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Riva E, Garrido D, Villano F, Bove V. Epidemiology and risk factors for the development of infectious complications in newly diagnosed multiple myeloma: a multicenter prospective cohort study in Uruguay. Hematol Transfus Cell Ther 2024; 46:434-442. [PMID: 38307822 DOI: 10.1016/j.htct.2023.09.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Infections represent a significant cause of morbidity and mortality in patients with multiple myeloma (MM). In Latin America, data on infectious complications in newly diagnosed MM (NDMM) patients are limited. METHODS We conducted a multicenter, prospective cohort study of patients with NDMM in Uruguay between June 2019 and December 2020. Patients with active disease, on active therapy and who provided written informed consent were included. Elegible patients were followed for 6 months from the time of diagnosis and before proceeding to autologous stem cell transplantation or until death, whichever occurred first. Our primary endpoint was the number of infectious events that required hospitalization for ≥ 24 h. MAIN RESULTS Of 124 patients with NDMM, 54 (43.5 %) had infectious complications (74 infectious events), the majority (74.3 %) within the first 3 months from diagnosis. The most common sites of infection were urinary (39.2 %) and respiratory tracts (33.8 %). The microbial agent was identified in 60.8 % of patients with Gram-negative bacteria (71.4 %) as the most common pathogen. Viral and fungal infections were infrequent. In the multivariable analysis, the Eastern Cooperative Oncology Group (ECOG) performance status was ≥ 2 (odds ratio [OR], 2.16; 95 % confidence interval [95 %CI], 1.23 - 3.79; p = 0.008) and creatinine ≥ 2 mg/dl (OR, 2.33; 95 %CI, 1.33 - 4.07; p = 0.003) were independent factors associated with bacterial infections. At 6 months, 14 patients (11.3 %) had died, 50 % related to infectious complications. CONCLUSION Bacterial infections are a substantial cause of hospital admissions and early death in patients with NDMM. Antibiotic prophylaxis should be considered to reduce infectious complications in patients with MM.
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Affiliation(s)
- Eloísa Riva
- Hospital de Clínicas, Montevideo, Uruguay; Hospital Británico, Montevideo, Uruguay
| | | | | | - Virginia Bove
- Hospital Central de las FF.AA., Montevideo, Uruguay.
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Suwal A, Subedi N, Shrestha N, Shrestha U. Pericapsular nerve group block followed by regional anesthesia for pathological fracture fixation in a multiple myeloma patient. Clin Case Rep 2024; 12:e9374. [PMID: 39210924 PMCID: PMC11358699 DOI: 10.1002/ccr3.9374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Appropriate anesthetic technique for fracture fixation in multiple myeloma is crucial in minimizing perioperative complications. The use of pericapsular nerve group block followed by spinal anesthesia for the operative management of pathological fracture in multiple myeloma patient along with proper pre- and postanesthetic care ensures better outcome for the patient. Abstract Multiple myeloma is a malignant plasma cell disease that often presents with anemia, renal failure, hyperkalemia and osteolytic bone lesions. The advancements in drug therapy of multiple myeloma have prolonged the lifespan of the affected people, resulting in a rise in cases of surgical management of fractures in such patients. Anesthetic management, despite being of utmost importance in minimizing perioperative complications in such patients, has not been widely studied, especially in this part of the world. Hence, we report a case of 64 years diabetic, HbSAg positive male with hypothyroidism and a known case of multiple myeloma since the last 6 years, under medication for his comorbidities who suffered acetabular fracture. In this case report, the use of pericapsular nerve group block followed by spinal anesthesia for the operative management of the fracture has been discussed along with several pre- and postanesthetic considerations. With appropriate anesthetic techniques and proper pre- and postanesthetic care, better outcomes can be guaranteed.
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Affiliation(s)
- Aayusha Suwal
- Kathmandu Medical College and Teaching HospitalKathmanduNepal
| | - Nischal Subedi
- Kathmandu Medical College and Teaching HospitalKathmanduNepal
| | | | - Ujma Shrestha
- Department of AnesthesiologyKathmandu Medical College and Teaching HospitalKathmanduNepal
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Giordano L, Cacciola R, Barone P, Vecchio V, Nasso ME, Alvaro ME, Gangemi S, Cacciola E, Allegra A. Autoimmune Diseases and Plasma Cells Dyscrasias: Pathogenetic, Molecular and Prognostic Correlations. Diagnostics (Basel) 2024; 14:1135. [PMID: 38893662 PMCID: PMC11171610 DOI: 10.3390/diagnostics14111135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Multiple myeloma and monoclonal gammopathy of undetermined significance are plasma cell dyscrasias characterized by monoclonal proliferation of pathological plasma cells with uncontrolled production of immunoglobulins. Autoimmune pathologies are conditions in which T and B lymphocytes develop a tendency to activate towards self-antigens in the absence of exogenous triggers. The aim of our review is to show the possible correlations between the two pathological aspects. Molecular studies have shown how different cytokines that either cause inflammation or control the immune system play a part in the growth of immunotolerance conditions that make it easier for the development of neoplastic malignancies. Uncontrolled immune activation resulting in chronic inflammation is also known to be at the basis of the evolution toward neoplastic pathologies, as well as multiple myeloma. Another point is the impact that myeloma-specific therapies have on the course of concomitant autoimmune diseases. Indeed, cases have been observed of patients suffering from multiple myeloma treated with daratumumab and bortezomib who also benefited from their autoimmune condition or patients under treatment with immunomodulators in which there has been an arising or worsening of autoimmunity conditions. The role of bone marrow transplantation in the course of concomitant autoimmune diseases remains under analysis.
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Affiliation(s)
- Laura Giordano
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (L.G.); (P.B.); (V.V.); (M.E.N.); (M.E.A.)
| | - Rossella Cacciola
- Hemostasis/Hematology Unit, Department of Experimental and Clinical Medicine, University of Catania, 95123 Catania, Italy;
| | - Paola Barone
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (L.G.); (P.B.); (V.V.); (M.E.N.); (M.E.A.)
| | - Veronica Vecchio
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (L.G.); (P.B.); (V.V.); (M.E.N.); (M.E.A.)
| | - Maria Elisa Nasso
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (L.G.); (P.B.); (V.V.); (M.E.N.); (M.E.A.)
| | - Maria Eugenia Alvaro
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (L.G.); (P.B.); (V.V.); (M.E.N.); (M.E.A.)
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Emma Cacciola
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Alessandro Allegra
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (L.G.); (P.B.); (V.V.); (M.E.N.); (M.E.A.)
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Almuhaysen LM, Alaa ABAA. A Study on Renal Failure Management in Patients Diagnosed With Multiple Myeloma. Cureus 2023; 15:e47460. [PMID: 38022312 PMCID: PMC10660674 DOI: 10.7759/cureus.47460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Renal impairment, often occurring as a result of multiple myeloma, poses a significant risk to patient health and quality of life. Therefore, the study was conducted with the objective of investigating the management of renal failure in patients diagnosed with multiple myeloma in Saudi Arabia. METHODS A retrospective observational study was conducted during the period from January to August 2023 for the duration of eight months. The data were collected from the patients diagnosed with multiple myeloma, available from the medical records of Prince Sultan Military Medical City, Saudi Arabia. RESULTS The data were collected from a cohort of 85 patients with multiple myeloma. Among patients, males were 62 (72.94%), and females were 23 (27.06%). The mean (SD) age was 68.43 (7.24) years. Among the cohort, 42 (49.1%) were International Staging System (ISS) stage III, and 32 (37.6%) were light chain myeloma. Most patients underwent novel agent-based treatment regimens (a combination of immunomodulator, proteasome inhibitor, and monoclonal antibody; 59, 69.41%), followed by conventional therapy; 16, 18.82%). Multivariate analysis of patient survival showed significant associations with three variables: increased calcium level (P=0.007), eGFR <30 mL/min (P=0.004), and novel agent induction (P=0.001). CONCLUSION This study sheds light on the intricate management of renal failure in multiple myeloma patients, specifically within the Saudi population. The observed associations between survival and various variables emphasize the critical role of renal function in overall patient outcomes.
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Khadka S, Balaji S, Kaur J, Solanki D, Kasianchyk M, Chowdhury H, Patel I, Qasim M, Desai M, Maiyani P, Moradiya DV, Lal D, Patel AA, Lekkala M. Disparities in Outcomes of Hospitalizations Due to Multiple Myeloma: A Nationwide Comparison. Cureus 2023; 15:e47319. [PMID: 38022254 PMCID: PMC10656933 DOI: 10.7759/cureus.47319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background With the advent of novel treatments, there is a declining trend in the multiple myeloma (MM) mortality rate with an increasing hospitalization rate. However, there is limited population-based data on trends and outcomes of hospitalizations due to MM in the United States (US). Methods We analyzed the publicly available Nationwide Inpatient Sample (NIS) from 2007 to 2017 to identify MM hospitalizations. Results Hospitalizations for MM increased from 17,100 (8.71%) in 2007 to 19,490 (9.92%) in 2017. The in-hospital mortality rate declined from 8.4% in 2007 to 4.9% in 2017 (P <0.001) and discharge to facilities decreased from 20.4% in 2007 to 17.4% in 2017 (P <0.001). The odds of in-hospital mortality were higher with increasing age (odds ratio (OR): 1.46; 95% confidence interval (CI): 1.38 -1.54; P <0.0001), pneumonia (OR: 4.18; 95% CI: 3.63 - 4.81, P <0.0001), septicemia (OR: 2.50; 95% CI: 2.22 - 2.82; P <0.0001), renal failure (OR: 1.48; 95% CI: 1.34 -1.64; P <0.0001), uninsured/self-pay insurance status (OR: 2.69; 95% CI: 2.18 - 3.3; P <0.0001), rural hospital (OR: 2.26; 95% CI: 1.88 -2.72; P<0.0001), and urban-non-teaching hospitals (OR: 1.38; 95% CI: 1.23 - 1.56; P <0.0001). Also, increasing age (OR: 1.14; 95% CI: 1.11-1.18, P <0.0001), Black race (OR: 1.12; 95% CI: 1.02-1.23, P <0.0001), and multiple comorbidities were associated with higher disability. Conclusion Hospitalizations for MM continued to increase, whereas in-hospital mortality continued to decrease. Advanced age, sepsis, pneumonia, and renal failure were associated with higher odds of mortality in MM patients.
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Affiliation(s)
- Sushmita Khadka
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Swetha Balaji
- Medicine, Scripps Clinic John R. Anderson V Medical Pavilion, San Diego, USA
| | - Japjeet Kaur
- Medicine, Sub-divisional Civil Hospital, Ajnala, IND
| | | | | | | | - Ishani Patel
- Medicine, Houston Medical Center, Warner Robins, USA
| | - Muhammad Qasim
- Internal Medicine, Hospital Corporation of America (HCA) Healthcare/University of South Florida (USF) Morsani College of Medicine Graduate Medical Education (GME) Oak Hill Hospital, Brooksville, USA
| | - Maheshkumar Desai
- Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Dalton, USA
| | - Prakash Maiyani
- Internal Medicine, Gold Coast University Hospital, Southport, AUS
| | | | - Darshan Lal
- Hospital Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Achint A Patel
- Internal Medicine, Hospital Corporation of America (HCA) Healthcare/University of South Florida (USF) Morsani College of Medicine Graduate Medical Education (GME) Oak Hill Hospital, Brooksville, USA
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Hajji M, Barbouch S, Goucha R, Abderrahim E. Multiple Myeloma in a Young Adult with Renal Involvement. Clin Case Rep 2023; 11:e6986. [PMID: 36852120 PMCID: PMC9957701 DOI: 10.1002/ccr3.6986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/06/2022] [Accepted: 01/23/2023] [Indexed: 02/27/2023] Open
Abstract
Multiple myeloma (MM) results from malignant plasma cell disorder. It represents approximately 10% of hematological malignancies and it is typically diagnosed in the elderly with a median age of 70 years and has a steep increase in incidence with advancing age. N Engl J Med. 2004, 1860; Clin Interv Aging. 2020, 619. The incidence of MM has been increasing over time, mostly due to population aging. Mayo Clin Proc. 2010, 225 However, certain MMs are diagnosed at young age even under 40 years old (2%). Leuk Lymphoma. 1998, 493; Blood. 2010, 5501. We report a case of a MM in a thirty-four-year-old woman whose circumstance of discovery was acute kidney failure.
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Affiliation(s)
- Meriam. Hajji
- Department of Medecine ACharles Nicolle HospitalTunisTunisia
- Laboratory of renal pathology LR00SP01TunisTunisia
- Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
| | - Samia. Barbouch
- Department of Medecine ACharles Nicolle HospitalTunisTunisia
- Laboratory of renal pathology LR00SP01TunisTunisia
- Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
| | - Rim. Goucha
- Laboratory of renal pathology LR00SP01TunisTunisia
- Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
| | - Ezzeddine. Abderrahim
- Department of Medecine ACharles Nicolle HospitalTunisTunisia
- Laboratory of renal pathology LR00SP01TunisTunisia
- Faculty of Medecine of TunisTunis El Manar UniversityTunisTunisia
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Cheng J, Li Q, Xiao S, Nie L, Liao J, Jiang Q, Xiang B, Zhang H, Jiang Y, Yao C. The advanced lung cancer inflammation index predicts chemotherapy response and infection risk in multiple myeloma patients receiving induction chemotherapy. Front Genet 2022; 13:1047326. [PMID: 36425070 PMCID: PMC9678942 DOI: 10.3389/fgene.2022.1047326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/24/2022] [Indexed: 10/13/2023] Open
Abstract
Objective: This study aims to determine the clinical significance of the advanced lung cancer inflammation index (ALI) in predicting prognosis, chemotherapy response, and infection risk in newly diagnosed multiple myeloma (MM) patients receiving induction therapy. Methods: A retrospective analysis of the clinical characteristics and laboratory data of 111 newly diagnosed MM patients from the Haematology Department of the Third Xiangya Hospital of Central South University from January 2014 to March 2020 was performed. We first determined the relationship between ALI and overall survival (OS), as well as clinical and laboratory parameters. Second, predictive factors for chemotherapy response were analysed by univariate and multivariate regression analyses. Third, univariate regression analysis of risk factors was performed using infection as the evaluable outcome. Results: Of the 111 evaluable patients, the low ALI group (<32.7) exhibited significantly poorer survival than the high ALI group (51 months versus 77 months). Multivariable analysis showed that advanced age, chemotherapy response and serum calcium level were independent prognostic factors for OS. Better chemotherapy efficacy in the high ALI group (89.3%) than in the low ALI group (42.2%) (p < 0.001) was noted. Multivariate analysis suggested that only ALI [HR: 0.110, 95% CI (0.035-0.350), p = 0.000] is an independent predictive factor in evaluating the efficiency of induction chemotherapy. Forty patients (36.04%) presented with infection after induction chemotherapy. Univariate analysis suggested that low ALI and abnormal renal function increase risk of infection in newly diagnosed MM patients. Conclusion: Our study confirmed that ALI is not only a prognostic biomarker for newly diagnosed patients, but also predicts chemotherapy efficacy in newly diagnosed MM patients receiving induction therapy.
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Affiliation(s)
- Jie Cheng
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Qianyuan Li
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Sheng Xiao
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lu Nie
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianping Liao
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Qingjie Jiang
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Biyu Xiang
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Hongfei Zhang
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yanhong Jiang
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Chenjiao Yao
- The Third Xiangya Hospital of Central South University, Changsha, China
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
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Baumgart L, Barz M, Delbridge C, Aftahy AK, Janssen IK, Jost PJ, Ryang YM, Meyer B, Gempt J. Spinal Lesions as Clinical Manifestations of Plasma Cell Neoplasia. Curr Oncol 2022; 29:6236-6244. [PMID: 36135059 PMCID: PMC9497614 DOI: 10.3390/curroncol29090490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Plasma cell neoplasia can be separated into independent subtypes including multiple myeloma (MM) and solitary plasmacytoma of the bone (SBP). The first clinical signs patients present with are skeletal pain, most commonly involving ribs and vertebrae. (2) Methods: Retrospective analysis of 114 patients (38 female, 76 male) receiving spinal surgery from March 2006 until April 2020. Neurological impairments and surgical instability were the criteria for intervention in this cohort. Analysis was based on demographic data, Spinal Instability Neoplastic Score (SINS), location of the lesion, spinal levels of tumor involvement, surgical treatment, histopathological workup, adjuvant therapy, functional outcome, and overall survival (OS). (3) Results: The following surgical procedures were performed: posterior stabilization only in 9 patients, posterior stabilization and decompression without vertebral body replacement in 56 patients, tumor debulking and decompression only in 8 patients, anterior approach in combined approach without vertebral body replacement and without biopsy and/or without kyphoplasty in 33 patients, 3 patients received biopsies only, and 5 patients received kyphoplasty only. The histopathology diagnoses were MM in 94 cases and SBP in 20 cases. Median OS was 72 months (53.4–90.6 months). Preoperative KPSS was 80% (range 40–100%), the postoperative KPSS was 80% (range 50–100%). (4) Conclusions: Surgery for patients with plasma cell neoplasia is beneficial in case of neurological impairment and spinal instability. Moreover, we were able to show that patients with MM and a low number of spinal levels to be supplied have a better prognosis as well as a younger age at the time of the surgical intervention.
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Affiliation(s)
- Lea Baumgart
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- Correspondence:
| | - Melanie Barz
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Claire Delbridge
- Department of Neuropathology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Amir Kaywan Aftahy
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Insa Katrin Janssen
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, 1205 Genève, Switzerland
| | - Philipp J. Jost
- III. Medical Department of Hematology and Oncology, Klinikum rechts der Isar, School of Medicine, Tech-nical University Munich, 81675 Munich, Germany
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
- Department of Neurosurgery, Helios Klinikum Berlin Buch, 13125 Berlin, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany
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Bove V, Riva E, Vásquez J, Peña C, Seehaus C, Samanez C, Bustos J, Hernández M, Fernández J, Ríos O, Rodríguez Y, Figueredo I, Fantl D, Malpica L. Epidemiology and Risk Factors for the Development of Infectious Complications in Newly Diagnosed Multiple Myeloma: A Multicenter Prospective Cohort Study in Latin America. JCO Glob Oncol 2022; 8:e2200068. [PMID: 35867949 PMCID: PMC9812460 DOI: 10.1200/go.22.00068] [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] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Infections are a significant cause of morbidity and mortality in patients with multiple myeloma (MM). In Latin America, data on infectious complications in this patient population are lacking. METHODS We conducted a prospective cohort study of patients with newly diagnosed MM (NDMM) in seven Latin American countries between June 2019 and May 2020. Patients with active disease, on active therapy, and with a follow-up of 6 months from the time of diagnosis were included. Our primary end point was the number of infectious events that required hospitalization for ≥ 24 hours. RESULTS Of 248 patients with NDMM, 89 (35.9%) had infectious complications (113 infectious events), the majority (67.3%) within the first 3 months from diagnosis. The most common sites of infection were respiratory (38%) and urinary tract (31%). The microbial agent was identified in 57.5% of patients with gram-negative bacteria (73.5%) as the most common pathogen. Viral infections were infrequent, and no patients with fungal infection were reported. In the multivariable analysis, diabetes mellitus (odds ratio [OR], 2.71; 95% CI, 1.23 to 6.00; P = .014), creatinine ≥ 2 mg/dL (OR, 4.87; 95% CI, 2.29 to 10.35; P < .001), no use of trimethoprim-sulfamethoxazole prophylaxis (OR, 6.66; 95% CI, 3.43 to 12.92; P < .001), and treatment with immunomodulatory drugs (OR, 3.02; 95% CI, 1.24 to 6.29; P = .003) were independent factors associated with bacterial infections. At 6 months, 21 patients (8.5%) had died, 47.6% related to infectious complications. CONCLUSION Bacterial infections are a substantial cause of hospital admissions and early death in patients with NDMM. Antibiotic prophylaxis should be considered to reduce infectious complications in patients with MM.
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Affiliation(s)
- Virginia Bove
- Department of Hematology, Hospital Central de las FF.AA., Montevideo, Uruguay,Virginia Bove, MD, Department of Hematology, Hospital Central de las FF.AA., Av. 8 de Octubre 3060, Montevideo 11600, Uruguay; Twitter: @VirginiaBove10; e-mail:
| | - Eloísa Riva
- Department of Hematology, Hospital de Clínicas, Montevideo, Uruguay
| | - Jule Vásquez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Camila Peña
- Department of Hematology, Hospital del Salvador, Santiago, Chile
| | - Cristian Seehaus
- Department of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - César Samanez
- Department of Medical Oncology, Oncosalud—AUNA, Lima, Peru
| | - Justina Bustos
- Department of Hematology and Bone Marrow Transplantation, Instituto Oncológico Nacional, Panamá, Panamá
| | - Marcos Hernández
- Department of Hematology, Universidad de Carabobo, Hospital Metropolitano del Norte, Carabobo, Venezuela
| | - Julio Fernández
- Department of Hematology, Hospital General Universitario Dr Gustavo Aldereguía Lima, Cienfuegos, Cuba
| | - Oliday Ríos
- Department of Hematology, Hospital Hermanos Ameijeiras, La Habana, Cuba
| | - Yusaima Rodríguez
- Department of Hematology, Hospital Hermanos Ameijeiras, La Habana, Cuba
| | - Irving Figueredo
- Department of Hematology, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba
| | - Dorotea Fantl
- Department of Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Malpica
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
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Serum Free Light-Chain Ratio at Diagnosis Is Associated with Early Renal Damage in Multiple Myeloma: A Case Series Real-World Study. Biomedicines 2022; 10:biomedicines10071657. [PMID: 35884962 PMCID: PMC9313319 DOI: 10.3390/biomedicines10071657] [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: 06/16/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
The serum free light-chain (FLC) ratio is a sensitive tool for the differential diagnosis of plasma cell disorders and is biomarker of multiple myeloma (MM) progression from premalignant conditions. Here, we investigate the potential role of FLC ratio at diagnosis in identifying early renal damage in MM patients and other correlations with clinical, laboratory, and molecular findings. A total of 34 MM patients who had undergone autologous stem cell transplantation were included in this retrospective case series study, and FLC quantification was performed with nephelometric assays. In our study, sFLC ratio was significantly associated with light-chain MM and β-2 microglobulin levels, likely indicating a high disease burden at diagnosis, especially in patients without heavy chain M-protein at serum electrophoresis. Moreover, the sFLC ratio was inversely correlated with glomerular filtration rate, possibly identifying early renal damage in MM patients. Our preliminary results confirm the importance of early sFLC evaluation, especially in patients with the light-chain MM type and low disease burden, to minimize the risk of late renal failure.
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Sheybani F, Brouwer MC, van de Beek D. BACTERIAL MENINGITIS IN PATIENTS WITH MULTIPLE MYELOMA: A PROSPECTIVE NATIONWIDE COHORT STUDY AND REVIEW OF THE LITERATURE. Int J Infect Dis 2022; 122:492-496. [PMID: 35760383 DOI: 10.1016/j.ijid.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To study the clinical features of bacterial meningitis in myeloma patients. METHODS We analyzed myeloma patients included in a nationwide cohort of patients >16 years old with community-acquired bacterial meningitis in the Netherlands between 2006 and 2018. Subsequently, we reviewed the literature for articles reporting myeloma patients with bacterial meningitis. RESULTS A total of 27 of 2306 (1.6%) episodes of bacterial meningitis occurred in myeloma patients. Six of 27 (22%) patients received stem cell transplantation. CSF showed a median leukocyte count of 172/µL and 12 (46%) of 26 patients had a CSF leukocyte count <100/µL. Streptococcus pneumoniae was the causative pathogen in 25 (93%) patients. Fourteen (52%) patients had unfavorable outcome of whom 10 (37%) died. Ninety-one myeloma patients with bacterial meningitis were described in the literature. The most common pathogen in these patients was S. pneumoniae (35 of 48; 73%) and four (20%) of 20 cases died. CONCLUSION Bacterial meningitis in patients with multiple myeloma is a severe disease with high rates of unfavorable outcome. Patients often present with a low CSF leukocyte count compared to bacterial meningitis in patients without multiple myeloma. Physicians should have a low threshold to perform a lumbar puncture in myeloma patients and start antibiotic treatment pending CSF chemistry and culture results.
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Affiliation(s)
- Fereshte Sheybani
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Infectious diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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12
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Encinas C, Hernandez-Rivas JÁ, Oriol A, Rosiñol L, Blanchard MJ, Bellón JM, García-Sanz R, de la Rubia J, de la Guía AL, Jímenez-Ubieto A, Jarque I, Iñigo B, Dourdil V, de Arriba F, Pérez-Ávila CC, Gonzalez Y, Hernández MT, Bargay J, Granell M, Rodríguez-Otero P, Silvent M, Cabrera C, Rios R, Alegre A, Gironella M, Gonzalez MS, Sureda A, Sampol A, Ocio EM, Krsnik I, García A, García-Mateo A, Soler JA, Martín J, Arguiñano JM, Mateos MV, Bladé J, San-Miguel JF, Lahuerta JJ, Martínez-López J. A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma. Blood Cancer J 2022; 12:68. [PMID: 35440057 PMCID: PMC9018751 DOI: 10.1038/s41408-022-00652-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022] Open
Abstract
Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures. We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis. The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM. A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0-2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.
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Affiliation(s)
- Cristina Encinas
- Hospital General Universitario Gregorio Marañón (HGUGM), IiSGM, Madrid, Spain
| | | | - Albert Oriol
- Hospital Universitario Germans Trias i Pujol, Badalona (Barcelona), Barcelona, Spain
| | | | | | - José-María Bellón
- Hospital General Universitario Gregorio Marañón (HGUGM), IiSGM, Madrid, Spain
| | - Ramón García-Sanz
- University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | | | - Isidro Jarque
- Hospital Universitario la Fe, CIBERONC, Valencia, Spain
| | | | - Victoria Dourdil
- Hospital Clínico Universitario "Lozano Blesa", Zaragoza, IIS Aragón, Spain
| | | | | | | | | | - Joan Bargay
- Hospital Son Llatzer, Palma de Mallorca, Spain
| | | | | | | | | | - Rafael Rios
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Adrián Alegre
- Hospital Universitario de la Princesa y Hospital Universitario Quirónsalud, Madrid, Spain
| | | | | | - Anna Sureda
- ICO-L'Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Antonia Sampol
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Enrique M Ocio
- Hospital Universitario Marqués de Valdecilla, (IDIVAL). Universidad de Cantabria, Santander, Spain
| | - Isabel Krsnik
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Jesús Martín
- Complejo Hospitalario Regional Virgen del Rocío, CIBERONC, Sevilla, Spain
| | | | - María-Victoria Mateos
- University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Joan Bladé
- Hospital Clinic, CIBERONC, Barcelona, Spain
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13
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Hu Y, Yang H, Fu S, Wu J. Therapeutic Plasma Exchange: For Cancer Patients. Cancer Manag Res 2022; 14:411-425. [PMID: 35140519 PMCID: PMC8818550 DOI: 10.2147/cmar.s340472] [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: 09/21/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Therapeutic plasma exchange is used as a trial method for the treatment of cancer patients. Therapeutic plasma exchange uses in vitro technology to remove pathogenic factors in the plasma, returning the replacement and remaining components to the patient to facilitate cure. In the effort to explore new methods of cancer treatment, the introduction of therapeutic plasma exchange brings new hope for cancer treatment; however, the current evidence supporting therapeutic plasma exchange is controversial, and most of the evidence comes from observational studies, lacking large prospective randomized trials. Therefore, this review attempts to focus on the main indications of therapeutic plasma exchange for the treatment of tumors and their complications, including hematological tumors (multiple myeloma cast nephropathy and hyperviscosity syndrome), nervous system tumors (myasthenia gravis associated with thymoma, paraneoplastic neurological syndrome, Lambert–Eaton myasthenia syndrome, and anti-N-methyl-D-aspartate receptor encephalitis), overdose of chemotherapy drugs. In addition, the issues of side-effects and safety in the use of therapeutic plasma exchange are also discussed. However, well-designed prospective trials are needed to better define the role of therapeutic plasma exchange in cancer.
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Affiliation(s)
- Yuru Hu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hanshan Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Correspondence: Jingbo Wu; Shaozhi Fu, Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China, Tel +8613980257136, Email ;
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14
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Allegra A, Tonacci A, Musolino C, Pioggia G, Gangemi S. Secondary Immunodeficiency in Hematological Malignancies: Focus on Multiple Myeloma and Chronic Lymphocytic Leukemia. Front Immunol 2021; 12:738915. [PMID: 34759921 PMCID: PMC8573331 DOI: 10.3389/fimmu.2021.738915] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Secondary immunodeficiency is reported in most patients with hematological malignancies such as chronic lymphocytic leukemia and multiple myeloma. The aim of our review was to evaluate the existing literature data on patients with hematological malignancies, with regard to the effect of immunodeficiency on the outcome, the clinical and therapeutic approach, and on the onset of noninfectious complications, including thrombosis, pleural effusion, and orofacial complications. Immunodeficiency in these patients has an intense impact on their risk of infection, in turn increasing morbidity and mortality even years after treatment completion. However, these patients with increased risk of severe infectious diseases could be treated with adequate vaccination coverage, but the vaccines' administration can be associated with a decreased immune response and an augmented risk of adverse reactions. Probably, immunogenicity of the inactivated is analogous to that of healthy subjects at the moment of vaccination, but it undertakes a gradual weakening over time. However, the dispensation of live attenuated viral vaccines is controversial because of the risk of the activation of vaccine viruses. A particular immunization schedule should be employed according to the clinical and immunological condition of each of these patients to guarantee a constant immune response without any risks to the patients' health.
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MESH Headings
- Animals
- Humans
- Immunocompromised Host
- Immunogenicity, Vaccine
- Immunologic Deficiency Syndromes/epidemiology
- Immunologic Deficiency Syndromes/immunology
- Immunologic Deficiency Syndromes/therapy
- Incidence
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Multiple Myeloma/epidemiology
- Multiple Myeloma/immunology
- Multiple Myeloma/therapy
- Opportunistic Infections/epidemiology
- Opportunistic Infections/immunology
- Opportunistic Infections/prevention & control
- Risk Factors
- Vaccination
- Vaccine Efficacy
- Vaccines/administration & dosage
- Vaccines/adverse effects
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Caterina Musolino
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Sebastiano Gangemi
- School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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15
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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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16
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Banaszkiewicz M, Małyszko J, Vesole DH, Woziwodzka K, Jurczyszyn A, Żórawski M, Krzanowski M, Małyszko J, Batko K, Kuźniewski M, Krzanowska K. New Biomarkers of Ferric Management in Multiple Myeloma and Kidney Disease-Associated Anemia. J Clin Med 2019; 8:jcm8111828. [PMID: 31683939 PMCID: PMC6912471 DOI: 10.3390/jcm8111828] [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: 10/07/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
Multiple myeloma (MM) is a malignancy of clonal plasma cells accounting for approximately 10% of haematological malignancies. MM mainly affects older patients, more often males and is more frequently seen in African Americans. The most frequent manifestations of MM are anaemia, osteolytic bone lesions, kidney failure and hypercalcemia. The anaemia develops secondary to suppression of erythropoiesis by cytokine networks, similarly to the mechanism of anaemia of chronic disease. The concomitant presence of kidney failure, especially chronic kidney disease (CKD) and MM per se, leading to anaemia of chronic disease (ACD) in combination, provoked us to pose the question about their reciprocal dependence and relationship with specific biomarkers; namely, soluble transferrin receptor (sTfR), growth differentiation factor 15 (GDF15), hepcidin 25 and zonulin. One or more of these are new biomarkers of ferric management may be utilized in the near future as prognostic predictors for patients with MM and kidney failure.
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Affiliation(s)
- Małgorzata Banaszkiewicz
- Departament of Nephrology, Jagiellonian University Medical College, Kopernika 15-15c, 31-501 Cracow, Poland.
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Banacha 1a, 02-097 Warsaw, Poland.
| | - David H Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, 92 2nd St, Hackensack, NJ 07601, USA.
| | - Karolina Woziwodzka
- Departament of Nephrology, Jagiellonian University Medical College, Kopernika 15-15c, 31-501 Cracow, Poland.
| | - Artur Jurczyszyn
- Departament of Hematology, Jagiellonian University Medical College, Kopernika 17, 30-501 Cracow, Poland.
| | - Marcin Żórawski
- Departament of Clinical Medicine, Medical University, Szpitalna 37, 15-254 Bialystok, Poland.
| | - Marcin Krzanowski
- Departament of Nephrology, Jagiellonian University Medical College, Kopernika 15-15c, 31-501 Cracow, Poland.
| | - Jacek Małyszko
- Departament of Nephrology, Medical University, Żurawia 14, 15-540 Bialystok, Poland.
| | - Krzysztof Batko
- Departament of Nephrology, Jagiellonian University Medical College, Kopernika 15-15c, 31-501 Cracow, Poland.
| | - Marek Kuźniewski
- Departament of Nephrology, Jagiellonian University Medical College, Kopernika 15-15c, 31-501 Cracow, Poland.
| | - Katarzyna Krzanowska
- Departament of Nephrology, Jagiellonian University Medical College, Kopernika 15-15c, 31-501 Cracow, Poland.
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17
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Kim SH, Kim I, Koh Y, Shin D, Hong J, Seo KS. The importance of physical function in patients with multiple myeloma for improving quality of life. Support Care Cancer 2019; 28:2361-2367. [PMID: 31486982 DOI: 10.1007/s00520-019-05054-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/22/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the relationship between physical function and quality of life in multiple myeloma patients. METHODS In this retrospective cross-sectional study, data from patients with multiple myeloma (N = 63), who were referred to the department of Rehabilitation Medicine from October 2017 to May 2018, were reviewed. Patients were excluded based on the following criteria: acute illness, unstable medical conditions, impaired cognition or communication, refusal, or inability to perform the assessment. Physical function was evaluated with the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-MY20 were used for the evaluation of quality of life. To evaluate fatigue and psychotic status, the Fatigue Severity Scale and Beck Depression Inventory were used. Patients were divided into two groups ("good-function group" and "poor-function group"), based on previously studied normative values of the Mini-BESTest. Clinical data was reviewed to interrogate the contributing factors of physical function. RESULTS Positive correlations were observed between Mini-BESTest scores and all domains of the QLQ-C30. The Mini-BESTest score was lower in patients with lower serum hemoglobin (r = 0.396, p = 0.001) and albumin levels (r = 0.440, p < 0.001), severe disease-related symptoms (r = - 0.39, p = 0.02), and depression (r = - 0.538, p < 0.001). Further, the poor-function group showed lower hemoglobin (p = 0.024) and albumin levels (p = 0.004). CONCLUSION In patients with multiple myeloma, physical function had a significant relationship with quality of life. Low hemoglobin and albumin levels, severe disease- or treatment-related symptoms, and depression were related to decreased physical function, and thus consequentially exert an effect on quality of life in multiple myeloma patients.
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Affiliation(s)
- Shin Hoo Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dongyeop Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Joonsik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kwan Sik Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea. .,Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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18
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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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Li L, Wang L. Multiple Myeloma: What Do We Do About Immunodeficiency? J Cancer 2019; 10:1675-1684. [PMID: 31205523 PMCID: PMC6548011 DOI: 10.7150/jca.29993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is an incurable hematological malignancy. Immunodeficiency results in the incapability of immunity to eradicate both tumor cells and pathogens. Immunotherapies along with antibiotics and other anti-infectious agents are applied as substitutes for immunity in MM. Immunotherapies including monoclonal antibodies, immune checkpoints inhibitors, affinity- enhanced T cells, chimeric antigen receptor T cells and dendritic cell vaccines are revolutionizing MM treatment. By suppressing the pro-inflammatory milieu and pathogens, prophylactic and therapeutic antibiotics represent anti-tumor and anti-infection properties. It is expected that deeper understanding of infection, immunity and tumor physio-pathologies in MM will accelerate the optimization of combined therapies, thus improving prognosis in MM.
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Affiliation(s)
- Linrong Li
- Second Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Hematology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
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20
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Dimopoulos M, Weisel K, van de Donk NWCJ, Ramasamy K, Gamberi B, Streetly M, Offidani M, Bridoux F, de la Rubia J, Mateos MV, Ardizzoia A, Kueenburg E, Collins S, Di Micco A, Rosettani B, Li Y, Bacon P, Sonneveld P. Pomalidomide Plus Low-Dose Dexamethasone in Patients With Relapsed/Refractory Multiple Myeloma and Renal Impairment: Results From a Phase II Trial. J Clin Oncol 2018; 36:2035-2043. [PMID: 29394124 DOI: 10.1200/jco.2017.76.1742] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Renal impairment (RI) limits treatment options in patients with relapsed/refractory multiple myeloma (RRMM). Here, we prospectively studied pomalidomide plus low-dose dexamethasone (LoDEX) in patients with RRMM and moderate or severe RI, including those receiving hemodialysis. Patients and Methods MM-013, a noncomparative, European phase II trial, enrolled three patient cohorts: moderate RI (cohort A; estimated glomerular filtration rate, 30 to < 45 mL/min/1.73 m2); severe RI (cohort B; estimated glomerular filtration rate, < 30 mL/min/1.73 m2); and severe RI that requires hemodialysis (cohort C). Patients received pomalidomide 4 mg/d on days 1 to 21 and LoDEX 20 or 40 mg once per week in 28-day cycles. The primary end point was overall response rate. Results Of 81 enrolled patients (33, 34, and 14 patients in cohorts A, B, and C, respectively), 13 were still receiving treatment at data cutoff (January 28, 2017). Overall response rates were 39.4%, 32.4%, and 14.3%, with a median duration of response of 14.7 months, 4.6 months, and not estimable, respectively. Of importance, 100%, 79.4%, and 78.6% of patients, respectively, achieved disease control. With a median follow-up of 8.6 months, median overall survival was 16.4 months, 11.8 months, and 5.2 months, respectively. Complete renal responses were observed only in cohort A (18.2%), and no patients in cohort C became hemodialysis independent. Grade 3 and 4 hematologic treatment-emergent adverse events and pomalidomide discontinuations as a result of treatment-emergent adverse events occurred more frequently in cohort C. Pomalidomide pharmacokinetics were comparable among the three renal cohorts. Conclusion Pomalidomide 4 mg/d plus LoDEX is efficacious in patients with RRMM with moderate or severe RI, including those who had more advanced disease and required hemodialysis. The safety profile was acceptable among the three groups, and no new safety signals were observed.
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Affiliation(s)
- Meletios Dimopoulos
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Katja Weisel
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Niels W C J van de Donk
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Karthik Ramasamy
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Barbara Gamberi
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Matthew Streetly
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Massimo Offidani
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Frank Bridoux
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Javier de la Rubia
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Maria-Victoria Mateos
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Antonio Ardizzoia
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Elisabeth Kueenburg
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Shona Collins
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Antonia Di Micco
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Barbara Rosettani
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Yan Li
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Pamela Bacon
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
| | - Pieter Sonneveld
- Meletios Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Katja Weisel, University Hospital of Tuebingen, Tuebingen, Germany; Niels W.C.J. van de Donk, VU Universiteit Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Karthik Ramasamy, Oxford University Hospital and NIHR BRC Blood Theme, Oxford; Matthew Streetly, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Barbara Gamberi, Arcispedale S. Maria Nuova, Reggio Emilia; Massimo Offidani, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona; Antonio Ardizzoia, Oncology Department, ASST Lecco, Lecco, Italy; Frank Bridoux, University Hospital and University of Poitiers, Poitiers, France; Javier de la Rubia, Hematology Service University Hospital Doctor Peset and Universidad Católica de Valencia "San Vicente Mártir," Valencia; Maria-Victoria Mateos, Instituto de Investigación Biomédica de Salamanca and University of Salamanca, Salamanca, Spain; Elisabeth Kueenburg, Shona Collins, Antonia Di Micco, Barbara Rosettani, and Pamela Bacon, Celgene International, Boudry, Switzerland; and Yan Li, Translational Development and Clinical Pharmacology, Celgene Corporation, Summit, NJ
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Premuzic V, Batinic J, Roncevic P, Basic-Jukic N, Nemet D, Jelakovic B. Role of Plasmapheresis in the Management of Acute Kidney Injury in Patients With Multiple Myeloma: Should We Abandon It? Ther Apher Dial 2017; 22:79-86. [DOI: 10.1111/1744-9987.12606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/23/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Josip Batinic
- Department of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - Pavle Roncevic
- Department of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - Nikolina Basic-Jukic
- Department of Nephrology, Hypertension, Dialysis and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Damir Nemet
- Department of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
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Heaney JLJ, Campbell JP, Yadav P, Griffin AE, Shemar M, Pinney JH, Drayson MT. Multiple myeloma can be accurately diagnosed in acute kidney injury patients using a rapid serum free light chain test. BMC Nephrol 2017; 18:247. [PMID: 28728609 PMCID: PMC5520226 DOI: 10.1186/s12882-017-0661-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background Acute kidney injury (AKI) is common in patients with multiple myeloma (MM). Whether serum free light chain (sFLC) measurements can distinguish between myeloma and other causes of AKI requires confirmation to guide early treatment. A rapid and portable sFLC test (Seralite®) is newly available and could reduce delays in obtaining sFLC results and accelerate diagnosis in patients with unexplained AKI. This study evaluated the accuracy of Seralite® to identify MM as the cause of AKI. Method sFLCs were retrospectively analysed in patients with AKI stage 3 as per KDIGO criteria (i.e. serum creatinine ≥354 μmol/L or those on dialysis treatment) (n = 99); 45/99 patients had a confirmed MM diagnosis. Results The Seralite® κ:λ FLC ratio accurately diagnosed all MM patients in the presence of AKI: a range of 0.14–2.02 returned 100% sensitivity and specificity for identifying all non-myeloma related AKI patients. The sFLC difference (dFLC) also demonstrated high sensitivity (91%) and specificity (100%): an optimal cut-off of 399 mg/L distinguished between myeloma and non-myeloma AKI patients. We propose a pathway of patient screening and stratification in unexplained AKI for use of Seralite® in clinical practice, with a κ:λ ratio range of 0.14–2.02 and dFLC 400 mg/L as decision points. Conclusions Seralite® accurately differentiates between AKI due to MM and AKI due to other causes in patients considered at risk of myeloma. This rapid test can sensitively screen for MM in patients with AKI and help inform early treatment intervention.
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Affiliation(s)
- Jennifer L J Heaney
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | - John P Campbell
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.,Department for Health, University of Bath, Bath, UK
| | - Punit Yadav
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.,Department of Renal Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ann E Griffin
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | | | - Jennifer H Pinney
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.,Department of Renal Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
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Nwabuko OC, Igbigbi EE, Chukwuonye II, Nnoli MA. Multiple myeloma in Niger Delta, Nigeria: complications and the outcome of palliative interventions. Cancer Manag Res 2017; 9:189-196. [PMID: 28579833 PMCID: PMC5446965 DOI: 10.2147/cmar.s126136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Multiple myeloma (MM) is one of the hematological malignancies that require palliative care. This is because of the life-threatening nature and the suffering associated with the illness. The aim of this study is to bring to the fore the complications experienced by people living with MM in the Niger-Delta region of Nigeria and the outcome of various palliative interventions. Methods This was a 10-year multi-center retrospective study of 26 patients diagnosed and managed in three major centers in the Niger-Delta region of Nigeria from January 2003 to December 2012. Information on the clinical, laboratory, radiological data, and palliative treatment was obtained at presentation and subsequently at intervals of 3 months until the patient was lost to follow-up. Result The mean duration from onset of symptoms to diagnosis was 13.12 months (95% CI, 6.65–19.58). A total of 16 (61.5%), eight (30.8%), and two subjects (7.7%) presented in Durie–Salmon (DS) stages III, II, and I, respectively. The complications presented by patients at diagnoses included bone pain (84.6%), anemia (61.5%), nephropathy (23.1%), and hemiplegia (35%). All the patients received analgesics, while 50.0% received blood transfusion, 56.7% had surgery performed, 19% had hemodialysis, and 3.8% received radiotherapy. A total of 10 (38%) patients benefited from bisphosphonates (BPs). A total of 57.6% of patients were on melphalan–prednisone (MP) double regimen, while 19% and 8% patients were on MP–thalidomide and MP–bortezomib triple regimens, respectively. A total of 3.8% of patients at DS stage IIIB disease had autologous stem-cell transplantation (ASCT). Only 7.6% of the myeloma patients survived up to 5 years post diagnosis. The overall mean survival interval was 39.7 months (95% CI, 32.1–47.2). Conclusion Late diagnosis and inadequate palliative care account for major complications encountered by MM patients in the Niger-Delta region of Nigeria. This could be responsible for the poor prognostic outcome and low survival interval of MM individuals in this region. There is, therefore, a need to improve the quality of palliative care received by myeloma patients in this region. This is achievable via provision of relevant and affordable health care facilities for diagnosis and treatment of the disease.
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Affiliation(s)
- Ogbonna Collins Nwabuko
- Department of Haematology, Federal Medical Center, Umuahia.,Department of Haematology, College of Health Science, Abia State University, Aba, Abia State
| | - Elizabeth Eneikido Igbigbi
- Department of Haematology, Blood Transfusion and Immunology, Faculty of Basic Medical Sciences, University of Port Harcourt, Port Harcourt
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Huang CT, Liu CJ, Ko PS, Liu HT, Yu YB, Hsiao LT, Gau JP, Tzeng CH, Chiou TJ, Liu JH, Yang MH, Huang LJ, Liu CY. Risk factors and characteristics of blood stream infections in patients with newly diagnosed multiple myeloma. BMC Infect Dis 2017; 17:33. [PMID: 28056867 PMCID: PMC5217598 DOI: 10.1186/s12879-016-2155-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with multiple myeloma are generally immune-compromised either due to pronounced depression in primary antibody responses or because of anti-myeloma therapy. Infection is a major risk factor for early deaths among these patients. The impact of blood stream infections (BSI) on newly diagnosed myeloma patients has been less studied. We aimed to study the incidence and risk factors of BSI within 3 months after diagnosis of multiple myeloma in a tertiary referral center. METHODS Between November 2002 and December 2008, consecutive patients with multiple myeloma in Taipei Veterans General Hospital were retrospectively enrolled. Characteristics of patients with or without BSI were collected. Possible factors associated with development of BSI were analyzed by Cox regression. RESULTS There were a total of 222 patients. The incidence of BSI within 3 months after diagnosis is 11.7%. The patients with BSI had poorer survival outcomes than those without (mortality rate: 50% vs. 20.9%, p < 0.001). Moreover, advanced International Staging System stage (stage III vs. I/II: odds ratio [OR] 2.69, p = 0.049) and poor Eastern Cooperative Oncology Group (ECOG) performance status (ECOG > 2 vs. ≤ 2: OR 3.58, p = 0.005) were the independent risk factors of BSI, whereas immunoglobulin deficiency and low absolute lymphocyte count were not associated with risk of BSI development. CONCLUSIONS Our study highlights the characteristic of myeloma patients with BSI and the importance of disease and host factors on risk of BSI. Myeloma patients with risks of BSI should be properly managed to reduce early mortality.
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Affiliation(s)
- Chun-Teng Huang
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Hematology & Oncology, Department of Medicine, Yang-Ming Branch of Taipei City Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Han-Tsung Liu
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Muh-Hwa Yang
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Ju Huang
- National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan.
| | - Chun-Yu Liu
- National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
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25
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Weisel KC, Dimopoulos MA, Moreau P, Lacy MQ, Song KW, Delforge M, Karlin L, Goldschmidt H, Banos A, Oriol A, Alegre A, Chen C, Cavo M, Garderet L, Ivanova V, Martinez-Lopez J, Knop S, Yu X, Hong K, Sternas L, Jacques C, Zaki MH, San Miguel J. Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma. Haematologica 2016; 101:872-8. [PMID: 27081177 DOI: 10.3324/haematol.2015.137083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/12/2016] [Indexed: 01/28/2023] Open
Abstract
Pomalidomide + low-dose dexamethasone is effective and well tolerated for refractory or relapsed and refractory multiple myeloma after bortezomib and lenalidomide failure. The phase III trial MM-003 compared pomalidomide + low-dose dexamethasone with high-dose dexamethasone. This subanalysis grouped patients by baseline creatinine clearance ≥ 30 - < 60 mL/min (n=93, pomalidomide + low-dose dexamethasone; n=56, high-dose dexamethasone) or ≥ 60 mL/min (n=205, pomalidomide + low-dose dexamethasone; n=93, high-dose dexamethasone). Median progression-free survival was similar for both subgroups and favored pomalidomide + low-dose dexamethasone versus high-dose dexamethasone: 4.0 versus 1.9 months in the group with baseline creatinine clearance ≥ 30 - < 60 mL/min (P<0.001) and 4.0 versus 2.0 months in the group with baseline creatinine clearance ≥ 60 mL/min (P<0.001). Median overall survival for pomalidomide + low-dose dexamethasone versus high-dose dexamethasone was 10.4 versus 4.9 months (P=0.030) and 15.5 versus 9.2 months (P=0.133), respectively. Improved renal function, defined as an increase in creatinine clearance from < 60 to ≥ 60 mL/min, was similar in pomalidomide + low-dose dexamethasone and high-dose dexamethasone patients (42% and 47%, respectively). Improvement in progression-free and overall survival in these patients was comparable with that in patients without renal impairment. There was no increase in discontinuations of therapy, dose modifications, and adverse events in patients with moderate renal impairment. Pomalidomide at a starting dose of 4 mg + low-dose dexamethasone is well tolerated in patients with refractory or relapsed and refractory multiple myeloma, and of comparable efficacy if moderate renal impairment is present. This trial was registered with clinicaltrials.gov identifier 01311687 and EudraCT identifier 2010-019820-30.
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Affiliation(s)
- Katja C Weisel
- Hematology and Oncology, Department of Medicine, University Hospital Tübingen, Germany
| | | | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Michel Delforge
- Department of Hematology, University Hospitals Leuven, Belgium
| | - Lionel Karlin
- Centre Hospitalier Lyon Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Anne Banos
- Hematology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Albert Oriol
- Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | | | - Michele Cavo
- Bologna University School of Medicine, Institute of Hematology and Medical Oncology, Bologna, Italy
| | | | | | | | - Stefan Knop
- Hematology and Oncology, Würzburg University Medical Center, Würzburg, Germany
| | - Xin Yu
- Celgene Corporation, Summit, NJ, USA
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26
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Poor Correlation between Pneumococcal IgG and IgM Titers and Opsonophagocytic Activity in Vaccinated Patients with Multiple Myeloma and Waldenstrom's Macroglobulinemia. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:379-85. [PMID: 26912783 DOI: 10.1128/cvi.00654-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/17/2016] [Indexed: 11/20/2022]
Abstract
Patients with multiple myeloma and other B cell disorders respond poorly to pneumococcal vaccination. Vaccine responsiveness is commonly determined by measuring pneumococcal serotype-specific antibodies by enzyme-linked immunosorbent assay (ELISA), by a functional opsonophagocytosis assay (OPA), or by both assays. We compared the two methods in vaccinated elderly patients with multiple myeloma, Waldenstrom's macroglobulinemia, and monoclonal gammopathy of undetermined significance (MGUS). Postvaccination sera from 45 patients (n= 15 from each patient group) and 15 control subjects were analyzed by multiplexed OPA for pneumococcal serotypes 4, 6B, 14, and 23F, and the results were compared to IgG and IgM antibody titers measured by ELISA. While there were significant correlations between pneumococcal OPA and IgG titers for all serotypes among the control subjects (correlation coefficients [r] between 0.51 and 0.85), no significant correlations were seen for any of the investigated serotypes in the myeloma group (r= -0.18 to 0.21) or in the group with Waldenstrom's macroglobulinemia (borderline significant correlations for 2 of 4 serotypes). The MGUS group resembled the control group by having good agreement between the two test methods for 3 of 4 serotypes (r= 0.53 to 0.80). Pneumococcal postvaccination IgM titers were very low in the myeloma patients compared to the other groups and did not correlate with the OPA results. To summarize, our data indicate that ELISA measurements may overestimate antipneumococcal immunity in elderly subjects with B cell malignancies and that a functional antibody test should be used specifically for myeloma and Waldenstrom's macroglobulinemia patients.
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27
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Connelly-Smith LS, Linenberger ML. Therapeutic Apheresis for Patients with Cancer. Cancer Control 2015; 22:60-78. [DOI: 10.1177/107327481502200109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Laura S. Connelly-Smith
- Seattle Cancer Care Alliance, School of Medicine, University of Washington, Seattle, Washington
- Division of Hematology, School of Medicine, University of Washington, Seattle, Washington
| | - Michael L. Linenberger
- Seattle Cancer Care Alliance, School of Medicine, University of Washington, Seattle, Washington
- Division of Hematology, School of Medicine, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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28
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Oriol A. Pomalidomide in the treatment of multiple myeloma and perspectives in other hematological malignancies. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Pomalidomide is an immunomodulatory drug recently approved by the US FDA and EMA for the treatment of refractory and relapsed multiple myeloma. Pomalidomide appears to be more potent and less toxic than thalidomide and lenalidomide and has proven to be effective in a proportion of patients already exposed and refractory to these agents. The approved combination of pomalidomide and weekly dexamethasone offers clinical benefit to at least one-third of patients with multiple myeloma that have failed both bortezomib and lenolidomide treatment. This review will focus on the preclinical data and clinical experience in this setting. Off-label use of pomalidomide, mainly its combination with other active drugs for multiple myeloma and the role of pomalidomide in other hematologic malignancies still remain to be explored in depth and are discussed briefly.
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29
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Pathogenesis of renal failure in multiple myeloma: any role of contrast media? BIOMED RESEARCH INTERNATIONAL 2014; 2014:167125. [PMID: 24877060 PMCID: PMC4022292 DOI: 10.1155/2014/167125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022]
Abstract
The spectrum of kidney disease-associated monoclonal immunoglobulin and plasma cell malignancies is remarkably broad and encompasses nearly all nephropathologic entities. Multiple myeloma with kidney impairment at presentation is a medical emergency since the recovery of kidney function is associated with survival benefits. In most cases, kidney impairment may be the first clinical manifestation of malignant plasma cell dyscrasias like multiple myeloma and light chain amyloidosis. Multiple myeloma per se cannot be considered a main risk factor for developing acute kidney injury following intravascular administration of iodinated contrast media. The risk is increased by comorbidities such as chronic kidney disease, diabetes, hypercalcemia, dehydration, and use of nephrotoxic drugs. Before the administration of contrast media, the current recommended laboratory tests for assessing kidney function are serum creatinine measurement and the estimation of glomerular filtration rate by using the CKD-EPI equation. The assessment of Bence Jones proteinuria is unnecessary for evaluating the risk of kidney failure in patients with multiple myeloma, since this test cannot be considered a surrogate biomarker of kidney function.
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30
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Kastritis E, Terpos E, Dimopoulos MA. Current treatments for renal failure due to multiple myeloma. Expert Opin Pharmacother 2013; 14:1477-95. [DOI: 10.1517/14656566.2013.803068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Karlsson J, Hogevik H, Andersson K, Roshani L, Andréasson B, Wennerås C. Pneumococcal vaccine responses in elderly patients with multiple myeloma, Waldenstrom’s macroglobulinemia, and monoclonal gammopathy of undetermined significance. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.trivac.2013.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Successful Treatment of Patients With Multiple Myeloma and Impaired Renal Function With Lenalidomide: Results of 4 German Centers. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:191-6. [DOI: 10.1016/j.clml.2012.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/23/2011] [Accepted: 01/09/2012] [Indexed: 11/21/2022]
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33
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Faiman BM, Mangan P, Spong J, Tariman JD. Renal complications in multiple myeloma and related disorders: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs 2012; 15 Suppl:66-76. [PMID: 21816711 DOI: 10.1188/11.cjon.s1.66-76] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kidney dysfunction is a common clinical feature of symptomatic multiple myeloma. Some degree of renal insufficiency or renal failure is present at diagnosis or will occur during the course of the disease and, if not reversed, will adversely affect overall survival and quality of life. Chronic insults to the kidneys from other illnesses, treatment, or multiple myeloma itself can further damage renal function and increase the risk for additional complications, such as anemia. Patients with multiple myeloma who have light chain (Bence Jones protein) proteinuria may experience renal failure or progress to end-stage renal disease (ESRD) and require dialysis because of light chain cast nephropathy. Kidney failure in patients with presumed multiple myeloma also may result from amyloidosis, light chain deposition disease, or acute tubular necrosis caused by nephrotoxic agents; therefore, identification of patients at risk for kidney damage is essential. The International Myeloma Foundation's Nurse Leadership Board has developed practice recommendations for screening renal function, identifying positive and negative contributing risk and environmental factors, selecting appropriate therapies and supportive care measures to decrease progression to ESRD, and enacting dialysis to reduce and manage renal complications in patients with multiple myeloma.
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Affiliation(s)
- Beth M Faiman
- Hematology and Medical Oncology Department, Cleveland Clinic in Ohio, USA.
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34
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Chanan-Khan AA, San Miguel JF, Jagannath S, Ludwig H, Dimopoulos MA. Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment. Clin Cancer Res 2012; 18:2145-63. [PMID: 22328563 DOI: 10.1158/1078-0432.ccr-11-0498] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal impairment is a major complication of multiple myeloma. Patients presenting with severe renal impairment represent a greater therapeutic challenge and generally have poorer outcome. However, once patients with renal impairment achieve remission, their outcomes are comparable with those of patients without renal impairment. Therapies that offer substantial activity in this setting are needed. Bortezomib, thalidomide, and lenalidomide have substantially improved the survival of patients with multiple myeloma. Here we review the pharmacokinetics, activity, and safety of these agents in patients with renal impairment. Bortezomib can be administered at the full approved dose and schedule in renally impaired patients; similarly, no dose reductions are required with thalidomide. The pharmacokinetics of lenalidomide is affected by its renal route of excretion, and dose adjustments are recommended for moderate/severe impairment. Substantial evidence has emerged showing that these novel agents improve outcomes of patients with renal impairment, including impairment reversal. Bortezomib, thalidomide, and lenalidomide (at the recommended doses) are active options for patients with mild to moderate impairment, although limited data are available for thalidomide. Information on lenalidomide-based combinations is still emerging, but the available data indicate considerable activity. Substantial evidence indicates that bortezomib-high-dose dexamethasone with or without a third drug (e.g., cyclophosphamide, thalidomide, or doxorubicin) is an appropriate option for patients with any degree of renal impairment.
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Affiliation(s)
- Asher A Chanan-Khan
- Roswell Park Cancer Institute, Buffalo, and Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA
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35
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Extracorporeal light chain elimination: high cut-off (HCO) hemodialysis parallel to chemotherapy allows for a high proportion of renal recovery in multiple myeloma patients with dialysis-dependent acute kidney injury. Ann Hematol 2011; 91:729-735. [DOI: 10.1007/s00277-011-1383-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/28/2011] [Indexed: 01/22/2023]
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36
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Ludwig H, Zojer N. Supportive therapy in multiple myeloma. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 2011; 183:307-33. [PMID: 21509692 DOI: 10.1007/978-3-540-85772-3_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this chapter we want to give an overview on various supportive measures, which help to prevent or to fight complications of multiple myeloma, improve patient wellbeing and increase safety of administration of specific anti-myeloma therapy.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria.
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37
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Comparative study of immune status to infectious agents in elderly patients with multiple myeloma, Waldenstrom's macroglobulinemia, and monoclonal gammopathy of undetermined significance. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:969-77. [PMID: 21508164 DOI: 10.1128/cvi.00021-11] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Whereas patients with multiple myeloma (MM) have a well-documented susceptibility to infections, this has been less studied in other B-cell disorders, such as Waldenstrom's macroglobulinemia (WM) and monoclonal gammopathy of undetermined significance (MGUS). We investigated the humoral immunity to 24 different pathogens in elderly patients with MM (n = 25), WM (n = 16), and MGUS (n = 18) and in age-matched controls (n = 20). Antibody titers against pneumococci, staphylococcal alpha-toxin, tetanus and diphtheria toxoids, and varicella, mumps, and rubella viruses were most depressed in MM patients, next to lowest in WM and MGUS patients, and highest in the controls. In contrast, levels of antibodies specific for staphylococcal teichoic acid, Moraxella catarrhalis, candida, aspergillus, and measles virus were similarly decreased in MM and MGUS patients. Comparable titers in all study groups were seen against Haemophilus influenzae type b (Hib), borrelia, toxoplasma, and members of the herpesvirus family. Finally, a uniform lack of antibodies was noted against Streptococcus pyogenes, salmonella, yersinia, brucella, francisella, and herpes simplex virus type 2. To conclude, although MM patients displayed the most depressed humoral immunity, significantly decreased antibody levels were also evident in patients with WM and MGUS, particularly against Staphylococcus aureus, pneumococci, and varicella. Conversely, immunity was retained for Hib and certain herpesviruses in all study groups.
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39
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Yu SF, Lui CC, Pei SN, Liu JW, Cheng TT. Unsuspected multiple myeloma presenting as Escherichia coli infectious spondylitis: a case report. Int J Rheum Dis 2011; 13:e55-8. [PMID: 21199454 DOI: 10.1111/j.1756-185x.2010.01558.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Multiple myeloma associated with infectious spondylitis at initial presentation is rare. We report a previously healthy woman with back pain for 3 weeks, initially diagnosed as Escherichia coli infectious spondylitis. Because magnetic resonance imaging revealed skip lesions other than infectious spondylitis, extensive work-up disclosed monoclonal immunoglobulin G kappa and 30% plasma cells in bone marrow. The patient was treated with antibiotics for 8 weeks without recurrence in the subsequent 6 months. Although the panorama of infectious spondylitis was obvious and substantial, our case demonstrates that further investigations for underlying diseases are critical, especially when image findings are incompatible with common presentations of infectious spondylitis.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy and Immunology Department of Radiology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang-Gung University College of Medicine, Kaohsiung, Taiwan
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40
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Dimopoulos MA, Terpos E, Chanan-Khan A, Leung N, Ludwig H, Jagannath S, Niesvizky R, Giralt S, Fermand JP, Bladé J, Comenzo RL, Sezer O, Palumbo A, Harousseau JL, Richardson PG, Barlogie B, Anderson KC, Sonneveld P, Tosi P, Cavo M, Rajkumar SV, Durie BG, San Miguel J. Renal Impairment in Patients With Multiple Myeloma: A Consensus Statement on Behalf of the International Myeloma Working Group. J Clin Oncol 2010; 28:4976-84. [DOI: 10.1200/jco.2010.30.8791] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m2) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease.
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Affiliation(s)
- Meletios A. Dimopoulos
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Evangelos Terpos
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Asher Chanan-Khan
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Nelson Leung
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Heinz Ludwig
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Sundar Jagannath
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Ruben Niesvizky
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Sergio Giralt
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jean-Paul Fermand
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Joan Bladé
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Raymond L. Comenzo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Orhan Sezer
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Antonio Palumbo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jean-Luc Harousseau
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Paul G. Richardson
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Bart Barlogie
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Kenneth C. Anderson
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Pieter Sonneveld
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Patrizia Tosi
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Michele Cavo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - S. Vincent Rajkumar
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Brian G.M. Durie
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jésus San Miguel
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
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Dimopoulos M, Alegre A, Stadtmauer EA, Goldschmidt H, Zonder JA, de Castro CM, Masliak Z, Reece D, Olesnyckyj M, Yu Z, Weber DM. The efficacy and safety of lenalidomide plus dexamethasone in relapsed and/or refractory multiple myeloma patients with impaired renal function. Cancer 2010; 116:3807-14. [PMID: 20564094 PMCID: PMC2970911 DOI: 10.1002/cncr.25139] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND: In patients with multiple myeloma, renal impairment (RI) at the time of diagnosis is associated with poor survival. To the authors' knowledge, the current retrospective analysis presented is the first to assess the impact of various degrees of renal dysfunction on safety and efficacy outcomes in a large cohort of patients with relapsed and/or refractory multiple myeloma who received treatment with lenalidomide plus dexamethasone. METHODS: Three hundred fifty-three patients from 2 large phase 3 trials were randomized to receive lenalidomide (25 mg) plus dexamethasone (40 mg). For the purpose of this analysis, RI was defined according to the calculated creatinine clearance (CLCr) level as follows: mild or no RI (CLCr ≥ 60 mL/minute), moderate RI (CLCr from ≥ 30 mL/minute to <60 mL/minute), and severe RI (CLCr <30 mL/minute). RESULTS: The RI subgroups did not differ significantly in terms of the overall response rate (range, 50%-64%) or response quality (very good partial response or better, 27%-37%). In all RI subgroups, the time to progression and progression-free survival did not differ significantly compared with the mild or no RI group. Patients with RI experienced an increased incidence of thrombocytopenia, required more frequent lenalidomide dose reduction or interruption, and had shorter overall survival than patients with mild or no RI (P = .006). Lenalidomide plus dexamethasone led to improvement in renal function in the majority of patients. CONCLUSIONS: The results from this study indicated that, with careful monitoring of the CLCr level and adverse events as well as appropriate dose adjustments, lenalidomide plus dexamethasone is an effective and well tolerated treatment option for patients with multiple myeloma who have RI. Cancer 2010. © 2010 American Cancer Society.
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Affiliation(s)
- Meletios Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
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Guney I, Solak Y, Atalay H, Altintepe L, Tonbul HZ. A rare masquerader of lung cancer: nonsecretory multiple myeloma with plasmacytoma of bone presenting as acute kidney injury. Intern Med 2010; 49:2133-5. [PMID: 20930442 DOI: 10.2169/internalmedicine.49.3709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Multiple myeloma (MM) is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells which produce immunglobulins. If a monoclonal spike is not found in serum or urine but the patient has clinical findings and bone marrow plasma cell infiltration suggestive of MM, then the patient may have a rare subtype known as nonsecretory multiple myeloma (NSMM). Here, we describe a rare case of NSMM with plasmacytoma of bone who presented with severe hypercalcemia, acute kidney injury and a large thoracal mass on chest X-ray masquerading as lung cancer.
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Affiliation(s)
- Ibrahim Guney
- Department of Nephrology, Meram Research and Training Hospital, Konya, Turkey
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KALAMBOKIS GN, CHRISTOU L, TSIANOS EV. Multiple myeloma presenting with an acute bacterial infection. Int J Lab Hematol 2009; 31:375-83. [DOI: 10.1111/j.1751-553x.2009.01154.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Renal failure is a frequent complication in patients with multiple myeloma (MM) that causes significant morbidity. In the majority of cases, renal impairment is caused by the accumulation and precipitation of light chains, which form casts in the distal tubules, resulting in renal obstruction. In addition, myeloma light chains are also directly toxic on proximal renal tubules, further adding to renal dysfunction. Adequate hydration, correction of hypercalcemia and hyperuricemia and antimyeloma therapy should be initiated promptly. Recovery of renal function has been reported in a significant proportion of patients treated with conventional chemotherapy, especially when high-dose dexamethasone is also used. Severe renal impairment and large amount of proteinuria are associated with a lower probability of renal recovery. Novel agents, such as thalidomide, bortezomib and lenalidomide, have significant activity in pretreated and untreated MM patients. Although there is limited experience with thalidomide and lenalidomide in patients with renal failure, data suggest that bortezomib may be beneficial in this population. Clinical studies that have included newly diagnosed and refractory patients indicate that bortezomib-based regimens may result in rapid reversal of renal failure in up to 50% of patients and that full doses of bortezomib can be administered without additional toxicity.
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Puig N, De La Rubia J, Jarque I, Salavert M, Moscardó F, Sanz J, Lorenzo I, Montesinos P, Martín G, Martínez J, Sanz G, Blanes M, Sanz M. Characteristics of and risk factors for pneumonia in patients with hematological malignancies developing fever after autologous blood stem cell transplantation. Leuk Lymphoma 2008; 48:2367-74. [PMID: 18067012 DOI: 10.1080/10428190701694178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We analyzed the incidence, etiology, risk factors and outcomes of 49 episodes of pneumonia that developed in 326 adult patients undergoing autologous stem-cell transplantation (ASCT) from January 1990 to December 2005. The median time for the onset of pneumonia after transplantation was 11 days (range 0-148). Empirical antibiotic therapy in patients with pneumonia consisted of piperacillin-tazobactam (20 cases, 49%), third-generation cephalosporin (11 cases, 27%) and carbapenem (8 cases, 19%). Multivariate analysis showed that a higher risk of pneumonia could be predicted for patients with myeloma (P = 0.006) and for patients with an absolute neutrophil count <0.5 x 10(9)/L >7 days (P = 0.008). Cumulative incidence of transplant-related mortality at 6 months was 51% versus 8% for patients with or without pneumonia, respectively (P = 0.001). Pneumonia after ASCT is a severe complication more commonly observed in patients with myeloma and with prolonged duration of neutropenia.
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Affiliation(s)
- Noemí Puig
- Hematology Service, University Hospital La Fe, Valencia, Spain
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Efficacy and safety of bortezomib in patients with renal impairment: results from the APEX phase 3 study. Leukemia 2008; 22:842-9. [PMID: 18200040 DOI: 10.1038/sj.leu.2405087] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Renal impairment is associated with poor prognosis in multiple myeloma (MM). This subgroup analysis of the phase 3 Assessment of Proteasome Inhibition for Extending Remissions (APEX) study of bortezomib vs high-dose dexamethasone assessed efficacy and safety in patients with relapsed MM with varying degrees of renal impairment (creatinine clearance (CrCl) <30, 30-50, 51-80 and >80 ml min(-1)). Time to progression (TTP), overall survival (OS) and safety were compared between subgroups with CrCl < or =50 ml min(-1) (severe-to-moderate) and >50 ml min(-1) (no/mild impairment). Response rates with bortezomib were similar (36-47%) and time to response rapid (0.7-1.6 months) across subgroups. Although the trend was toward shorter TTP/OS in bortezomib patients with severe-to-moderate vs no/mild impairment, differences were not significant. OS was significantly shorter in dexamethasone patients with CrCl < or =50 vs >50 ml min(-1) (P=0.003), indicating that bortezomib is more effective than dexamethasone in overcoming the detrimental effect of renal impairment. Safety profile of bortezomib was comparable between subgroups. With dexamethasone, grade 3/4 adverse events (AEs), serious AEs and discontinuations for AEs were significantly elevated in patients with CrCl < or =50 vs >50 ml min(-1). These results indicate that bortezomib is active and well tolerated in patients with relapsed MM with varying degrees of renal insufficiency. Efficacy/safety were not substantially affected by severe-to-moderate vs no/mild impairment.
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Abstract
Multiple myeloma is the second most common hematological malignancy. It is defined by the presence of monoclonal plasma cells capable to produce a monoclonal paraprotein causing clinical abnormalities such as anemia, renal insufficiency, hypercalcemia, or bone lesions. New chromosomal or molecular abnormalities have been identified allowing a better management. Multiple myeloma is treatable and, although it remains incurable, the patient prognosis and quality of life has notably improved, so it is not rare to see series with a median survival longer than 5 years. Even more, it is possible by now to expect improvements respect to the standard autologous stem cell transplantation. This must be attributed to the emergence of a number of new therapies entering clinical practice over the last 6 years: thalidomide (Thalidomid Pharmion, Boulder, CO, USA), lenalidomide (Revlimid, Celgene Corporation, Summit, NJ, USA) and bortezomib (Velcade, Janssen Pharmaceutica N.V., Belgium). Finally, we also will review the current clinical experience in supportive therapy, which has also contributed to the patient outcome improvement with approaches such as: new indications for dialysis, use of erythropoietin receptor stimulating agents and bisphosphonates, and new surgical therapies such as vertebroplastia and kyphoplastia.
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Affiliation(s)
- Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca, Centro de Investigación del Cáncer, Salamanca, España.
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Abstract
Current standards of care for first-line treatment of multiple myeloma are evolving rapidly because of the introduction of regimens based on novel agents with unique mechanisms of action: the proteasome inhibitor bortezomib and the immunomodulatory drugs thalidomide and lenalidomide. These regimens are becoming increasingly widely used, offering substantially greater benefit to patients in terms of higher response rates and, more importantly, prolonged response durations and survival compared with established standard first-line treatment strategies. A notable aspect of many of these emerging treatment options is the very high rates of complete response (CR) reported, previously only seen with transplantation-based strategies. Achievement of CR is prognostic for improved overall survival; therefore, the higher rates and quality of responses seen with the new regimens might substantially improve patient outcomes versus established standards of care. For example, addition of each of the 3 novel agents to melphalan/prednisone results in higher overall response rates and CR rates, as well as prolonged progression-free and overall survival, compared with melphalan/prednisone alone. Similar substantial improvements in response are seen with addition of the 3 agents to single-agent dexamethasone and the use of bortezomib or thalidomide in VAD (vincristine/doxorubicin/dexamethasone)-like regimens, as induction therapies before stem cell transplantation and in patients not proceeding to transplantation. Ultimately, these novel regimens might obviate the need for stem cell transplantation in a sizeable proportion of patients. The emergence of these new therapeutic options appears likely to significantly alter the first-line treatment paradigm for patients with multiple myeloma.
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Affiliation(s)
- Sundar Jagannath
- St. Vincent's Comprehensive Cancer Center, New York, NY 10011-8202, USA.
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Ardalan MR, Shoja MM. Multiple myeloma presented as acute interstitial nephritis and rheumatoid arthritis-like polyarthritis. Am J Hematol 2007; 82:309-13. [PMID: 17022047 DOI: 10.1002/ajh.20796] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute interstitial nephritis and rheumatoid arthritis (RA) or RA-like polyarthritis are among the very rare paraneoplastic manifestations of multiple myeloma (MM). A 47-year-old man with acute renal failure due to interstitial nephritis was admitted to our university hospital and successfully treated with corticosteroid. He later developed a symmetric distal polyarthritis with morning stiffness mimicking RA. On follow-up, the patient had a rise in serum creatinine, hypercalcemia, anemia, and a monoclonal spike (Bence Jones protein) on the urine protein electrophoresis. Bone marrow biopsy demonstrated a diffuse neoplastic plasma cell infiltration. Diagnosis of MM was made and the patient received chemotherapy. After four-course chemotherapy, the patient's articular manifestations resolved, urine monoclonal spike disappeared, and serum creatinine returned to a near normal level. We hypothesize that in this case, immunologic hypersensitivity reactions to the light-chain molecules or other tumoral antigens deposited within the kidney or joint spaces, in the context of MM cytokine milieu may have resulted in this unusual presentation. Ultimately, clinicians and pathologists should consider MM in the differential diagnosis of the acute interstitial nephritis and RA-like polyarthritis.
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Affiliation(s)
- Mohammad Reza Ardalan
- Department of Nephrology, Dialysis and Renal Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran.
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