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Steinbach M, Neupane K, Aziz M, Lee-Smith W, Julian K, Godara A, McClune B, Kelkar AH, Sborov D, Mohyuddin GR. Multiple Myeloma in Young Patients: A Scoping Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:15-22. [PMID: 37722944 DOI: 10.1016/j.clml.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
Data on the disease course, presenting features, outcomes, and prognosis of younger patients with multiple myeloma (MM) are lacking. Younger patients with MM have historically been considered to have better outcomes primarily based on better tolerance of treatment and lack of medical comorbidities, but the specific age range of this population has not been uniformly defined. Given the lack of consistent data reporting in patients considered to be young MM patients, we performed a scoping review to highlight the research currently available to start drawing conclusions about these patients and highlight unmet areas of need to focus on further investigation. We searched Embase, Cochrane Central Register of Controlled Trials, CINAHL Plus, Web of Science, and the OVID version of MEDLINE including broad terms that embody the concept of young patients with MM. Our final review included 201 studies which were then categorized according to age group, number of patients, outcomes, and comparators to older patients, along with location and database when available. We have chosen to categorize 3 age groupings: <50: young adults with MM (YA MM), 50 to 65: mid-life adults with multiple myeloma (ML MM) and 65+: older adults with multiple myeloma (OA MM). This review demonstrates the heterogeneity that exists in defining and describing young patients with MM, highlights the lack of studies specifically addressing the unique needs of younger patients, and emphasizes areas of future research unique to this population.
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Affiliation(s)
- Mary Steinbach
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.
| | - Karun Neupane
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH
| | - Wade Lee-Smith
- Mulford Health Science Library, University of Toledo, Toledo, OH
| | - Kelley Julian
- Department of Pharmacy, Huntsman Cancer Hospital, Salt Lake City, UT
| | - Amandeep Godara
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Brian McClune
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | - Douglas Sborov
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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Magen H, Simchen MJ, Erman S, Avigdor A. Diagnosis and management of multiple myeloma during pregnancy: case report, review of the literature, and an update on current treatments. Ther Adv Hematol 2022; 13:20406207211066173. [PMID: 35083030 PMCID: PMC8785339 DOI: 10.1177/20406207211066173] [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: 08/29/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
The simultaneous occurrence of pregnancy and multiple myeloma (MM) is rare. The challenge of diagnosing MM during pregnancy is demonstrated in the case presented here. Despite the rarity of concurrent MM and pregnancy, this possibility should be considered in patients with signs and symptoms that may be attributed to MM so as not to delay the diagnosis and decision about pregnancy continuation and initiation of an appropriate and safe therapy to the mother and fetus. Treating physicians should be aware of the potential effects of MM therapies on the fetus and pregnancy outcomes.
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Affiliation(s)
- Hila Magen
- Head of Multiple Myeloma Unit, Hematology Department, Chaim Sheba Medical Center, 2 Derech Sheba, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal J. Simchen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shira Erman
- Hematology Department, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Abraham Avigdor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Department, Chaim Sheba Medical Center, Ramat Gan, Israel
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Ponticelli C, Moroni G. Fetal Toxicity of Immunosuppressive Drugs in Pregnancy. J Clin Med 2018; 7:jcm7120552. [PMID: 30558290 PMCID: PMC6306731 DOI: 10.3390/jcm7120552] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 01/20/2023] Open
Abstract
Women affected by autoimmune diseases, organ transplantation, or neoplasia need to continue immunosuppressive treatment during pregnancy. In this setting, not only a careful planning of pregnancy, but also the choice of drugs is critical to preventing maternal complications and minimizing the fetal risks. Some immunosuppressive drugs are teratogenic and should be replaced even before the pregnancy, while other drugs need to be managed with caution to prevent fetal risks, including miscarriage, intrauterine growth restriction, prematurity, and low birth weight. In particular, the increasing use of biologic agents raises the question of their compatibility with reproduction. In this review we present data on the indication and safety in pregnancy of the most frequently used immunosuppressive drugs.
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Affiliation(s)
- Claudio Ponticelli
- Former Director Renal Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Gabriella Moroni
- Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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Matthai SM, Jacob S, Devasia AJ, Bindra M, David VG, Varughese S. Unmasking and successful management of light chain deposition disease of kidney in pregnancy: a complex case, mirroring the complex needs of pregnancy with kidney disease in India. J Nephrol 2018; 31:785-791. [PMID: 30187379 DOI: 10.1007/s40620-018-0532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/22/2018] [Indexed: 11/26/2022]
Abstract
Pregnancy offers a precious window of opportunity to diagnose previously undetected or new onset kidney diseases in emerging countries like India, where access to medical, educational and health care facilities are not equitably distributed across varied sections of society. We report a case of a 33 year-old primi gravida who had a successful pregnancy following what was initially considered to represent preeclampsia at 38 weeks of gestation, in whom a subsequent kidney biopsy for persistence of pregnancy-related acute kidney injury (Pr-AKI) revealed light chain deposition disease (LCDD). The etiological evaluation of LCDD led to the detection of an underlying plasma cell dyscrasia which was treated effectively with chemotherapy and autologous stem cell transplant. In this report, we explore the hitherto uncharted pathophysiological relationship between LCDD and pregnancy-related kidney injury by transmission electron microscopic (TEM) studies of endothelial injury in this setting, and underscore the benefits of medical care in a multidisciplinary environment which yielded gratifying results in preservation of maternal kidney health and fetal outcome.
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Affiliation(s)
- Smita Mary Matthai
- Central Electron Microscopy Facility, Wellcome Trust Research Laboratory, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India.
| | - Anup J Devasia
- Department of Haematology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Mandeep Bindra
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Vinoi George David
- Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
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Jurczyszyn A, Olszewska-Szopa M, Vesole AS, Vesole DH, Siegel DS, Richardson PG, Paba-Prada C, Callander NS, Huras H, Skotnicki AB. Multiple Myeloma in Pregnancy--A Review of the Literature and a Case Series. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 16:e39-45. [PMID: 26847816 DOI: 10.1016/j.clml.2015.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022]
Abstract
Multiple myeloma (MM) typically affects older patients with a median age at diagnosis of 67 to 70 years and only 3% of cases are diagnosed before the age of 40. Moreover, MM is more common in men. Therefore, pregnancy rarely occurs in patients with MM and only 37 cases of MM in pregnancy have been reported in the literature. Herein we report an additional 5 cases. The diagnosis of MM might be problematic in this context because some of the symptoms and signs, such as back pain and anemia, can be attributed to pregnancy. Furthermore, if the patient wishes to continue her pregnancy, therapeutic options are currently limited. The list of agents that can be safely administered in pregnant women includes glucocorticoids. Moreover, any continuation of pregnancy has obvious long-term psychosocial repercussions for the patient and her family because of the currently incurable nature of MM. The reported cases of MM in pregnancy represent a spectrum of clinical manifestations. The selection of efficacious and safe treatments is challenging, especially if continuation of pregnancy is desired. Although some authors postulate that pregnancy might lead to progression of MM, data are limited and no consensus on this point has been reached.
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Affiliation(s)
- Artur Jurczyszyn
- Department and Clinic of Haematology, Jagiellonian University Medical College, Krakow, Poland.
| | - Magdalena Olszewska-Szopa
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Medical University, Wroclaw, Poland
| | - Adam S Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | - David H Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ and Georgetown University, Department of Medicine, Washington, DC
| | - David S Siegel
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | | | | | - Natalie S Callander
- Carbone Cancer Center, Department of Medicine, University of Wisconsin, Madison, WI
| | - Hubert Huras
- Department and Clinic of Obstetrics and Perinatology, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksander B Skotnicki
- Department and Clinic of Haematology, Jagiellonian University Medical College, Krakow, Poland
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