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Larsen RF, Jarden M, Minet LR, Frølund UC, Hermann AP, Breum L, Möller S, Abildgaard N. Exercise in newly diagnosed patients with multiple myeloma: A randomized controlled trial of effects on physical function, physical activity, lean body mass, bone mineral density, pain, and quality of life. Eur J Haematol 2024; 113:298-309. [PMID: 38717071 DOI: 10.1111/ejh.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 08/03/2024]
Abstract
Reduced physical function caused by bone destruction, pain, anemia, infections, and weight loss is common in multiple myeloma (MM). Myeloma bone disease challenges physical exercise. Knowledge on the effects and safety of physical exercise in newly diagnosed patients with MM is limited. In a randomized, controlled trial, we studied the effect of a 10-week individualized physical exercise program on physical function, physical activity, lean body mass (LBM), bone mineral density (BMD), quality of life (QoL), and pain in patients newly diagnosed with MM. Lytic bone disease was assessed, and exercise was adjusted accordingly. Primary outcome: knee extension strength. Secondary outcomes: Six-Minute-Walk-Test, 30-s Sit-to-Stand-Test (SST), grip strength, level of physical activity, LBM, BMD, QoL, and pain. Measurements were conducted pre- and post-intervention, and after 6 and 12 months. We included 100 patients, 86 were evaluable; 44 in the intervention group (IG) and 42 in the control group (CG). No statistically significant differences between groups were observed. Knee extension strength declined in the IG (p = .02). SST, aerobic capacity, and global QoL improved in both groups. Pain decreased consistently in the IG regardless of pain outcome. No significant safety concerns of physical exercise in newly diagnosed patients with MM were observed.
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Affiliation(s)
- Rikke F Larsen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth R Minet
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric, Odense University Hospital, Odense, Denmark
- The Competence Centre for Rehabilitation - KCR, Odense University Hospital, Odense, Denmark
| | | | | | - Leif Breum
- Department of Medicine and Endocrinology, Zealand University Hospital, Koge, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Haematology, Odense University Hospital, Odense, Denmark
- The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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Räder J, Ihorst G, Möller MD, Pahl A, Greil C, Dreyling E, Arends J, Deibert P, Wäsch R, Engelhardt M. Physical activity and exercise motivation of multiple myeloma patients: a prospective cross-sectional study. Oncologist 2024:oyae111. [PMID: 38955491 DOI: 10.1093/oncolo/oyae111] [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: 02/28/2024] [Accepted: 04/26/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) is the second most common hematological malignancy with its prevalence increasing. Patients with symptomatic MM can show numerous comorbidities, affecting their quality of life (QoL). Physical activity (PA) may improve QoL but is not a standardized intervention of comprehensive cancer centers (CCCs). Since data on the PA of patients with MM are scarce, we aimed to prospectively assess fitness levels and patients' motivation to join PA-interventions at our CCC. METHODS We generated an exercise questionnaire to interview consecutive patients MM. We prospectively collected data on (a) past and current PA, defined by the World Health Organization (WHO) recommendations, (b) knowledge on exercise effects, (c) exercise motivation, and (d) willingness to participate in PA-interventions. Demographics, comorbidities, response, progression-free survival (PFS), and overall survival (OS) were assessed in 211 symptomatic patients MM. RESULTS While our patients were elderly and most showed bone involvement, their PA was similar to healthy individuals. Aerobic PA (≥ 60 minutes/week) was performed by 65%, and 25% exercised ≥ 150 minutes/week. WHO PA recommendations were fulfilled by 17% of patients. No sport activities or complete physical inactivity were observed in 35% and 16%, respectively. Notably, 38% were motivated to join MM-specific sport interventions. Self-reported knowledge of PA-induced benefits for patients cancer was high (82%), but only 27% knew which exercises were safe to perform. CONCLUSION This study provides an overview of the PA of patients MM. Our results suggest that the PA of patients MM might not be much lower than in the age-matched general population.
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Affiliation(s)
- Jan Räder
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Mandy-Deborah Möller
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Antonia Pahl
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Christine Greil
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Esther Dreyling
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Jann Arends
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Peter Deibert
- Department of Medicine, Medical Center University of Freiburg, Faculty of Medicine, Institute for Exercise and Occupational Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I Hematology and Oncology, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, 79106 Freiburg, Germany
- Clinical Trials Unit, Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Yun X, Zhou Y, Wu D, Liu Y, Wu Q. A real‑world pharmacovigilance study of FDA adverse event reporting system events for daratumumab. Expert Opin Drug Saf 2024; 23:581-591. [PMID: 38600747 DOI: 10.1080/14740338.2024.2328321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Daratumumab, a first-in-class humanized IgG1κ monoclonal antibody that targets the CD38 epitope, has been approved for treatment of multiple myeloma by FDA. The current study was to evaluate daratumumab-related adverse events (AEs) through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS). RESEARCH DESIGN AND METHODS Disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN) and the multi-item gamma Poisson shrinker (MGPS) algorithms were employed to quantify the signals of daratumumab-associated AEs. RESULTS Out of 10,378,816 reports collected from the FAERS database, 8727 reports of daratumumab-associated AEs were identified. A total of 183 significant disproportionality preferred terms (PTs) were retained. Unexpected significant AEs such as meningitis aseptic, leukoencephalopathy, tumor lysis syndrome, disseminated intravascular coagulation, hyperviscosity syndrome, sudden hearing loss, ileus and diverticular perforation were also detected. The median onset time of daratumumab-related AEs was 11 days (interquartile range [IQR] 0-76 days), and most of the cases occurred within 30 days. CONCLUSION Our study found potential new and unexpected AEs signals for daratumumab, suggesting prospective clinical studies are needed to confirm these results and illustrate their relationship.
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Affiliation(s)
- Xiaolin Yun
- Department of Pharmacy, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yingying Zhou
- Department of Pharmacy, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Danna Wu
- Department of Pharmacy, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yuanbo Liu
- Department of Pharmacy, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Qiongshi Wu
- Department of Pharmacy, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Kuehl R, Koeppel M, Goldschmidt H, Maatouk I, Rosenberger F, Wiskemann J. Physical activity-related health competence and symptom burden for exercise prescription in patients with multiple myeloma: a latent profile analysis. Ann Hematol 2023; 102:3091-3102. [PMID: 37355476 PMCID: PMC10567830 DOI: 10.1007/s00277-023-05326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
The purpose of this study is to ensure best possible supply of exercise therapy to patients with multiple myeloma (MM); it is helpful to identify patient groups with similar symptom burden and physical activity-related health competences (PAHCO). Latent profile analyses (LPA) of MM patients were used to identify profiles of patients with similar PAHCO and symptom burden. Analysis of variance was applied to investigate group differences in important covariates. N = 98 MM patients (57% male, age 64 ± 9 years) could be assigned to three distinct PAHCO profiles: 46% were patients with high PAHCO, 48% patients with moderate, and 5% were patients with low PAHCO. The mean probability to be assigned to a certain profile was over 99%. The first group showed significant higher physical activity (PA) and lower comorbidities. Regarding symptom burden, three different profiles exist, including group one (32% of patients) with very low symptom burden, profile two (40%) with medium symptom burden, and group three (15%) with very high symptom burden (mean probability ≥ 98%). Patients in profile one had a lower number of treatment lines compared to the other profiles. Patients who were assigned to the high PAHCO profile were more likely to display a milder symptoms profile. In this exploratory analysis, we identified different patient profiles for PAHCO and symptom burden that may be used to individualize exercise recommendations and supervision modalities in MM patients. PAHCO and symptom burden level may be used to stratify MM patients in order to provide more personalized and effective exercise counseling. The profiles require individualized exercise recommendations and different supervision modalities, including educational instructions tailored particularly to every patient's needs, according to their PAHCO and symptom profile. TRIAL REGISTRATION NUMBER: NCT04328038.
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Affiliation(s)
- Rea Kuehl
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Maximilian Koeppel
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Wuerzburg, Wuerzburg, Germany
| | - Friederike Rosenberger
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management, Saarbruecken, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
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McCourt O, Fisher A, Land J, Ramdharry G, Yong K. The views and experiences of people with myeloma referred for autologous stem cell transplantation, who declined to participate in a physiotherapist-led exercise trial: a qualitative study. Physiother Theory Pract 2023:1-13. [PMID: 37555437 DOI: 10.1080/09593985.2023.2244068] [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: 02/06/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Recruitment rates to rehabilitation trials are variable among cancer survivors, and deeper investigation into the causes for declining participation is needed. The aim of this study was to qualitatively explore the experiences of people with myeloma referred for autologous stem cell transplant who were approached to take part in a physiotherapist-led exercise trial but declined. METHODS Participants were asked to participate in this qualitative study after declining to participate in a trial conducted at a UK tertiary cancer center. Semi-structured interviews were conducted. Data was analyzed inductively using reflexive thematic analysis. RESULTS Interviews from 18 myeloma patients (56% male, mean age 62 years) were analyzed. Four themes were identified: 1) Traveling to the specialist center is challenging, not just logistically; 2) Individualized approach valued but recall of research information variable; 3) Being less active has profound impact yet ameliorative support is lacking; and 4) Common side-effects of treatment are expected and endured but personal impact underestimated and unaddressed. CONCLUSION A number of barriers to participation were identified. Travel, a commonly cited reason for declining research participation, is more than a logistical issue for cancer survivors experiencing side-effects and the time burden of clinical appointments. Expectation or knowledge of the typical side-effects from myeloma and its treatment may lead to under-reporting of concerns to care providers, despite their impact upon daily activities and quality of life. Approaches used for research recruitment should consider the timing and consequences of ongoing cancer treatment to reduce potential barriers to participation.
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Affiliation(s)
- Orla McCourt
- Therapies and Rehabilitation, University College London Hospitals NHS Foundation Trust, London, UK
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Abigail Fisher
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Joanne Land
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Gita Ramdharry
- Queens Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust/UCL Institute of Neurology, University College London, London, UK
| | - Kwee Yong
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
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Purdy GM, Sobierajski FM, Al Onazi MM, Effa CJ, Venner CP, Tandon P, McNeely ML. Exploring participant perceptions of a virtually supported home exercise program for people with multiple myeloma using a novel eHealth application: a qualitative study. Support Care Cancer 2023; 31:298. [PMID: 37097319 PMCID: PMC10126542 DOI: 10.1007/s00520-023-07762-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Supervision, tailoring, and flexibility have been proposed as key program elements for delivering successful exercise programs for people with multiple myeloma (MM). However, no studies to date have evaluated the acceptability of an intervention employing these components. The aim of this study was to determine the acceptability of a virtually supported exercise program and eHealth application for people with MM. METHODS A qualitative description approach was used. One-on-one interviews were conducted with participants who completed the exercise program. Content analysis was used to analyze verbatim transcripts from interviews. RESULTS Twenty participants were interviewed (64.9 ± 6.7 years of age, n = 12 females). Participants had positive perceptions of the exercise program. Two themes emerged related to strengths/limitations: One Size Does Not Fit All (sub-themes: Supportive & Responsive Programming and Diverse Exercise Opportunities), and App Usability. Supportive and Responsive Programming was a main strength of the program, characterized as programming that was tailored, involved active support, and delivered by appropriate personnel. The inclusion of Diverse Exercise Opportunities was also regarded as a strength, as it accommodated the preferences of all participants. Related to App Usability, participants felt the app was simple and user friendly but had a few less intuitive components. CONCLUSION The virtually supported exercise program and eHealth application were acceptable for people with MM. Programs should employ tailoring, active support, and appropriate personnel to bolster acceptability and include both supervised and flexible exercise formats. eHealth apps should be simple to use so technology proficiency is not a barrier to participation.
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Affiliation(s)
- Graeme M Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Frances M Sobierajski
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Corrie J Effa
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Puneeta Tandon
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
- Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
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McCourt O, Fisher A, Land J, Ramdharry G, Roberts AL, Bekris G, Yong K. "What I wanted to do was build myself back up and prepare": qualitative findings from the PERCEPT trial of prehabilitation during autologous stem cell transplantation in myeloma. BMC Cancer 2023; 23:348. [PMID: 37069548 PMCID: PMC10107576 DOI: 10.1186/s12885-023-10799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The addition of qualitative methodology to randomised controlled trials evaluating complex interventions allows better understanding of contextualised factors and their potential influence on trial delivery and outcomes, as well as opportunities for feedback on trial participation to improve future trial protocols. This study explored the experiences of participation in cancer rehabilitation research during active cancer treatment. Participants were people living with haematological cancer myeloma, undergoing autologous stem cell transplantation (ASCT) recruited to the PERCEPT myeloma pilot trial. METHODS A qualitative semi-structured interview study, embedded within a pilot randomised controlled trial of a physiotherapist-led exercise intervention delivered before, during and after ASCT among people living with myeloma. Transcripts were analysed using reflexive thematic analysis. RESULTS Interviews from 16 trial participants (n = 8 intervention group; n = 8 control group; mean age 61 years, 56% male) were analysed. Four main themes were identified: (1) "It's not just beneficial for me, it's for people after me as well"; (2) Disparities in experience of recovery - expectations, feeling prepared and support; (3) "What I wanted to do was build myself back up and prepare"; (4) Active ingredients - participants' experience of the trial intervention. Participants reported both altruistic and perceived personal gain as motivators for enrolling in the trial. Disappointment caused by allocation to control arm may have led to participants seeking exercise elsewhere, indicating possible contamination of control condition. Disparities in experience of recovery from transplant were evident with intervention participants reporting greater trajectory of recovery. CONCLUSIONS The findings from this embedded qualitative study highlight numerous considerations required when designing pilot and efficacy trials of complex interventions. The addition of qualitative investigation offers greater understanding of motivations for participation, intervention mechanisms at play as well as effects of participation that may impact interpretation of quantitative outcomes. TRIAL REGISTRATION Qualitative findings from a prospectively registered pilot trial (ISRCTN15875290), registered 13/02/2019.
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Affiliation(s)
- Orla McCourt
- Therapies & Rehabilitation, Inpatient Therapy Office, University College London Hospitals NHS Foundation Trust, University College Hospital, T-1/Lower Ground Floor, 235 Euston Road, London, NW1 2BU, UK.
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK.
| | - Abigail Fisher
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Joanne Land
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Gita Ramdharry
- Queens Square Centre for Neuromuscular diseases, National Hospital for Neurology & Neurosurgery, UCL Institute of Neurology, UCLH NHS Trust, University College London, London, UK
| | - Anna L Roberts
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Georgios Bekris
- UCL Department of Behavioural Science and Health, University College London, London, UK
| | - Kwee Yong
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
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Provision and delivery of survivorship care for adult patients with haematological malignancies: A scoping review protocol. PLoS One 2023; 18:e0282458. [PMID: 36862719 PMCID: PMC9980752 DOI: 10.1371/journal.pone.0282458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Haematological malignancies are a heterogenous group of blood and lymphatic cancers. Survivorship care is a similarly diverse term concerning patients' health and wellbeing from diagnosis to end of life. Survivorship care for patients with haematological malignancies has traditionally been consultant-led and secondary care-based, although shifts away from this model have been occurring, largely via nurse-led clinics and interventions with some remote monitoring. However, there remains a lack of evidence regarding which model is most appropriate. Although previous reviews exist, patient populations, methodologies, and conclusions are varied, and further high-quality research and evaluation has been recommended. AIMS The aim of the scoping review this protocol describes is to summarise current evidence on the provision and delivery of survivorship care for adult patients diagnosed with a haematological malignancy, and to identify existing gaps to inform future research. METHODOLOGY A scoping review will be carried out utilising Arksey and O'Malley's guidelines as its methodological framework. Studies published in the English language from December 2007 to the present will be searched on bibliographic databases, including Medline, CINAHL, PsycInfo, Web of Science, and Scopus. Papers' titles, abstracts, and full text will predominantly be screened by one reviewer with a second reviewer blind screening a proportion. Data will be extracted using a customised table developed in collaboration with the review team, and presented in tabular and narrative format, arranged thematically. Studies included will contain data regarding adult (25+) patients diagnosed with any haematological malignancy in combination with aspects related to survivorship care. The survivorship care elements could be delivered by any provider within any setting, but should be delivered pre- or post-treatment, or to patients on a watchful waiting pathway. REGISTRATION The scoping review protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/rtfvq; DOI: 10.17605/OSF.IO/RTFVQ).
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Nicol JL, Chong JE, McQuilten ZK, Mollee P, Hill MM, Skinner TL. Safety, Feasibility, and Efficacy of Exercise Interventions for People With Multiple Myeloma: A Systematic Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:86-96. [PMID: 36450625 DOI: 10.1016/j.clml.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/08/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Bone lesions and other disease- and treatment-related side effects commonly experienced by people with multiple myeloma (MM) may impede their ability to exercise. This systematic review evaluated the safety, feasibility, and efficacy of exercise program participation on the physiological and/or psychological health of people with MM. Literature searches were conducted through five electronic databases and appraised using the Delphi list of criteria. Controlled trials that assessed the safety and feasibility of an exercise intervention and its effects on disease- or treatment-related symptoms in people with MM were included. Seven studies of varying quality involving 563 participants were included. All studies concluded that exercise was safe, reporting zero serious and 4 adverse events attributable to exercise testing or training. Attendance ranged from 58% to 96%, however no study reported adherence to the exercise prescription. Compared to a control group, exercise did not appear to affect fatigue, depression, anxiety, body composition, quality of life, or sleep. Isolated studies identified between-group differences favoring exercise in lower limb strength (+8.4 kg, 95% CI 0.5, 16.3, P= .04), peak oxygen uptake (+1.2 mL/kg/min, 95% CI 0.3, 3.7, P= .02), physical activity (+6.5MET-hs/wk, P< .001), stem cell collection attempts (1.1 ± 0.2 vs. 1.5 ± 0.9, P< .01), and red blood cell (1.8 ± 2.2 vs. 2.4 ± 2.6, P< .05) and platelet transfusions (2.3 ± 1.6 vs. 3.5 ± 3.4, P < .05) during transplantation. Exercise interventions appear safe and well attended by people with MM. The lack of improvements in disease- and treatment-related symptoms requires further exploration to determine whether exercise is a sufficient stimulus to elicit benefits in this unique population.
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Affiliation(s)
- Jennifer L Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Jamie E Chong
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Zoe K McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Mollee
- Haematology Department, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Michelle M Hill
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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10
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Kars TU, Yaşkıran O, Çeneli Ö. Pneumonitis associated with bortezomib in a patient with multiple myeloma. J Oncol Pharm Pract 2022:10781552221143789. [DOI: 10.1177/10781552221143789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Bortezomib, which is widely used in the treatment of multiple myeloma (MM), is a proteasome inhibitor and acts by inducing apoptosis. Bortezomib has many side effects, mainly hematological, neurological, and gastrointestinal. A few cases of bortezomib-induced pneumonitis (BIP) have been reported in the literature. Case Report A 51-year-old male patient who was newly diagnosed with MM received bortezomib, cyclophosphamide, and dexamethasone as first-line therapy. In the first cycle, the patient developed dyspnea, tachypnea, and hypoxia after the fourth day of administration of bortezomib monotherapy according to the treatment protocol. Management and outcome Infection and pulmonary involvement of MM were excluded after radiological evaluations, and a diagnosis of BIP was made. Clinical control was achieved quickly with steroid therapy and oxygen support, and radiological findings improved with treatment. Due to this rare side effect of bortezomib, the treatment regimen containing bortezomib was changed. The patient is still receiving treatment that does not contain bortezomib and does not have any pulmonary problems. Discussion In cancer patients receiving treatment, infection and metastasis should be quickly ruled out when pulmonary problems occur, and drug-induced pneumonitis should be considered. This diagnosis, which often responds dramatically to steroids, has the potential to have serious consequences when not considered. In this case, we present bortezomib-associated pneumonitis, a rare side effect of bortezomib. The most important feature of this case is the development of this side effect at the beginning of the treatment, unlike other cases reported in the literature.
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Affiliation(s)
- Taha Ulutan Kars
- Department of Internal Medicine, Division of Hematology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Osman Yaşkıran
- Department of Internal Medicine, Division of Hematology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Özcan Çeneli
- Department of Internal Medicine, Division of Hematology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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11
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Exploring health behaviors and the feasibility of a lifestyle intervention for patients with multiple myeloma. Support Care Cancer 2022; 30:9771-9779. [DOI: 10.1007/s00520-022-07385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/02/2022] [Indexed: 10/31/2022]
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12
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Purdy GM, Venner CP, Tandon P, McNeely ML. Feasibility of a tailored and virtually supported home exercise program for people with multiple myeloma using a novel eHealth application. Digit Health 2022; 8:20552076221129066. [PMID: 36249481 PMCID: PMC9554139 DOI: 10.1177/20552076221129066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction eHealth exercise interventions have the unique ability to leverage the benefits of in-person programming (tailoring and supervision) with the benefits of home programming (flexibility). There may be a role for eHealth-delivered exercise for people with multiple myeloma (MM), as exercise tailoring and supervision are critical for successful outcomes due to the significant impacts/risks of myeloma-related side effects. The purpose of this study was to determine the safety, feasibility, and preliminary efficacy of a 12-week virtually supported eHealth exercise program. Methods Participants with MM completed a 12-week virtually supported home exercise program involving virtually supervised group workouts, independent workouts, and aerobic exercise. Tailoring was facilitated by the functionality of HEAL-Me, a novel eHealth app. Participants completed virtual fitness assessments and questionnaires at baseline and week 12. Results Twenty-nine participants consented, 26 completed all follow-up testing (90%). Exercise adherence was 90% (group), 83% (independent), and 90% (aerobic). No serious adverse events (grade ≥3) occurred. Significant improvements were found for quality of life and physical fitness. There was a high level of program/app satisfaction: 96% of participants agreed or strongly agreed that the exercise program was beneficial, 93% found it enjoyable, 89% were satisfied or very satisfied with delivery through the HEAL-Me app, and 48% felt that the eHealth program helped them manage cancer-related symptoms and side-effects. Conclusion An eHealth intervention that is individually tailored and includes virtual supervision and active support from the healthcare team is feasible and acceptable to people with MM. The findings from this study warrant investigation using a large-scale randomized controlled trial.
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Affiliation(s)
- Graeme M. Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada,Margaret L. McNeely, Department of Physical Therapy, Faculty of Rehabilitation Medicine, Department of Oncology, Cross Cancer Institute, University of Alberta, 3-44L Corbett Hall, Edmonton, Alberta, Canada.
| | | | - Puneeta Tandon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Margaret L. McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada,Cross Cancer Institute, Edmonton, Canada
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13
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Celik Z, Boşnak Güçlü M, Özkurt ZN. Exercise capacity, physical activity and quality of life in patients with newly diagnosed hematologic malignancies: a cross-sectional study. Physiother Theory Pract 2022; 39:1152-1162. [DOI: 10.1080/09593985.2022.2035865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Zeliha Celik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Meral Boşnak Güçlü
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Department of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
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14
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Clinical exercise therapy program with multiple myeloma patients: Impacts on feasibility, adherence and efficacy. Support Care Cancer 2022; 30:9615-9623. [PMID: 36190557 PMCID: PMC9633464 DOI: 10.1007/s00520-022-07369-9] [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: 04/05/2022] [Accepted: 09/18/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Multiple myeloma (MM) is a severe hemato-oncological disease with high mortality and increasing incidence rate. Since evidence on exercise therapy in MM patients remains limited, this study examines feasibility, adherence, and efficacy based on real-life data from an oncologic care structure. METHODS A data evaluation of MM patients who participated in the oncologic exercise and movement therapy (OTT) at the Cologne University Hospital between 2012 and 2019 was conducted. The patient flow was incrementally reduced to four cohorts, intention-to-treat cohort (ITTC), safety cohort (SC), adherence cohort (AC), and efficacy cohort (EC). Cohorts were evaluated descriptively and by means of correlation analysis as well as group and time comparisons. RESULTS Thirty patients registered at the OTT between 2012 and 2019 (ITTC). The SC (N = 26) attended exercise therapy on average about one session per week over a period of 8 months. One-third dropped out within 3 months. In the AC (N = 15), BMI at baseline exhibited a strong and very significant negative correlation with exercise adherence. In the EC (N = 8), a significant improvement in physical functioning and a tendency towards significance in fatigue reduction between two measurement points was observed. No adverse events were documented. CONCLUSIONS The present observatory study reveals safety and feasibility while indicating adherence and efficacy of exercising MM patients under real-life therapy circumstances. Found obstacles to exercising as well as improvements in questionnaire scale scores need to be further examined in confirmatory study designs.
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15
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Hevroni G, Korde N. Examining health related quality of life outcomes in multiple myeloma: Past and future perspectives. Semin Oncol 2022; 49:94-102. [DOI: 10.1053/j.seminoncol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 01/02/2022] [Indexed: 11/11/2022]
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16
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Shapiro YN, Peppercorn JM, Yee AJ, Branagan AR, Raje NS, Donnell EKO. Lifestyle considerations in multiple myeloma. Blood Cancer J 2021; 11:172. [PMID: 34702799 PMCID: PMC8548591 DOI: 10.1038/s41408-021-00560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
As the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life (QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.
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Affiliation(s)
| | - Jeffrey M Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew J Yee
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew R Branagan
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Noopur S Raje
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elizabeth K O' Donnell
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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17
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Yuan Y, Guo M, Gu C, Yang Y. The role of Wnt/β-catenin signaling pathway in the pathogenesis and treatment of multiple myeloma (review). Am J Transl Res 2021; 13:9932-9949. [PMID: 34650674 PMCID: PMC8507016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Multiple myeloma (MM) is a refractory hematological malignancy characterized by aberrant accumulation of plasma cells. Patients with MM are susceptible to becoming resistant to chemotherapy, eventually leading to relapse. Progression of MM is largely dependent on the bone marrow microenvironment. Stromal cells in the bone marrow microenvironment secrete Wnt ligands to activate Wnt signaling in MM, which is mediated through the transcription regulator β-catenin. In addition, Wnt/β-catenin pathway encourages osteoblast differentiation and bone formation, dysregulation of which is responsible for proliferation and drug resistance of MM cells. As a result, direct inhibition or silencing of β-catenin or associated genes in the Wnt/β-catenin pathway has been proposed to be an effective therapeutic anti-MM strategy. However, the underlying regulatory mechanism of the Wnt/β-catenin pathway in MM remains to be fully elucidated. Herein, we summarized research advances on the specific genes and molecular biology process of Wnt/β-catenin pathway involved in tumorigenesis of MM, as well as the interaction with bone marrow microenvironment. Additionally, comprehensive summaries of drugs or small molecule inhibitors acting on Wnt/β-catenin pathway and targeting MM were introduced. This review intends to provide an overview of theoretical supports for novel Wnt/β-catenin pathway based treatment strategies in MM.
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Affiliation(s)
- Yuxia Yuan
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 210022, Jiangsu, China
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese MedicineNanjing 210023, Jiangsu, China
| | - Mengjie Guo
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese MedicineNanjing 210023, Jiangsu, China
| | - Chunyan Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 210022, Jiangsu, China
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese MedicineNanjing 210023, Jiangsu, China
| | - Ye Yang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 210022, Jiangsu, China
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese MedicineNanjing 210023, Jiangsu, China
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18
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Impact of exercise on the immune system and outcomes in hematologic malignancies. Blood Adv 2021; 4:1801-1811. [PMID: 32343800 DOI: 10.1182/bloodadvances.2019001317] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/27/2020] [Indexed: 12/13/2022] Open
Abstract
Exercise is increasingly recognized as important to cancer care. The biology of how exercise improves outcomes is not well understood, however. Studies show that exercise favorably influences the immune system in healthy individuals (neutrophils, monocytes, natural killer cells, T cells, and a number of cytokines). Thus, exercise in patients with hematologic cancer could significantly improve immune function and tumor microenvironment. We performed a literature search and identified 7 studies examining exercise and the immune environment in hematologic malignancies. This review focuses on the role of exercise and physical activity on the immune system in hematologic malignancies and healthy adults.
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19
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Mohananey D, Sarau A, Kumar R, Lewandowski D, Abreu-Sosa SM, Nathan S, Okwuosa TM. Role of Physical Activity and Cardiac Rehabilitation in Patients Undergoing Hematopoietic Stem Cell Transplantation. JACC CardioOncol 2021; 3:17-34. [PMID: 34396304 PMCID: PMC8352115 DOI: 10.1016/j.jaccao.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a standard treatment for several malignancies, and >50,000 HSCT are performed annually worldwide. As survival after HSCT improves, cardiovascular disease and associated risk factors have gained importance as a significant cause of morbidity and mortality in this cohort. In this article, we detail the risk factors for cardiovascular disease and their impact in patients undergoing HSCT. Additionally, we critically review the data on the impact of physical exercise in patients undergoing HSCT. Although limited by significant heterogeneity in methodologies, small sample sizes, attrition, and lack of long-term cardiovascular follow-up, most of these studies reinforce the beneficial effects of physical activity and exercise in this patient population. Cardiac rehabilitation (CR) is a structured exercise and lifestyle modification program that is typically instituted in patients who experience acute cardiovascular events. We review the data on CR in the oncologic and nononcologic populations with an aim of building a framework for use of CR in HSCT patients.
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Key Words
- ACSM, American College of Sports Medicine
- AHA, American Heart Association
- CR, cardiac rehabilitation
- CVD, cardiovascular disease
- GVHD, graft-versus-host disease
- HSCT, hematopoietic stem cell transplantation
- MFI, Multidimensional Fatigue Inventory
- MI, myocardial infarction
- PCI, percutaneous coronary interventions
- Vo2max, maximal oxygen consumption
- cardiac rehabilitation
- hematopoietic stem cell transplantation
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Affiliation(s)
- Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Wisconsin, USA
| | - Alexandra Sarau
- Department of Internal Medicine, Rush University, Chicago, Illinois, USA
| | - Rohit Kumar
- Hematology and Medical Oncology Division, University of Louisville, Louisville, Kentucky, USA
| | - David Lewandowski
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Wisconsin, USA
| | - Sol M. Abreu-Sosa
- Department of Physical Medicine and Rehabilitation, Rush University, Chicago, Illinois, USA
| | - Sunita Nathan
- Division of Hematology/Oncology and Cell Therapy, Rush University, Chicago, Illinois, USA
| | - Tochukwu M. Okwuosa
- Division of Cardiovascular Medicine, Rush University, Chicago, Illinois, USA
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20
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Song Y, Hu N, Song X, Yang J. Hsa_Circ_0007841 Enhances Multiple Myeloma Chemotherapy Resistance Through Upregulating ABCG2. Technol Cancer Res Treat 2021; 19:1533033820928371. [PMID: 32552614 PMCID: PMC7307286 DOI: 10.1177/1533033820928371] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The current researches have reported that circular RNA is an important regulatory
factor in the progression of various human disease. However, the function and
mechanism of most circular RNAs remain unknown in cancers including multiple
myeloma. Our study has confirmed that hsa_circ_0007841 is up regulated in U266
doxorubicin resistant cells (U266R) and 8226 doxorubicin resistant cells (8226R)
compared to U266 parent cells (U266P) and 8226 parent cells (8226P). Silence of
hsa_circ_0007841 in U266R and 8226R could reduce the half-maximal inhibitory
concentration which indicated reduction in chemoresistance. In doxorubicin
resistant cells, the messenger RNA and protein level of ATP-binding cassette
transporters G2 increased. Silence of hsa_circ_0007841 in drug resistant cells
could decrease both the messenger RNA and protein levels of ATP-binding cassette
transporters G2; reexpression of hsa_circ_0007841 could block the reduction.
However, overexpression of hsa_circ_0007841 could effectively upregulate the
ATP-binding cassette transporters G2 messenger RNA and protein level. Inhibition
of ATP-binding cassette transporters G2 could block hsa_circ_0007841
overexpression induced chemoresistance in U266P and 8226P cells. What’s more,
inhibition of ATP-binding cassette transporters G2 could reduce differences of
half-maximal inhibitory concentration between parent cell lines and
drug-resistant cell lines. Our data collectively suggest a new model in which
hsa_circ_0007841 promotes acquired chemotherapy resistance by upregulating
ATP-binding cassette transporters G2 providing a novel molecular basis of
chemotherapy in multiple myeloma cancer.
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Affiliation(s)
- Yan Song
- Department of Nephrology, The First People's Hospital of Jingmen, Hubei, China
| | - Ning Hu
- Department of Nephrology, The First People's Hospital of Jingmen, Hubei, China
| | - Xiaowei Song
- Department of Nephrology, The First People's Hospital of Jingmen, Hubei, China
| | - Juhong Yang
- Department of Nephrology, The First People's Hospital of Jingmen, Hubei, China
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21
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Prevalence and significance of sarcopenia in multiple myeloma patients undergoing autologous hematopoietic cell transplantation. Bone Marrow Transplant 2020; 56:225-231. [PMID: 32732941 PMCID: PMC7855279 DOI: 10.1038/s41409-020-01008-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023]
Abstract
Sarcopenia, defined as loss of muscle mass, can occur with aging. We conducted a single-center retrospective analysis to evaluate the impact of muscle quality in multiple myeloma (MM), a hematologic cancer of older adults, undergoing autologous hematopoietic cell transplantation (autoHCT). Healthy muscle was quantified by measuring the percent of high-density muscle within the L3 psoas muscle using a novel computed tomography method in 142 eligible patients. Early post-transplant complications were assessed in the first 100 days after transplant. Sarcopenia, defined as ≤80% high-density muscle, was found in 72 (51%) patients. Sarcopenic obesity, defined as sarcopenia and a BMI≥30, was found in 32 (23%) patients. One or more early complications occurred in 22 (16%) patients. Cardiovascular events accounted for 36% of all complications. Patients with sarcopenia had more cardiac complications (12.5%) than patients without (2.9%, p=0.03). Multivariate analysis revealed increased BMI at transplant, but not sarcopenia, was associated with worse OS (hazard ratio: 1.11, 95% confidence interval: 1.02–1.22, p=0.02). Our analysis suggests that sarcopenia is prevalent in MM and associated with increased early post-transplant cardiovascular complications in MM. Obesity, regardless of sarcopenia, is associated with worse survival in MM. Our study generates hypothesis-generating data to risk-stratify patients being considered for autoHCT.
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22
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Rasch S, Lund T, Asmussen JT, Lerberg Nielsen A, Faebo Larsen R, Østerheden Andersen M, Abildgaard N. Multiple Myeloma Associated Bone Disease. Cancers (Basel) 2020; 12:E2113. [PMID: 32751464 PMCID: PMC7465468 DOI: 10.3390/cancers12082113] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023] Open
Abstract
The lytic bone disease is a hallmark of multiple myeloma, being present in about 80% of patients with newly diagnosed MM, and in more during the disease course. The myeloma associated bone disease (MBD) severely affects the morbidity and quality of life of the patients. MBD defines treatment demanding MM. In recent years, knowledge of the underlying pathophysiology has increased, and novel imaging technologies, medical and non-pharmaceutical treatments have improved. In this review, we highlight the major achievements in understanding, diagnosing and treating MBD. For diagnosing MBD, low-dose whole-body CT is now recommended over conventional skeletal survey, but also more advanced functional imaging modalities, such as diffusion-weighted MRI and PET/CT are increasingly important in the assessment and monitoring of MBD. Bisphosphonates have, for many years, played a key role in management of MBD, but denosumab is now an alternative to bisphosphonates, especially in patients with renal impairment. Radiotherapy is used for uncontrolled pain, for impeding fractures and in treatment of impeding or symptomatic spinal cord compression. Cement augmentation has been shown to reduce pain from vertebral compression fractures. Cautious exercise programs are safe and feasible and may have the potential to improve the status of patients with MM.
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Affiliation(s)
- Stine Rasch
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Department of Internal Medicine, Division of Haematology, Sydvestjysk Sygehus, Finsensgade 35, DK-6700 Esbjerg, Denmark
| | - Thomas Lund
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Haematology Research Unit, Department of Clinical Research, University of Southern Denmark, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark
| | - Jon Thor Asmussen
- Department of Clinical Radiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark;
| | - Anne Lerberg Nielsen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark;
| | - Rikke Faebo Larsen
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
| | - Mikkel Østerheden Andersen
- Center for Spine Surgery & Research, Lillebaelt Hospital, Østre Hougvel 55, DK-5500 Middelfart, Denmark;
| | - Niels Abildgaard
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Haematology Research Unit, Department of Clinical Research, University of Southern Denmark, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark
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23
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Peres de Oliveira A, Kazuo Issayama L, Betim Pavan IC, Riback Silva F, Diniz Melo-Hanchuk T, Moreira Simabuco F, Kobarg J. Checking NEKs: Overcoming a Bottleneck in Human Diseases. Molecules 2020; 25:molecules25081778. [PMID: 32294979 PMCID: PMC7221840 DOI: 10.3390/molecules25081778] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/02/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
In previous years, several kinases, such as phosphoinositide 3-kinase (PI3K), mammalian target of rapamycin (mTOR), and extracellular-signal-regulated kinase (ERK), have been linked to important human diseases, although some kinase families remain neglected in terms of research, hiding their relevance to therapeutic approaches. Here, a review regarding the NEK family is presented, shedding light on important information related to NEKs and human diseases. NEKs are a large group of homologous kinases with related functions and structures that participate in several cellular processes such as the cell cycle, cell division, cilia formation, and the DNA damage response. The review of the literature points to the pivotal participation of NEKs in important human diseases, like different types of cancer, diabetes, ciliopathies and central nervous system related and inflammatory-related diseases. The different known regulatory molecular mechanisms specific to each NEK are also presented, relating to their involvement in different diseases. In addition, important information about NEKs remains to be elucidated and is highlighted in this review, showing the need for other studies and research regarding this kinase family. Therefore, the NEK family represents an important group of kinases with potential applications in the therapy of human diseases.
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Affiliation(s)
- Andressa Peres de Oliveira
- Instituto de Biologia, Departamento de Bioquímica e Biologia Tecidual, Universidade Estadual de Campinas, Campinas, São Paulo 13083-862, Brazil; (A.P.d.O.); (L.K.I.); (I.C.B.P.); (F.R.S.); (T.D.M.-H.)
| | - Luidy Kazuo Issayama
- Instituto de Biologia, Departamento de Bioquímica e Biologia Tecidual, Universidade Estadual de Campinas, Campinas, São Paulo 13083-862, Brazil; (A.P.d.O.); (L.K.I.); (I.C.B.P.); (F.R.S.); (T.D.M.-H.)
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo 13083-871, Brazil
| | - Isadora Carolina Betim Pavan
- Instituto de Biologia, Departamento de Bioquímica e Biologia Tecidual, Universidade Estadual de Campinas, Campinas, São Paulo 13083-862, Brazil; (A.P.d.O.); (L.K.I.); (I.C.B.P.); (F.R.S.); (T.D.M.-H.)
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo 13083-871, Brazil
- Laboratório Multidisciplinar em Alimentos e Saúde, Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, São Paulo 13484-350, Brazil;
| | - Fernando Riback Silva
- Instituto de Biologia, Departamento de Bioquímica e Biologia Tecidual, Universidade Estadual de Campinas, Campinas, São Paulo 13083-862, Brazil; (A.P.d.O.); (L.K.I.); (I.C.B.P.); (F.R.S.); (T.D.M.-H.)
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo 13083-871, Brazil
| | - Talita Diniz Melo-Hanchuk
- Instituto de Biologia, Departamento de Bioquímica e Biologia Tecidual, Universidade Estadual de Campinas, Campinas, São Paulo 13083-862, Brazil; (A.P.d.O.); (L.K.I.); (I.C.B.P.); (F.R.S.); (T.D.M.-H.)
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo 13083-871, Brazil
| | - Fernando Moreira Simabuco
- Laboratório Multidisciplinar em Alimentos e Saúde, Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, São Paulo 13484-350, Brazil;
| | - Jörg Kobarg
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo 13083-871, Brazil
- Correspondence: ; Tel.: +55-19-3521-8143
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24
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Guo D, Xu P, Guan C, Xu Y, Yang Y, Xu J, Zhou R, Chen B. Hepatitis B virus infection and 1q21 amplification in multiple myeloma. Oncol Lett 2019; 18:6196-6206. [PMID: 31788095 DOI: 10.3892/ol.2019.10926] [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: 09/14/2018] [Accepted: 02/27/2019] [Indexed: 11/05/2022] Open
Abstract
Hepatitis B virus (HBV) is a hepatotropic and a lymphotropic virus. An association between HBV and hematologic malignancies has been determined previously; however, the association between HBV infection and multiple myeloma (MM) remains controversial. The present study aimed to assess the prevalence of HBV infection in patients with MM, and investigate their characteristics and prognostic significance. The clinical data of 165 patients with MM who had received at least four cycles of chemotherapy between April 2008 and February 2017 at Nanjing Drum Tower Hospital (Nanjing, China) were collected. HBV markers were determined using ELISA. The rates of acute or chronic HBV infection and resolved HBV infection in patients with MM were 12.12 and 26.06%, respectively. The gain of 1q21 was significantly more prevalent in the patients who were classified as HBV-positive compared with the patients who were classified as HBV-negative (54 vs. 38.2%; P=0.048), and the level of alanine transaminase in patients who were classified as HBV-positive was significantly increased compared with the non-infected group (63.29 vs. 24.66 U/l; P=0.043). Lactate dehydrogenase, serum creatinine and serum calcium levels were additionally determined to be significant risk factors of overall survival. The progression-free survival (PFS) of patients who were classified as HBV-positive was decreased compared with patients who were classified as HBV-negative (18.97 vs. 29.67 months; P=0.006), and being HBV-positive was determined to be an independent prognostic factor of PFS. HBV infection may contribute to MM progression through 1q21 amplification, and improved monitoring of HBV markers in patients with MM may be required.
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Affiliation(s)
- Dan Guo
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, P.R. China.,Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Peipei Xu
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Chaoyang Guan
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yong Xu
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yonggong Yang
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jingyan Xu
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Rongfu Zhou
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Bing Chen
- Department of Hematology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Keilani M, Kainberger F, Pataraia A, Hasenöhrl T, Wagner B, Palma S, Cenik F, Crevenna R. Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma. Wien Klin Wochenschr 2019; 131:567-575. [PMID: 31267163 PMCID: PMC6851044 DOI: 10.1007/s00508-019-1524-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma. Methods A narrative review of the relevant scientific literature and presentation of clinical experiences. Results In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation. Conclusion In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.
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Affiliation(s)
- Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anna Pataraia
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Timothy Hasenöhrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Wagner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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De Luca R, Kachel P, Kropivsek K, Snijder B, Manz MG, Neri D. A novel dual-cytokine-antibody fusion protein for the treatment of CD38-positive malignancies. Protein Eng Des Sel 2019; 31:173-179. [PMID: 29982719 DOI: 10.1093/protein/gzy015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 12/17/2022] Open
Abstract
A novel dual-cytokine-antibody fusion protein, consisting of an antibody directed against CD38 [a tumor-associated antigen mainly expressed on the surface of multiple myeloma (MM) cells], simultaneously fused to both tumor necrosis factor ligand superfamily member 10 (TRAIL) and interleukin-2 (IL2), was designed, expressed and purified to homogeneity. The novel fusion protein, termed IL2-αCD38-αCD38-scTRAIL, was able to selectively recognize its cognate antigen expressed on the surface of MM and lymphoma cell lines, as evidenced by flow cytometry analysis. Moreover, the targeted version of TRAIL was able to induce cancer cell death in vitro, both with MM cell lines and with fresh isolates from the bone marrow of MM patients. The experiments provide a rationale for possible future applications of IL2-αCD38-αCD38-scTRAIL for the treatment of patients with MM or other CD38-positive malignancies.
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Affiliation(s)
- Roberto De Luca
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zürich), Vladimir-Prelog-Weg 4, Zürich, Switzerland
| | - Paul Kachel
- Department of Hematology, University Hospital and University of Zurich, Rämistrasse 100, Zürich, Switzerland
| | - Klara Kropivsek
- Department of Biology, Institute of Molecular System Biology, Swiss Federal Institute of Technology (ETH Zürich), Auguste-Piccard-Hof 1, Zurich, Switzerland
| | - Berend Snijder
- Department of Biology, Institute of Molecular System Biology, Swiss Federal Institute of Technology (ETH Zürich), Auguste-Piccard-Hof 1, Zurich, Switzerland
| | - Markus G Manz
- Department of Hematology, University Hospital and University of Zurich, Rämistrasse 100, Zürich, Switzerland
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zürich), Vladimir-Prelog-Weg 4, Zürich, Switzerland
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Crevenna R. Physical medicine in cancer rehabilitation: A narrative review. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huang H, Liu Y, Lin QD, Liu YZ, Liu LN, Zhang QL, Yu FK, Song YP, Fang BJ. Clinical observation of recombinant human endostatin in treating relapsed refractory multiple myeloma. Clin Exp Pharmacol Physiol 2018; 45:1325-1327. [PMID: 30075047 DOI: 10.1111/1440-1681.13016] [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: 11/01/2017] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
Recombinant human endostatin (rhES) can inhibit multiple myeloma, while its clinical efficacy in treating relapsed refractory multiple myeloma (RRMM) has not been assessed. One hundred and eleven RRMM patients were treated with four different regimens: combination of VD (velcade+dexamethasone) and rhES (n = 25), Thalidomide (Tha) and VD (VTD, n = 22) combination, rhES and conventional chemotherapy combination (n = 32), and combination of conventional chemotherapy and Tha (n = 32). Significant differences were found in progression-free survival (PFS) between rhES combination groups and conventional chemotherapy combination groups. No statistical difference was found in overall response rate, overall survival or incidences of adverse effects. The combination of rhES with VD or conventional chemotherapy is active in patients with RRMM and prolongs the PFS to improve the quality of life.
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Affiliation(s)
- Hao Huang
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yang Liu
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Quan-de Lin
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu-Zhang Liu
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li-Na Liu
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qing-Lan Zhang
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Feng-Kuan Yu
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yong-Ping Song
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bai-Jun Fang
- Department of Hematology, Cancer hospital of Henan province , The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Islam MS. Treat patient, not just the disease: holistic needs assessment for haematological cancer patients. Oncol Rev 2018; 12:374. [PMID: 30283608 PMCID: PMC6151346 DOI: 10.4081/oncol.2018.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022] Open
Abstract
Haematological malignancies can have devastating effects on the patients' physical, emotional, psycho-sexual, educational and economic health. With the improvement of therapies patients with these malignancies are living longer, however significant proportion these patient show poor quality of life (QoL) due to various physical and psychological consequences of the disease and the treatments. Health-related QoL (HRQoL) is multi-dimensional and temporal, relating to a state of functional, physical, psychological and social/family well-being. Compared with the general population, HRQoL of these patients is worse in most dimensions. However without routine holistic need assessment (HNA), clinicians are unlikely to identify patients with clinically significant distress. Surviving cancer is a chronic life-altering condition with several factors negatively affecting their QoL, such as psychological problems, including depression and excessive fear of recurrence, as well as social aspects, such as unemployment and social isolation. These need to be adequately understood and addressed in the healthcare of long-term survivors of haematological cancer. Applying a holistic approach to patient care has many benefits and yet, only around 25% of cancer survivors in the UK receive a holistic needs assessment. The efforts of the last decade have established the importance of ensuring access to psychosocial services for haematological cancer survivors. We need to determine the most effective practices and how best to deliver them across diverse settings. Distress, like haematological cancer, is not a single entity, and one treatment does not fit all. Psychosocialoncology needs to increase its research in comparative effectiveness.
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Affiliation(s)
- Md Serajul Islam
- Department of Haematology, Guy's & St. Thomas Hospital, London.,Department of Haematology, Broomfield Hospital, Chelmsford, UK
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Curado MP, Oliveira MM, Silva DRM, Souza DLB. Epidemiology of multiple myeloma in 17 Latin American countries: an update. Cancer Med 2018; 7:2101-2108. [PMID: 29573332 PMCID: PMC5943416 DOI: 10.1002/cam4.1347] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/10/2017] [Accepted: 12/26/2017] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to describe incidence, mortality rates, and trends for multiple myeloma (MM) in Latin America (LA), contributing to better knowledge on the epidemiology of MM in this continent. Incidence data were extracted from the International Agency for Research on Cancer (IARC), for the period 1990-2007. Mortality data were obtained for 17 countries from the World Health Organization, for the period 1995-2013. Annual average percentage change (AAPC) and 95% confidence interval (95% CI) were calculated for incidence and mortality. The average incidence rate of MM was higher in Cali (Colombia). For the age-group over 60 years old, rates were 14.2 and 12.8 per 100,000 inhabitants for men and women, respectively. Increasing incidence trends were verified for Cali (Colombia). Mortality rates were higher among men; most countries presented increasing trends, and the highest increments were observed in Guatemala (12.5% [95% CI: 10.6; 14.5] in men; 8.8% [95% CI: 7.8; 9.8] in women), Ecuador (5.5% [95% CI: 5.0; 6.0] in men; 3.7 [95% CI: 3.1; 4.3] in women), Paraguay (2.9% [95% CI: 2.3; 3.5] in men; 3.2% [95% CI: 2.1; 4.3] in women), and Brazil (1.4% [95% CI: 1.3; 1.5] in men; 0.9% [95% CI: 0.8; 1.0] in women). Multiple myeloma presented heterogeneous incidence patterns in Cali (Colombia), Quito (Ecuador), and Costa Rica. Increasing mortality trends were verified for most Latin American countries and could be related to limited access to diagnosis and new therapies.
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Affiliation(s)
- Maria Paula Curado
- Epidemiology and Statistics GroupResearch CenterA.C Camargo Cancer CenterSão PauloBrazil
- International Prevention Research InstituteEcullyFrance
- National Institute for Science and Technology in Oncogenomics and Therapeutic InnovationBrazil
| | - Max M. Oliveira
- Epidemiology and Statistics GroupResearch CenterA.C Camargo Cancer CenterSão PauloBrazil
- Graduate Program in Public HealthSchool of Public HealthUniversity of São PauloSão PauloBrazil
| | - Diego R. M. Silva
- Epidemiology and Statistics GroupResearch CenterA.C Camargo Cancer CenterSão PauloBrazil
| | - Dyego L. B. Souza
- Collective Health DepartmentFederal University of Rio Grande do NorteNatalBrazil
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Keen C, Skilbeck J, Ross H, Smith L, Collins K, Dixey J, Walters S, Greenfield DM, Snowden JA, Mawson S. Is it feasible to conduct a randomised controlled trial of pretransplant exercise (prehabilitation) for patients with multiple myeloma awaiting autologous haematopoietic stem cell transplantation? Protocol for the PREeMPT study. BMJ Open 2018; 8:e021333. [PMID: 29525775 PMCID: PMC5855173 DOI: 10.1136/bmjopen-2017-021333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION While myeloma is an incurable malignancy, developments in disease management have led to increased life expectancy in recent years. Treatment typically involves stem-cell transplantation. Increased survival rates equate to more patients living with the burden of both the disease and its treatment for increasing number of years, rendering myeloma a long-term condition.Evidence exists to demonstrate the benefits of exercise for patients recovering from stem-cell transplantation, and prehabilitation-exercise before treatment-has been shown to be effective in other disease areas. To date there has been no research into prehabilitation in patients with myeloma awaiting transplantation treatment.Our objective is to determine whether it is feasible to conduct a randomised controlled trial into pretransplant exercise for patients with multiple myeloma who are awaiting autologous stem-cell transplantation. METHODS AND ANALYSIS This mixed methods study identifies patients with diagnosis of multiple myeloma who have been assigned to the autologous transplantation list and invites them to participate in six weekly sessions of individualised, supervised exercise while awaiting transplantation.Quantitative data to determine feasibility targets include rates of recruitment, adherence and adverse events, and outcome measures including 6 min walking distance test and quality of life.Qualitative interviews are undertaken with a purposive sample of patients to capture their experiences of the study and the intervention. ETHICS AND DISSEMINATION Ethics committee approval has been obtained. Dissemination will be through open-access publications and presentations and will seek to reach multiprofessional bases as well as patients and carer groups, addressing the widespread interest in this area of research. TRIAL REGISTRATION NUMBER NCT03135925; Pre-results.
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Affiliation(s)
- Carol Keen
- Acute Therapy Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Julie Skilbeck
- Department of Nursing, Sheffield Hallam University, Sheffield, UK
| | - Helen Ross
- Acute Therapy Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lauren Smith
- Acute Therapy Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Karen Collins
- Department of Nursing, Sheffield Hallam University, Sheffield, UK
| | - Joanne Dixey
- Acute Therapy Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Diana M Greenfield
- Acute Therapy Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- ScHARR, University of Sheffield, Sheffield, UK
| | - John A Snowden
- Acute Therapy Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- ScHARR, University of Sheffield, Sheffield, UK
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Sheill G, Guinan EM, Peat N, Hussey J. Considerations for Exercise Prescription in Patients With Bone Metastases: A Comprehensive Narrative Review. PM R 2018; 10:843-864. [DOI: 10.1016/j.pmrj.2018.02.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 12/17/2022]
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Rome S, Noonan K, Bertolotti P, Tariman J, Miceli T, Board A. Bone Health, Pain, and Mobility: Evidence-Based Recommendations for Patients With Multiple Myeloma. Clin J Oncol Nurs 2017; 21:47-59. [DOI: 10.1188/17.cjon.s5.47-59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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Catamero D, Noonan K, Richards T, Faiman B, Manchulenko C, Devine H, Bertolotti P, Gleason C, Board A. Distress, Fatigue, and Sexuality: Understanding and Treating Concerns and Symptoms in Patients With Multiple Myeloma. Clin J Oncol Nurs 2017; 21:7-18. [DOI: 10.1188/17.cjon.s5.7-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hu L, Wu H, Li B, Song D, Yang G, Chen G, Xie B, Xu Z, Zhang Y, Yu D, Hou J, Xiao W, Sun X, Chang G, Zhang Y, Gao L, Dai B, Tao Y, Shi J, Zhu W. Dihydrocelastrol inhibits multiple myeloma cell proliferation and promotes apoptosis through ERK1/2 and IL-6/STAT3 pathways in vitro and in vivo. Acta Biochim Biophys Sin (Shanghai) 2017; 49:420-427. [PMID: 28338993 DOI: 10.1093/abbs/gmx021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Indexed: 12/14/2022] Open
Abstract
Multiple myeloma (MM) is the second most frequent malignant hematological disease. Dihydrocelastrol (DHCE) is synthesized by hydrogenated celastrol, a treterpene isolated from Chinese medicinal plant Tripterygium regelii. In this study, we first reported the anti-tumor activity of DHCE on MM cells. We found that DHCE could inhibit cell proliferation and promote apoptosis through caspase-dependent way in vitro. In addition, DHCE could inactivate the expression of interleukin (IL)-6 and downregulate the phosphorylation of extracellular regulated protein kinases (ERK1/2) and the signal transducer and activator of transcription 3 (STAT3) in MM. It also retained its activity against MM cell lines in the presence of IL-6. Furthermore, treatment of MM cells with DHCE resulted in an accumulation of cells in G0/G1 phase of the cell cycle. Notably, DHCE reduced the expression of cyclin D1 and cyclin-dependent kinases 4 and 6 in MM cell lines. Additionally, its efficacy toward the MM cell lines could be enhanced in combination with the histone deacetylase inhibitor panobinostat (LBH589), which implied the possibility of the combination treatment of DHCE and LBH589 as a potential therapeutic strategy in MM. In addition, treatment of NCI-H929 tumor-bearing nude mice with DHCE (10 mg/kg/d, i.p., 1-14 days) resulted in 73% inhibition of the tumor growth in vivo. Taken together, the results of our present study indicated that DHCE could inhibit cellular proliferation and induce cell apoptosis in myeloma cells mediated through different mechanisms, possibly through inhibiting the IL-6/STAT3 and ERK1/2 pathways. And it may provide a new therapeutic option for MM patients.
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Affiliation(s)
- Liangning Hu
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Huiqun Wu
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Bo Li
- CAS Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Dongliang Song
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Guang Yang
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Gege Chen
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Bingqian Xie
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Zhijian Xu
- CAS Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Yong Zhang
- CAS Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Dandan Yu
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jun Hou
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wenqin Xiao
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xi Sun
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Gaomei Chang
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yiwen Zhang
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Lu Gao
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Bojie Dai
- College of Life Science and Technology, Tongji University, Shanghai 200092, China
| | - Yi Tao
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jumei Shi
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Weiliang Zhu
- CAS Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
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Evans BA, Ali K, Bulger J, Ford GA, Jones M, Moore C, Porter A, Pryce AD, Quinn T, Seagrove AC, Snooks H, Whitman S, Rees N. Referral pathways for patients with TIA avoiding hospital admission: a scoping review. BMJ Open 2017; 7:e013443. [PMID: 28196949 PMCID: PMC5318551 DOI: 10.1136/bmjopen-2016-013443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. DESIGN Scoping review. DATA SOURCES PubMed, CINAHL Web of Science, Scopus. STUDY SELECTION Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. DATA EXTRACTION We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. RESULTS 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6-10% predicted rate to 1.3-2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. CONCLUSIONS Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. TRIAL REGISTRATION NUMBER ISRCTN85516498. Stage: pre-results.
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Affiliation(s)
| | - Khalid Ali
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Gary A Ford
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Chris Moore
- Welsh Ambulance Service NHS Trust, Swansea, UK
| | | | - Alan David Pryce
- Lay Contributor c/o Swansea University Medical School, Swansea, UK
| | - Tom Quinn
- Kingston University and St George's, University of London, London, UK
| | | | | | - Shirley Whitman
- Lay Contributor c/o Swansea University Medical School, Swansea, UK
| | - Nigel Rees
- Welsh Ambulance Service NHS Trust, Swansea, UK
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Snowden JA, Greenfield DM, Bird JM, Boland E, Bowcock S, Fisher A, Low E, Morris M, Yong K, Pratt G. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment. Br J Haematol 2017; 176:888-907. [PMID: 28107574 DOI: 10.1111/bjh.14514] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A growing population of long-term survivors of myeloma is now accumulating the 'late effects' not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease. It is thus important to recognise the cumulative burden of the disease and treatment-related toxicity in both the stable and active phases of myeloma, some of which is unlikely to be detected by routine monitoring. We summarise here the evidence for the key late effects in long-term survivors of myeloma, including physical and psychosocial consequences (in Parts 1 and 2 respectively), and recommend the use of late-effects screening protocols in detection and intervention. The early recognition of late effects and effective management strategies should lead to an improvement in the management of myeloma patients, although evidence in this area is currently limited and further research is warranted.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Diana M Greenfield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer M Bird
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elaine Boland
- Palliative Medicine, Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Stella Bowcock
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Kwee Yong
- University College London, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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38
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Li J, Zhan J, Zhang F, Ye Z, Ouyang J. Secondary lymphoblastic leukemia occurring 38 months after the primary diagnosis of multiple myeloma: A case report. Oncol Lett 2016; 12:847-856. [PMID: 27446359 PMCID: PMC4950900 DOI: 10.3892/ol.2016.4728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 05/05/2016] [Indexed: 11/06/2022] Open
Abstract
Multiple myeloma (MM) is a malignant plasma cell neoplasm characterized by the accumulation of plasma cells in the bone marrow, the subsequent destruction of bone and organ dysfunction. The present study describes the case of a 66-year-old male patient who presented with the typical clinical manifestations of MM. The patient was administered a bortezomib and dexamethasone regimen for 2 cycles and achieved complete remission. Lenalidomide, vincristine, pirarubicin, dexamethasone, melphalan and thalidomide was used successively in consolidation therapy and maintenance therapy. The patient developed secondary B-cell lymphoblastic leukemia 38 months after the primary MM diagnosis was made. Owing to the exposure of the patient to a variety of therapeutic agents, it could be inferred that multiple immune defects may have played an important role in the secondary lymphoblastic leukemia of the patient. Microscopic examination and flow cytometry detection were important in identifying the secondary malignancy in this MM case.
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Affiliation(s)
- Junxun Li
- Department of Laboratory Science, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jieyu Zhan
- Department of Pediatrics, The First Hospital of Baiyun, Guangzhou, Guangdong 510410, P.R. China
| | - Fan Zhang
- Department of Laboratory Science, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Zhuangjian Ye
- Department of Laboratory Science, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Juan Ouyang
- Department of Laboratory Science, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
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Raedler LA. Ninlaro (Ixazomib): First Oral Proteasome Inhibitor Approved for the Treatment of Patients with Relapsed or Refractory Multiple Myeloma. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:102-105. [PMID: 27668055 PMCID: PMC5013850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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40
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Li J, Chen S, Hu Y, Cai J. Bortezomib-induced severe pulmonary complications in multiple myeloma: A case report and literature review. Oncol Lett 2016; 11:2255-2260. [PMID: 26998158 DOI: 10.3892/ol.2016.4204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/22/2016] [Indexed: 11/05/2022] Open
Abstract
The proteasome inhibitor bortezomib is indicated for use in the treatment of multiple myeloma (MM) patients. The most common side effects are neurological and gastrointestinal, while severe pulmonary complications are rarely described. The present study reports the case of a 62-year-old man with immunoglobulin (Ig)G-type MM who was treated with bortezomib, thalidomide and dexamethasone. Subsequent to the administration of chemotherapy, the patient developed an acute respiratory distress syndrome. High-resolution computed tomography of the chest showed bilateral diffuse alveolar infiltrations and multiple subpleural lesions. A diagnosis of bortezomib-induced severe pulmonary complications was formed. Systemic corticosteroid therapy led to a rapid improvement in clinical conditions and radiological findings. In addition, the present study reviewed the characteristics, including medical history, clinical manifestations, treatment strategies and outcomes, of all 16 MM patients with bortezomib-induced severe pulmonary complications reported previously in Pubmed. It was indicated that patients who were male, of IgG type, with a relapse status and a previous history of auto-PBSCT had a higher possibility of developing bortezomib-induced severe pulmonary complications. Additionally, a relatively low dose rather than a high dose of corticosteroids could obtain a better outcome.
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Affiliation(s)
- Jingbo Li
- Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Shuda Chen
- Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yinghong Hu
- Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jing Cai
- Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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