang
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Erbao Ruan
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zonghong Shao
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
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138
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Shah S, Ibrahim M, Delaney M, Schey S, Bygrave C, Streetly M, Benjamin R. Risk of relapse of multiple myeloma following kidney transplantation. Clin Kidney J 2019; 12:216-223. [PMID: 30976399 PMCID: PMC6452174 DOI: 10.1093/ckj/sfy137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Autologous stem cell transplantation (ASCT) and novel therapies have improved the prognosis for patients with multiple myeloma (MM). For those who undergo ASCT while on dialysis, a similar survival compared with the overall MM population has been reported. Therefore, for patients achieving remission following ASCT, kidney transplantation is an attractive option, offering an improved quality of life and significant economic advantage. Method This case series investigates the outcome of five patients who underwent an ASCT for MM with subsequent kidney transplantation between 2006 and 2012. Results Four patients presented with end-stage renal disease (ESRD) and one progressed to ESRD shortly after diagnosis. Induction chemotherapy regimens with novel agents including thalidomide and bortezomib were utilized. Following attainment of very good partial remission or complete remission, high-dose melphalan ASCTs were performed after a median of 10 months. Kidney transplantation (living donor n = 3, deceased donor n = 2) with tacrolimus-based immunosuppression regimens was completed at a median of 27 months after ASCT. Patients 1 and 3 experienced relapse of myeloma at 6 and 16 months after kidney transplantation. Patients 2, 4 and 5 remain alive at 55 months (median) after kidney transplantation with no evidence of relapse. Conclusion Forty percent of our cohort experienced a relapse in MM within 2 years of kidney transplantation. Death-censored graft survival and patient survival were 80% at 4 years. Our study adds to the growing literature supporting kidney transplantation following successful ASCT for MM and is useful when counselling patients regarding renal and haematological outcomes.
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Affiliation(s)
| | | | - Michael Delaney
- East Kent Hospital University NHS Foundation Trust, Kent, UK
| | - Steve Schey
- King's College Hospital NHS Trust, London, UK
| | - Ceri Bygrave
- Cardiff and Vale University Health Board, Cardiff, UK
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139
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Xue Y, Liu H, Nie G, Zhang J. Identifying the optimal target genes associated with multiple myeloma by a novel bioinformatical analysis. Oncol Lett 2019; 17:4375-4382. [PMID: 30944631 PMCID: PMC6444383 DOI: 10.3892/ol.2019.10100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
Multiple myeloma (MM) is one of the most frequent malignant hematopoietic diseases, the pathogenesis of which remains unclear. It is well known that miRNAs are aberrantly expressed in many tumors, thus, investigating the target genes of miRNAs contributes to understanding the functional effect of miRNAs on MM. In this study, plasma samples of 147 patients with MM and 15 normal donors were collected. Using high-throughout microarray and limma package to screen the differentially expressed genes. Furthermore, to accurately predict the optimal target genes of MM, the logFC, targetScanCS and targetScanPCT values of known genes in four miRNAs (i.e. has-miR-21, has-miR-20a, has-miR-148a and has-miR-99b) were used to compute the targetScore values. As a result, 171 genes with larger difference were screened out using t-test, F-test and eBayes statistics analysis. Furthermore, 34 potential target genes associated with MM were selected by integrating the differentially expressed genes (DEGs) and the genes obtained by targetScore algorithm. Additionally, combining with the mutated genes in MM and the obtained DEGs, 41 consistently expressed genes were obtained. Finally, 5 optimal target genes, including SYK, LCP1, HIF1A, ALDH1A1 and MAFB, were screened out by the intersection of 34 DEGs and 41 mutated genes. In a word, this novel target gene prediction algorithm may contribute to improve our understanding on the pathogenesis of miRNAs in MM, which open up a new approach for future study.
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Affiliation(s)
- Yan Xue
- Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, Heilongjiang 150040, P.R. China
| | - Hongmiao Liu
- Department of Pathology, General Hospital of Heilongjiang Province Land Reclamation Bureau, Harbin, Heilongjiang 150086, P.R. China
| | - Guangchen Nie
- Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, Heilongjiang 150040, P.R. China
| | - Jing Zhang
- Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, Heilongjiang 150040, P.R. China
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140
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Na IK, Buckland M, Agostini C, Edgar JDM, Friman V, Michallet M, Sánchez-Ramón S, Scheibenbogen C, Quinti I. Current clinical practice and challenges in the management of secondary immunodeficiency in hematological malignancies. Eur J Haematol 2019; 102:447-456. [PMID: 30801785 PMCID: PMC6849602 DOI: 10.1111/ejh.13223] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/30/2022]
Abstract
Objective Despite long‐standing safe and effective use of immunoglobulin replacement therapy (IgRT) in primary immunodeficiency, clinical data on IgRT in patients with secondary immunodeficiency (SID) due to B‐cell lymphoproliferative diseases are limited. Here, we examine the correlation between approved IgRT indications, treatment recommendations, and clinical practice in SID. Methods An international online survey of 230 physicians responsible for the diagnosis of SID and the prescription of IgRT in patients with hematological malignancies was conducted. Results Serum immunoglobulin was measured in 83% of patients with multiple myeloma, 76% with chronic lymphocytic leukemia, and 69% with non‐Hodgkin lymphoma. Most physicians (85%) prescribed IgRT after ≥2 severe infections. In Italy, Germany, Spain, and the United States, immunoglobulin use was above average in patients with hypogammaglobulinemia, while in the UK considerably fewer patients received IgRT. The use of subcutaneous immunoglobulin was highest in France (34%) and lowest in Spain (19%). Immunologists measured specific antibody responses, performed test immunization, implemented IgRT, and used subcutaneous immunoglobulin more frequently than physicians overall. Conclusions The management of SID in hematological malignancies varied regionally. Clinical practice did not reflect treatment guidelines, highlighting the need for robust clinical studies on IgRT in this population and harmonization between countries and disciplines.
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Affiliation(s)
- Il-Kang Na
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Matthew Buckland
- UCL Centre for Immunodeficiency, Royal Free Hospital and Great Ormond Street Hospital NHS Foundation Trusts, London, UK
| | - Carlo Agostini
- Department of Internal Medicine, University Hospital, Padua University, Treviso, Italy
| | | | - Vanda Friman
- Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mauricette Michallet
- Université Claude Bernard Lyon, Lyon, France.,Service d'Hématologie, Centre Léon Bérard, Lyon, France
| | - Silvia Sánchez-Ramón
- Departamento de Inmunología Clínica, Hospital Clínico San Carlos, Universidad Complutense of Madrid, Spain
| | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität (FU) Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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141
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Pulmonary function abnormalities are common in patients with multiple myeloma and are independently associated with worse outcome. Ann Hematol 2019; 98:1427-1434. [PMID: 30834954 DOI: 10.1007/s00277-019-03641-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
Pre-existing pulmonary disease may affect treatment choices, toxicity, and survival of patients with multiple myeloma (MM). However, data on the prognostic value of pulmonary function tests (PFTs) in myeloma patients' outcome, at the time of initial assessment of newly diagnosed patients, are scarce. Here, we prospectively performed PFTs in 121 newly diagnosed MM patients, before initiation of treatment, and we evaluated possible associations of lung function with their outcomes. Fifty-four patients (44.63%) had either obstructive or restrictive pulmonary function defects, even among those not reporting a history of lung disease. The survival was significantly worse in those with obstructive pulmonary defect (median OS 32.8 months) vs. those with restrictive (median OS 52.5 months) or normal lung function (median not reached, 3-year survival 76%) (p = 0.013), independently of other myeloma-related factors. Forced vital capacity (FVC) (lt) (p = 0.012), forced expiratory volume in 1 s (FEV1) (lt) (p = 0.018), peak expiratory flow (PEF) (lt/min) (p = 0.008), carbon monoxide diffusion capacity (DLCO) (p = 0.012), and expiratory/inspiratory pressures (Pe) (kPa) (p = 0.032)/(Pi) (kPa) (p = 0.023) were significantly associated with OS. Myeloma-related factors associated with survival included ISS stage (p = 0.008), hypercalcemia (p = 0.064), and high-risk cytogenetics (p = 0.004). In the multivariate analysis, only the presence of high-risk cytogenetics and presence of either or both PEF and DLCO < 65% of predicted were independent prognostic factors. We conclude that PEF and DLCO could be useful in the initial assessment of newly diagnosed MM patients as significant predictors of survival. Further research is needed to evaluate if respiratory screening should be included in the routine initial evaluation of myeloma patients, despite the presence or absence of respiratory symptoms or abnormal clinical respiratory examination.
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142
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The risk of infections in multiple myeloma before and after the advent of novel agents: a 12-year survey. Ann Hematol 2019; 98:713-722. [DOI: 10.1007/s00277-019-03621-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/17/2019] [Indexed: 12/26/2022]
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Girmenia C, Cavo M, Offidani M, Scaglione F, Corso A, Di Raimondo F, Musto P, Petrucci MT, Barosi G. Management of infectious complications in multiple myeloma patients: Expert panel consensus-based recommendations. Blood Rev 2019; 34:84-94. [PMID: 30683446 DOI: 10.1016/j.blre.2019.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
Abstract
The introduction of new therapeutic agents in multiple myeloma (MM), including proteasome inhibitors, immunoregulatory drugs and monoclonal antibodies, has improved the outcomes of patients, but in parallel has changed the frequency and epidemiology of infections. Hence, the great strides in the indications and use of new active treatments for MM need parallel progresses on the best approach to prophylaxis and supportive therapy for infections. Moving from the recognition that the above issue represents an unmet clinical need in MM, an expert panel assessed the scientific literature and composed a framework of recommendations for optimal infection control in patients candidate to active treatment for MM. The present publication represents a consensus document from questionnaires and consensus meetings held during 2017. The issues tackled in the project dealt with: infectious risk assessment, risk management and prophylaxis, intravenous immunoglobulin replacement therapy, antiviral and antibacterial vaccination. Considering the lack of conclusive and/or enough large studies for certain topics several recommendations derived from the personal experience of the experts.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Michele Cavo
- 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Scaglione
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Corso
- Division of Hematology, Fondazione IRCCS - Policlinico San Matteo, Pavia, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, and Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Pz, Italy
| | - Maria Teresa Petrucci
- Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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Ali H, Kishore B, Baharani J. Significance of paraprotein gap and β2 microglobulins in predialysis Population with multiple myeloma. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:825-831. [DOI: 10.4103/1319-2442.265458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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145
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Sørrig R, Klausen TW, Salomo M, Vangsted A, Gimsing P. Risk factors for infections in newly diagnosed Multiple Myeloma patients: A Danish retrospective nationwide cohort study. Eur J Haematol 2018; 102:182-190. [PMID: 30485563 DOI: 10.1111/ejh.13190] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Infections pose the greatest risk of early death in patients with Multiple Myeloma. However, few studies have analyzed the risk factors for infections in Multiple Myeloma patients. The aim of this study was to analyze the risk factors infections within a population-based MM cohort. METHODS Using Danish registries (from 2005 to 2013), we analyzed all ICD-10 codes for infections within the first 6 months of Multiple Myeloma diagnosis in 2557 patients. RESULTS Pneumonia and sepsis represented 46% of infections. Multivariable regression analysis showed that risk factors for pneumonia were male gender (HR 1.4; P = 0.001), ISS II (HR 1.6; P = 0.0004) and ISSIII (HR 1.8; P = 0.0004) and elevated LDH (HR 2.6; P = 0.0008). Risk factors for sepsis were high bone marrow plasma cell % (HR 1.1; P = 0.038), ISS II (HR 1.7; P = 0.007) ISS III (HR 2.0; P = 0.002) and creatinine (HR 2.1; P = 0.002). Neither immunoparesis (hypogammaglobulinemia) nor comorbidity was significant risk factors. CONCLUSIONS Our study suggests that tumor burden and renal impairment are risk factors for pneumonia and sepsis in the early phase of Multiple Myeloma.
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Affiliation(s)
- Rasmus Sørrig
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tobias W Klausen
- Hematological Research Laboratory, Herlev Hospital, Herlev, Denmark
| | - Morten Salomo
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Annette Vangsted
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Gimsing
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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146
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Progressive Elevation of NT-ProBNP During Chemotherapy Is Related to Asymptomatic Cardiovascular Events in Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:167-176.e1. [PMID: 30581158 DOI: 10.1016/j.clml.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/13/2018] [Accepted: 11/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with multiple myeloma (MM) are at risk of cardiovascular events (CVEs) as a result of disease burden- and treatment-related risk factors. Cardiac biomarkers have been reported to be more sensitive than left ventricular ejection fraction in detecting CVEs. We sought to explore CVEs risk factors in MM patients and to establish sensitive predictors of biomarkers. PATIENTS AND METHODS We studied 116 newly diagnosed MM patients who received chemotherapy in our department. Echocardiograms were examined at baseline and after 4 cycles of treatment, as well as upon clinical suspicion of a cardiac event or after an adjustment of treatment regimens. Cardiac biomarkers, including troponin T, myohemoglobin, and N terminal pro B-type natriuretic peptide (NT-proBNP), were estimated before each cycle and within 24 hours after chemotherapy, which was provided for at least 4 cycles. RESULTS Thirteen patients (11.2%) experienced CVEs, seven of which were subclinical. There was no significant difference between the CVE group and the non-CVE group in terms of general patient characteristics, MM disease factors, or chemotherapy drugs. The baseline levels of left ventricular ejection fraction and NT-proBNP were comparable between the 2 groups. NT-proBNP levels increased rapidly after chemotherapy and fell to normal levels before administration of the next cycle in all patients (60 pg/mL vs. 446 pg/mL, P < .001). Patients with asymptomatic CVEs showed a significantly higher proportion of progressively elevated NT-proBNP compared to symptomatic CVE and non-CVE patients (57% vs. 0 vs. 6.1%, P = .035). CONCLUSION The dynamic change in NT-proBNP may predict early asymptomatic cardiac damage and allow interventional strategies to avoid cardiac decompensation.
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147
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Ziogas DC, Dimopoulos MA, Kastritis E. Prognostic factors for multiple myeloma in the era of novel therapies. Expert Rev Hematol 2018; 11:863-879. [DOI: 10.1080/17474086.2018.1537776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Dimitrios C. Ziogas
- Department of Clinical Therapeutics, School of Medicine, “Alexandra” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, “Alexandra” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, “Alexandra” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Atkin C, Richter A, Sapey E. What is the significance of monoclonal gammopathy of undetermined significance? Clin Med (Lond) 2018; 18:391-396. [PMID: 30287433 PMCID: PMC6334115 DOI: 10.7861/clinmedicine.18-5-391] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is characterised by the presence of a monoclonal paraprotein in the blood, without the characteristic end organ damage seen in multiple myeloma. MGUS is more common in older age groups and has a risk of progression to myeloma of 1% per year. Population screening is not currently recommended, but retrospective studies have suggested improvements in myeloma outcomes in those under MGUS follow-up; in addition, MGUS has associated complications, including fracture, osteoporosis, renal disease and infection, which can be treated. Given this increasing evidence of disease related directly to MGUS, strategies for early identification might be needed. In this review, we discuss the complications of MGUS and whether MGUS fulfils the criteria needed to implement a screening programme. We also highlight areas where more evidence is needed, including identification of a higher risk population to make screening more practical and economically viable.
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Affiliation(s)
- Catherine Atkin
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Cavenagh JD, Popat R. Optimal Management of Histone Deacetylase Inhibitor-Related Adverse Events in Patients With Multiple Myeloma: A Focus on Panobinostat. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:501-507. [DOI: 10.1016/j.clml.2018.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/15/2022]
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150
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Bringhen S, Offidani M, Palmieri S, Pisani F, Rizzi R, Spada S, Evangelista A, Di Renzo N, Musto P, Marcatti M, Vallone R, Storti S, Bernardini A, Centurioni R, Aitini E, Palmas A, Annibali O, Angelucci E, Ferrando P, Baraldi A, Rocco S, Andriani A, Siniscalchi A, De Stefano V, Meneghini V, Palumbo A, Grammatico S, Boccadoro M, Larocca A. Early mortality in myeloma patients treated with first-generation novel agents thalidomide, lenalidomide, bortezomib at diagnosis: A pooled analysis. Crit Rev Oncol Hematol 2018; 130:27-35. [PMID: 30196909 DOI: 10.1016/j.critrevonc.2018.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/10/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Early toxic death (≤60 days of diagnosis) in elderly multiple myeloma (MM) patients is attributable to active disease, age and co-morbidities. Rate of early toxic deaths is 10% with conventional chemotherapy mainly due to infection and renal failure. Novel agents have improved MM outcome at the expense of newer toxicity. METHODS We analyzed 1146 individual patient data to assess toxic deaths during induction treatment with first-generation novel agents thalidomide, lenalidomide, bortezomib. RESULTS During first-line therapy, 119/1146 patients (10%) died for any cause, and 47/1146 (4%) due to toxicity, including 12/1146 (1%) early deaths. The 24-month cumulative incidence was 4.1% without any difference between bortezomib (18/503 patients, 4%) and lenalidomide (29/643patients, 5%; p = 0.31). Toxic deaths occurred in 34/1039 (3%) patients <80 years and 13/107 (12%) patients ≥80 years. Causes were cardiac events (28%), infections (26%) and vascular complications (15%). In a multivariate analysis, older age and unfavorable ISS stage increased the risk of death. CONCLUSION First-generation novel agents significantly reduced toxic deaths compared to conventional chemotherapy. One third of deaths during first-line therapy were due to cumulative drug-related toxicities, thus supportive approaches and prevention strategies should be optimized. The higher mortality rate for toxicity in octogenarians confirms the need for a careful frailty assessment.
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Affiliation(s)
- Sara Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Massimo Offidani
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Francesco Pisani
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Rita Rizzi
- Section of Hematology with Transplantation, Department of Emergency and Organ Transplantation, University of Bari Medical School, Bari, Italy
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | | | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Magda Marcatti
- U.O. Ematologia e Trapianto di Midollo, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Roberto Vallone
- Azienda Ospedaliera Gaetano Rummo, Immunoematologia e Trasfusione, Benevento, Italy
| | - Sergio Storti
- UOC Oncoematologia Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Annalisa Bernardini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Enrico Aitini
- Struttura Complessa di Oncologia Medica ed Ematologia, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - Angelo Palmas
- Divisione Ematologia, Ospedale San Francesco, Nuoro, Italy
| | - Ombretta Annibali
- UOC Ematologia e Trapianto di Cellule Staminali, Università Campus Bio-Medico, Roma, Italy
| | - Emanuele Angelucci
- IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | - Anna Baraldi
- SOC Ematologia ospedale SS Antonio e Biagio e C. Arrigo Alessandria, Italy
| | - Stefano Rocco
- Divisione di Ematologia, AO Cardarelli, Napoli, Italy
| | | | | | - Valerio De Stefano
- Istituto di Ematologia, Università Cattolica, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - Vittorio Meneghini
- Hematology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
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