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Kaufmann J, Täubl AU, Nikolaidou E, Rühle A, Hopprich A, Wollschläger D, Mayer A, Nicolay NH, Schmidberger H, Bostel T. Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma. Strahlenther Onkol 2024; 200:633-641. [PMID: 38289360 PMCID: PMC11186884 DOI: 10.1007/s00066-024-02198-7] [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: 07/18/2023] [Accepted: 01/03/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Multiple myeloma is associated with osteolytic bone lesions, often requiring surgery of the spine and postoperative radiotherapy (RT). Although common, data for clinical and informed decision-making are sparse. In this monocentric retrospective study, we aim to report the outcome of patients who underwent spinal surgery and postoperative RT due to multiple myeloma. METHODS A total of 54 patients with multiple myeloma who underwent prior spinal surgery and postoperative RT at our institution between 2009 and 2020 were analyzed. Spinal instability neoplastic score (SINS) and Bilsky score, posttherapeutic adverse events, clinical data, and outcomes were collected and analyzed. The primary endpoint of this study was overall survival (OS), secondary endpoints were progression-free survival (PFS), pain response, local control, and skeletal-related events (SRE). RESULTS The 3‑ and 5‑year overall survival (OS) was 74.9% (95% confidence interval [CI]: 63.5-88.4%) and 58% (95% CI: 44.5-75.6%), respectively. Median survival was not reached and 75% survival was 34.3 months (95% CI: 28.7-95.4 months). Median follow-up was 63 months (95% CI: 49-94 months). The number of patients with good to adequate performance status (Karnofsky performance score [KPS] ≥ 70) significantly increased after surgery (p < 0.01). We observed no grade 3/4 toxicity and only 13 (24%) grade 1/2 adverse events. Two patients (4%) experienced SRE. Overall, 92% of patients reported reduced pain after radiotherapy, with 66% reporting complete pain response. There was no difference in pain response between patients with different Bilsky scores. Bisphosphonate therapy and lower Bilsky score at the start of RT were associated with improved OS in univariate analysis (all p < 0.05). Multivariate Cox regression confirmed a Bilsky score of 2 or 3 as an independent negative prognostic factor (HR 3.89; 95 CI 1.4-10.7; p < 0.01). We observed no in-field recurrences. CONCLUSION In this study, we were able to show that the current standard of RT after spinal surgery of osteolytic lesions is safe. In addition, we observed a very low rate of SRE (4%) and no in-field recurrences, demonstrating the local efficacy of RT in multiple myeloma patients. Higher Bilsky scores were associated with worse OS in multivariate analysis, but had no effect on pain response.
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Affiliation(s)
- Justus Kaufmann
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany.
| | - Annika Ute Täubl
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Eirini Nikolaidou
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Alexander Rühle
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Anne Hopprich
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Daniel Wollschläger
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Arnulf Mayer
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nils Henrik Nicolay
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
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Montante B, Zampa B, Balestreri L, Ciancia R, Chini G, Ranavolo A, Rupolo M, Sawacha Z, Urbani M, Varrecchia T, Michieli M. Instrumental Evaluation of the Effects of Vertebral Consolidation Surgery on Trunk Muscle Activations and Co-Activations in Patients with Multiple Myeloma: Preliminary Results. SENSORS (BASEL, SWITZERLAND) 2024; 24:3527. [PMID: 38894318 PMCID: PMC11175183 DOI: 10.3390/s24113527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
Multiple myeloma (MM) patients complain of pain and stiffness limiting motility. To determine if patients can benefit from vertebroplasty, we assessed muscle activation and co-activation before and after surgery. Five patients with MM and five healthy controls performed sitting-to-standing and lifting tasks. Patients performed the task before and one month after surgery. Surface electromyography (sEMG) was recorded bilaterally over the erector spinae longissimus and rectus abdominis superior muscles to evaluate the trunk muscle activation and co-activation and their mean, maximum, and full width at half maximum were evaluated. Statistical analyses were performed to compare MM patients before and after the surgery, MM and healthy controls and to investigate any correlations between the muscle's parameters and the severity of pain in patients. The results reveal increased activations and co-activations after vertebroplasty as well as in comparison with healthy controls suggesting how MM patients try to control the trunk before and after vertebroplasty surgery. The findings confirm the beneficial effects of vertebral consolidation on the pain experienced by the patient, despite an overall increase in trunk muscle activation and co-activation. Therefore, it is important to provide patients with rehabilitation treatment early after surgery to facilitate the CNS to correctly stabilize the spine without overloading it with excessive co-activations.
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Affiliation(s)
- Barbara Montante
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Benedetta Zampa
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Luca Balestreri
- Radiology Department, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (L.B.); (M.U.)
| | - Rosanna Ciancia
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00078 Monte Porzio Catone, Italy; (A.R.); (T.V.)
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00078 Monte Porzio Catone, Italy; (A.R.); (T.V.)
| | - Maurizio Rupolo
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
| | - Zimi Sawacha
- Department of Information Engineering, University of Padua, 35131 Padua, Italy;
| | - Martina Urbani
- Radiology Department, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (L.B.); (M.U.)
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00078 Monte Porzio Catone, Italy; (A.R.); (T.V.)
| | - Mariagrazia Michieli
- Unit of Onco-Hematology and Stem Cell Transplantation and Cellular Therapies, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, 33081 Aviano, Italy; (B.M.); (B.Z.); (R.C.); (M.R.); (M.M.)
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Thalambedu N, Kamran M, Al-Hadidi S. The Role of Vertebral Augmentation Procedures in the Management of Multiple Myeloma. Clin Hematol Int 2024; 6:51-58. [PMID: 38817694 PMCID: PMC11086997 DOI: 10.46989/001c.92984] [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: 08/11/2023] [Accepted: 09/02/2023] [Indexed: 06/01/2024] Open
Abstract
Approximately 90% of patients with multiple myeloma experience significant pain from osseous involvement during their lifetime. Untreated osseous involvement results in vertebral compression fractures, leading to negative consequences for quality of life. Vertebral augmentation procedures, including percutaneous vertebroplasty and kyphoplasty, offer better and faster pain control and likely lower morbidity compared with non-operative interventions. Our review provides an up-to-date summary of the indications, contraindications, timing, outcomes, and potential complications of vertebral augmentation procedures to guide practicing oncologists in effectively managing bone disease in patients with multiple myeloma.
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Affiliation(s)
| | - Mudassar Kamran
- Interventional RadiologyUniversity of Arkansas for Medical Sciences
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Eseonu KC, Panchmatia JR, Streetly MJ, Grauer JN, Fakouri B. The role of Vertebral Augmentation Procedures in the management of vertebral compression fractures secondary to multiple myeloma. Hematol Oncol 2023; 41:323-334. [PMID: 36440820 DOI: 10.1002/hon.3102] [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: 10/30/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
Multiple myeloma (MM) is a systemic disorder characterised by proliferation of B-lymphocytes and plasma cells in the bone marrow. The primary aims of the management of spinal lesions in MM are pain control and fracture stabilisation. Vertebral augmentation procedures (VAP) can be subdivided into percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP). BKP involves the placement of orthopaedic balloons into the fractured vertebral body, creating a void into which polymethylmethacrylate bone cement is injected. This review outlines the management of spinal lesions in patients with MM, with a focus on the comparative risks and efficacy of vertebroplasty (VP) and balloon kyphoplasty (BKP). Soft tissue masses in MM are highly radiosensitive. Bisphosphonates and newer oncological therapies have decreased the indications for palliative radiotherapy, while spinal bracing can be utilised in selected cases to provide stability. BKP and VP provide equivalent long term pain control after MM vertebral compression fractures (VCF). BKP is superior to non-operative management and VP for restoration of vertebral body height and prevention of segmental kyphosis. Current evidence suggests a greater degree of correction of kyphotic deformity and restoration of mid vertebral height (MVH) with BKP when compared with VP. The literature supports the use of BKP even in the presence of posterior vertebral body wall (PVBW) fractures, a group previously considered a contraindication to VAP. Superior functional outcomes have been reported in patients undergoing early versus delayed BKP (<6-8 weeks). Current evidence supports a lower risk of cement extrusion with BKP than with VP, but serious complications following VAP are rare. MM spinal pathology should be managed in a multidisciplinary setting. Surgical decompression and instrumentation are rarely indicated, due to the radio-sensitivity of soft tissue lesions in MM. BKP is a safe and effective procedure for VCF secondary to MM.
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Smith LE, Li VY, Chan S. Tetraplegic spinal cord injury as a presentation of multiple myeloma: A case report. Clin Case Rep 2023; 11:e7667. [PMID: 37469367 PMCID: PMC10352540 DOI: 10.1002/ccr3.7667] [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: 04/24/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
Spinal cord injury is a devastating complication of cancers that exert physical compression on the spinal cord. Multiple myeloma is known predominantly as a condition that involves bony structures and can manifest with complications such as pathological fractures. However, involvement of other structures including spinal cord is a possible complication, with potentially catastrophic consequences. We describe a case of multiple myeloma presenting initially as severe paraplegia secondary to spinal cord compression in a 79-year-old man.
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Affiliation(s)
- Leon Edward Smith
- Department of Rehabilitation and Aged CareHornsby and Ku‐ring‐gai HospitalHornsbyNew South WalesAustralia
| | - Vicky Ying Li
- Department of Rehabilitation and Aged CareHornsby and Ku‐ring‐gai HospitalHornsbyNew South WalesAustralia
| | - Simon Chan
- Department of Rehabilitation and Aged CareHornsby and Ku‐ring‐gai HospitalHornsbyNew South WalesAustralia
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Ly R, Terrier LM, Cognacq G, Benboubker L, Destrieux C, Velut S, Zemmoura I, Francois P, Aggad M, Amelot A. Spinal lesions in multiple myeloma: Primary bone tumors with distinct prognostic factors. Surg Oncol 2023; 48:101927. [PMID: 36966661 DOI: 10.1016/j.suronc.2023.101927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/16/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE Although prognostic factors of spinal multiple myeloma (MM) seem to differ from those of other spine metastases (SpM), the data in the literature remains scarce. METHODS A prospective population of 361 patients treated for spine MM lesions between January 2014 and 2017. RESULTS OS for our series was 59.6 months (SD 6.0 months; CI 95%: 47.7-71.3). Cox multivariate proportional-hazards analysis showed that bone marrow transplant [HR: 0.390, 95% CI 0.264-0.577; p < 0.0001] and light-chain isotype [HR: 0.748, 95% CI 0.318-1.759; p = 0.005] were independent predictors of longer survival. In contrast, age >80 years [HR: 2.7, 95% CI 1.6-4.3; p < 0.0001], ISS III [HR: 2.510, 95% CI 2.01-3.124; p = 0.001], IgA isotype [HR: 1.475, 95% CI 1.031-2.11; p = 0.034] and IgD/M isotype [HR: 2.753, 95% CI 1.230-6.130; p = 0.013] were independent poor prognostic factors. However, ECOG (p = 0.486), spine surgery (p = 0.391), spine radiotherapy (p = 0.260), epidural involvement (p = 0.259), the number of vertebra lesions (p = 0.222), and synchronous/metachronous timeline (p = 0.412) were not significantly associated with improved OS. CONCLUSIONS Spinal involvement in the context of MM does not influence OS. The main prognostic factors to consider before spinal surgery are the characteristics of the primary MM disease (ISS score, IgG isotype and systemic treatment).
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Affiliation(s)
- Raphael Ly
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | - Gabrielle Cognacq
- University of Oxford, John Radcliffe Hospital, Headington, Oxford, Oxfordshire, OX3 9DU, UK
| | | | | | - Stéphane Velut
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | | | | | - Mourad Aggad
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, Tours, France.
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Na S, Lyu Z, Zhang S. Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions. Orthop Surg 2023. [PMID: 37186216 DOI: 10.1111/os.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.
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Affiliation(s)
- Shibo Na
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - ZhenShan Lyu
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - Shaokun Zhang
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
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Gersey ZC, Zenonos GA, Gardner PA. Malignant Brain and Spinal Tumors Originating from Bone or Cartilage. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:477-506. [PMID: 37452950 DOI: 10.1007/978-3-031-23705-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Malignant bone tumors affecting the brain and spine are a rare and exceedingly difficult-to-treat group of diseases. Most commonly consisting of chordoma and chondrosarcoma, these tumors also include giant-cell tumors and osteosarcomas. This chapter will cover the background, epidemiology, genetics, molecular biology, histopathology, radiographic features, clinical manifestations, therapeutic approaches, and clinical management of each entity.
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Affiliation(s)
- Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul A Gardner
- UPMC Center for Cranial Base Surgery, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA.
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Atencia-Flórez C, Quintero-Valencia C, Mondragón-Arismendy M, Cardona-Arias A, Regino-Agamez C, Vélez-Urrego J. Clinical, Laboratory, Cytometry and Cytogenetic Characteristics of a Cohort of Patients Diagnosed with Multiple Myeloma for the First Time in a Third-Level Hospital in Medellín, Colombia, Survival after 8 Years of Follow-Up. Int J Hematol Oncol Stem Cell Res 2023; 17:28-38. [PMID: 37638282 PMCID: PMC10448925 DOI: 10.18502/ijhoscr.v17i1.11711] [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] [Revised: 01/18/2021] [Accepted: 02/12/2022] [Indexed: 08/29/2023] Open
Abstract
Background: Multiple myeloma is the second most common hematologic malignancy after lymphomas. Few studies have characterized significant and full variables at the time of diagnosis of multiple myeloma in Colombia, and there is no data evaluating patients for follow-up. Materials and Methods: A retrospective cohort study is presented, describing the clinical, laboratory, cytometric, and cytogenetic characteristics of patients with a de novo diagnosis of multiple myeloma evaluated in a reference hematology laboratory attached to a highly complex hospital in Medellín, Colombia. We follow them until death as a main outcome. Results: A total of 170 patients with a de novo diagnosis of multiple myeloma were collected from a database of 421 patients with different monoclonal gammopathies. Mainly, it was found that 50.8% of the patients were men; the median age was 62 years; 65.4% had secretion of the IgG kappa; half of the patients presented International Staging System (ISS) Stage III. The β2 macroglobulin >4 mg/L and creatinine >2 mg/dl were the main variables significantly associated with survival (Hazard Ratio (HR) 2.4 and 2, respectively). Eighty-five percent of patients presented with bone lytic lesion involvement and less than 3% with extramedullary involvement. Conventional Banding Karyotype (CBK) genetic risk assessment yield was poor, compared with although scarce data regarding Cytogenetic risk assessment based on Fluorescence in-situ Hybridization (FISH). Conclusion: The clinical profile of the patients with a de novo diagnosis of multiple myeloma in our cohort is similar to that described in international studies. The diagnosis of multiple myeloma was documented at younger ages, with more advanced stages, anemia, and a high percentage of bone disease. ISS provides an excellent tool for prognosis purposes. Cytogenetic risk assessment based on FISH should be done for all MM patients from therapeutic implications. We need standardized protocols for bone marrow sample manipulation and processing in order to guarantee good correlation for plasma cells count methods.
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Affiliation(s)
- Carlos Atencia-Flórez
- Department of Internal Medicine, University of Antioquia School of Medicine, Medellín, Colombia
| | | | | | - Andrés Cardona-Arias
- University of Antioquia School of Medicine, the SURA Healthcare Insurance Company, Medellin (Antioquia), Colombia
| | - Carlos Regino-Agamez
- Department of Internal Medicine, University of Antioquia School of Medicine, Medellín, Colombia
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Correia B, Fernandes J, Botica MJ, Ferreira C, Quintas A. Novel Psychoactive Substances: The Razor's Edge between Therapeutical Potential and Psychoactive Recreational Misuse. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9030019. [PMID: 35323718 PMCID: PMC8950629 DOI: 10.3390/medicines9030019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Novel psychoactive substances (NPS) are compounds of natural and synthetic origin, similar to traditional drugs of abuse. NPS are involved in a contemporary trend whose origin lies in a thinner balance between legitimate therapeutic drug research and legislative control. The contemporary NPS trend resulted from the replacement of MDMA by synthetic cathinones in 'ecstasy' during the 2000s. The most common NPS are synthetic cannabinoids and synthetic cathinones. Interestingly, during the last 50 years, these two classes of NPS have been the object of scientific research for a set of health conditions. METHODS Searches were conducted in the online database PubMed using boolean equations. RESULTS Synthetic cannabinoids displayed protective and therapeutic effects for inflammatory, neurodegenerative and oncologic pathologies, activating the immune system and reducing inflammation. Synthetic cathinones act similarly to amphetamine-type stimulants and can be used for depression and chronic fatigue. CONCLUSIONS Despite the scientific advances in this field of research, pharmacological application of NPS is being jeopardized by fatalities associated with their recreational use. This review addresses the scientific achievements of these two classes of NPS and the toxicological data, ending with a reflection on Illicit and NPS control frames.
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Affiliation(s)
- Beatriz Correia
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
| | - Joana Fernandes
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
| | - Maria João Botica
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPO), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Carla Ferreira
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, 2825-084 Caparica, Portugal
- Faculty of Medicine of Porto University, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Alexandre Quintas
- Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário—Quinta da Granja, Monte de Caparica, 2825-084 Caparica, Portugal; (B.C.); (J.F.); (C.F.)
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, 2825-084 Caparica, Portugal
- Correspondence:
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Jiang L, Cui X, Ma H, Tang X. Comparison of denosumab and zoledronic acid for the treatment of solid tumors and multiple myeloma with bone metastasis: a systematic review and meta-analysis based on randomized controlled trials. J Orthop Surg Res 2021; 16:400. [PMID: 34158101 PMCID: PMC8218501 DOI: 10.1186/s13018-021-02554-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the efficacy and safety between denosumab and zoledronic acid for advanced cancer with bone metastasis. Methods MEDLINE, EMBASE, and the Cochrane library databases were searched for randomized controlled trials up to December 2020 that compared denosumab and zoledronic acid in the treatment of advanced cancer with bone metastasis. The following clinical outcomes were extracted for analysis: time to first skeletal-related event, time to first-and-subsequent skeletal-related events, overall survival, and disease progression. Safety outcomes including incidence of adverse events, serious adverse events, acute-phase reactions, renal toxicity, osteonecrosis of the jaw, and hypocalcemia were also extracted. Results Four randomized controlled trials involving 7201 patients were included. The overall analysis showed that denosumab was superior to zoledronic acid in delaying time to first skeletal-related event (hazard ratio = 0.86; 95% confidence interval, 0.80–0.93; P < 0.01) and time to first-and-subsequent skeletal-related events (risk ratio 0.87; 95% confidence interval 0.81–0.93; P < 0.01). Denosumab was associated with lower incidence of renal toxicity (risk ratio 0.69; 95% confidence interval 0.54–0.87; P < 0.01) and acute phase reaction (risk ratio 0.47; 95% confidence interval 0.38–0.56; P < 0.01), but higher incidence of hypocalcemia (risk ratio 1.78; 95% confidence interval 1.33–2.38; P < 0.01) and osteonecrosis of the jaw (risk ratio 1.41; 95% confidence interval 1.01–1.95; P = 0.04). No significant differences were found in overall survival, time to disease progression, or incidence of adverse events and serious adverse events between denosumab and zoledronic acid. Conclusions Compared with zoledronic acid, denosumab is associated with delayed first-and-subsequent skeletal-related events, lower incidence of renal toxicity, and acute phase reaction, but higher incidence of hypocalcemia and osteonecrosis of the jaw. Hence, denosumab seems to be a promising choice for advanced cancer with bone metastasis. Nonetheless, more randomized controlled trials are needed for further evaluation.
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Affiliation(s)
- Lianghai Jiang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, 266000, Shandong, China
| | - Xianghua Cui
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, 266000, Shandong, China
| | - Haoning Ma
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiangsheng Tang
- Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, China.
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12
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Lu H, Pundole X, Lee HC. The role of bone-modifying agents in myeloma bone disease. JBMR Plus 2021; 5:e10518. [PMID: 34368608 PMCID: PMC8328802 DOI: 10.1002/jbm4.10518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 01/23/2023] Open
Abstract
Bone disease is common in patients with multiple myeloma (MM), which manifests as bone pain and skeletal-related events (SREs) such as pathological fractures and spinal cord compression. Myeloma bone disease (MBD) can adversely affect the quality of life of patients and have negative effects on morbidity and mortality. The pathogenesis of MBD is complex, and several factors are involved in the dysregulation of bone metabolism and uncoupling of bone remodeling, which result in net bone loss and devastating SREs. Broadly speaking, elevated osteoclast activity, suppressed osteoblast activity, and an aberrant marrow microenvironment play a role in MBD. Interaction of MM cells with the main bone cell osteocytes also promote further bone destruction. This review focuses on the role of bone-modifying agents in the prevention and treatment of MBD. The mainstay of MBD prevention are antiresorptive agents, bisphosphonates and denosumab. However, these agents do not play a direct role in bone formation and repair of existing MBD. Newer agents with anabolic effects such as anti-sclerostin antibodies, parathyroid hormone, anti-Dickkopf-1 antibodies, and others have shown potential in repair of MBD lesions. With the development of several new agents, the treatment landscape of MBD is likely to evolve in the coming years. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Huifang Lu
- Department of General Internal Medicine Section of Rheumatology and Clinical Immunology Houston Texas USA
| | - Xerxes Pundole
- Department of Health Services Research The University of Texas MD Anderson Cancer Center Houston Texas USA.,Present address: Amgen Inc. Thousand Oaks CA USA
| | - Hans C Lee
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
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13
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Reinas R, Kitumba D, Pereira L, Alves OL. Minimally invasive surgery for spinal fractures due to multiple myeloma. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:117-122. [PMID: 34194156 PMCID: PMC8214237 DOI: 10.4103/jcvjs.jcvjs_2_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Multiple myeloma (MM) presents with spinal lesions in 60% of cases. The combination of osteolytic lesions with multifactorial osteopenia raises specific surgical treatment challenges. Minimally invasive spine surgery (MISS) could be a potential option for MM spinal lesions treatment. Objective: The objective of this study is to evaluate MISS techniques to treat patients presenting with spine fractures due to MM Methods: Retrospective analysis of consecutive patients with histology-proven pathological fractures caused by MM treated with MISS between 2009 and 2018. We collected the data from the clinical records on epidemiology, topography of spine lesions, surgical techniques, blood loss, operation time, complications, mean in-hospital time, and clinical evolution. Results: Twenty-one patients were studied – 13 males and 8 females, with a mean age of 64 years (range 43–83). Mean preoperative spinal instability neoplastic score was 9.8 ± 6 (range 5–16). All cases had a thoracolumbar location – 15 patients underwent kyphoplasty (KP) or vertebroplasty (VP) and 6 were treated with other more complex procedures. All patients had a reduction of pain and/or analgesic load. Vertebral body height increased by a mean of 2.9 mm after VP/KP. Mean hospital stay was 1.3 days for KP/VP and 5.0 days for other MISS procedures. Three patients had complications. Conclusions: The heterogeneity of techniques used reflected the variety of spine involvement by MM. KP and VP led to shorter hospital stays and less complications, being adequate for lesions without major instability. More complex MISS techniques offer an effective treatment with short delay for starting MM adjuvant treatment.
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Affiliation(s)
- Rui Reinas
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Angola, Portugal
| | - Djamel Kitumba
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Angola, Portugal.,Department of Neurosurgery, Hospital Américo Boavida, Angola, Portugal
| | - Leopoldina Pereira
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Angola, Portugal
| | - Oscar L Alves
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Angola, Portugal.,Department of Neurosurgery, Hospital Lusíadas Porto, Portugal
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14
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Gandham S, Islim A, Alhamad S, Thambiraj S. The outcome of expandable titanium mesh implants for the treatment of multi-level vertebral compression fractures caused by multiple myeloma. SICOT J 2021; 7:28. [PMID: 33929312 PMCID: PMC8086425 DOI: 10.1051/sicotj/2021026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Painful vertebral compression fractures (VCFs) in myeloma patients severely reduce quality of life. Currently, the International Myeloma Working Group (IMWG) and National Institute of Clinical Excellence NICE advocate the use of either balloon kyphoplasty or vertebroplasty in the management of these fractures. METHODS All patients with VCFs and myeloma who adhered to the IMWG indications for vertebral augmentation were treated with the Osseofix® implant. Visual analogue scores (VAS) and Oswestry disability index (ODI) were taken preoperatively and at least one year following surgery. Cobb angle and implant migration were measured on lateral standing radiographs. RESULTS Sixteen patients (average age 62, SD = 11.6) consisting of 82 levels (range 3-8) were stabilised with no perioperative complications or revisions at one year. There was an improvement in patient-reported outcomes with the median preoperative VAS of 8.6 (IQR 7.3-10.0) reducing to 3 (IQR 1.0-4.0) after one year (P < 0.001) whilst an average improvement of 31.4 (SD = 19.6) points in the ODI scores was reported (P < 0.001). There was no significant collapse or implant failure at one year with a greater improvement in the VAS/ODI score, when more implants were used (P = 0.049 and 0.008, respectively). The average length of stay was 2.2 days (SD = 1.7). CONCLUSION The use of the Osseofix® implant in VCFs caused by multiple myeloma has shown a statistically significant improvement in both pain and outcome scores. There were no complications or significant radiological deterioration of spinal alignment over the course of a year.
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Affiliation(s)
- Surya Gandham
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Abdurrahman Islim
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Saud Alhamad
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Sathya Thambiraj
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
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15
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Li J, Wei W, Xu F, Wang Y, Liu Y, Fu C. Clinical Therapy of Metastatic Spinal Tumors. Front Surg 2021; 8:626873. [PMID: 33937314 PMCID: PMC8084350 DOI: 10.3389/fsurg.2021.626873] [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: 11/07/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Metastatic spinal tumors (MST) have high rates of morbidity and mortality. MST can destroy the vertebral body or compress the nerve roots, resulting in an increased risk of pathological fractures and intractable pain. Here, we elaborately reviewed the currently available therapeutic options for MST according to the following four aspects: surgical management, minimally invasive therapy (MIT), radiation therapy, and systemic therapy. In particular, these aspects were classified and introduced to show their developmental process, clinical effects, advantages, and current limitations. Furthermore, with the improvement of treatment concepts and techniques, we discovered the prevalent trend toward the use of radiation therapy and MIT in clinic therapies. Finally, the future directions of these treatment options were discussed. We hoped that along with future advances and study will lead to the improvement of living standard and present status of treatment in patients with MST.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China.,Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - Wenjie Wei
- Key Laboratory of Pathobiology, Ministry of Education, School of Basic Medical Sciences, Jilin University, Changchun, China
| | - Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yadong Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Changfeng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
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16
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Saad A, Azzopardi C, Haleem S, Czyz M, James SL, Botchu R. Tumours of the odontoid peg revisited. Indian J Radiol Imaging 2021; 30:420-426. [PMID: 33737770 PMCID: PMC7954168 DOI: 10.4103/ijri.ijri_363_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction Tumours of the odontoid peg are rare but can potentially cause significant morbidity and mortality. Methods A retrospective review of oncology and radiology database of tertiary orthopaedic oncology centre for all lesions affecting the odontoid peg over the last 12 years was performed. Results We identified a total of 15 tumours involving the odontoid peg, majority being malignant. Myeloma was the most common tumour. Conclusion Tumours of the odontoid peg are rare. Spinal surgeons and Radiologists need to be aware of them.
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Affiliation(s)
- Ahmed Saad
- Department of Orthopedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - Shahnawaz Haleem
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Marcin Czyz
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Steven L James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
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17
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Multiple myeloma and chemical maxillary osteonecrosis. Can both occur simultaneously? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:523-526. [DOI: 10.1016/j.jormas.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/11/2019] [Indexed: 11/15/2022]
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18
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Aganesov AG, Alexanyan MM, Mardanyan GV, Novikova AA. [Aortic intramural hematoma after transpedicular thoracic spine fusion]. Khirurgiia (Mosk) 2020:84-88. [PMID: 32105261 DOI: 10.17116/hirurgia202002184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 55-year-old patient M. with compression fractures of Th7-Th8 underwent Th7-Th8 decompressive laminectomy, Th6-Th9 transpedicular spine fusion procedure on January 31, 2017. After that, multiple myeloma was diagnosed at the National Research Center for Hematology. Computed tomography revealed misplacement of a left Th6 screw, its anterior cortical perforation and penetration into the aorta. Signs of intramural hematoma were noticed in this area. The patient was referred to the Petrovsky National Research Center of Surgery. Two-stage surgical approach was preferred. Endovascular repair of the thoracic aorta (TEVAR) was followed by revision of transpedicular fusion system and reinstallation of the screw. Operation was performed on July 14, 2017. Postoperative period was uneventful.
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Affiliation(s)
- A G Aganesov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - M M Alexanyan
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Mardanyan
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A A Novikova
- National Research Center for Hematology, Moscow, Russia
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19
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Parrondo RD, Sher T. Prevention Of Skeletal Related Events In Multiple Myeloma: Focus On The RANK-L Pathway In The Treatment Of Multiple Myeloma. Onco Targets Ther 2019; 12:8467-8478. [PMID: 31686861 PMCID: PMC6798817 DOI: 10.2147/ott.s192490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/20/2019] [Indexed: 01/11/2023] Open
Abstract
More than 90% of patients with multiple myeloma (MM) have osteolytic bone lesions which increase the risk of skeletal-related events (SRE). The cytokine milieu in the bone marrow microenvironment (BMME) of MM plays a key role in myeloma bone disease by impairing the balance between osteoclastogenesis and osteoblastogenesis. This is orchestrated by the malignant plasma cell (MPC) with the ultimate outcome of MPC proliferation and survival at the expense of excess osteoclast activation resulting in osteolytic bone lesions. Prevention of SRE is currently accomplished by the inhibition of osteoclasts. Bisphosphonates (BPs) are pyrophosphate analogues that cause apoptosis of osteoclasts and have been proven to prevent and delay SRE. Denosumab, a fully humanized monoclonal antibody that binds and inhibits receptor activator of nuclear factor-ĸB ligand (RANKL), a key molecule in the BMME crucial for osteoclastogenesis, is also approved for the prevention of SRE in MM. The addition of BPs and denosumab to standard MM treatment affords a survival benefit for patients with MM. Specifically, the addition of denosumab to standard MM treatments results in superior PFS compared to BPs, highlighting the key role of the RANKL pathway in MM. This review focuses on the pathophysiology of myeloma bone disease as well as on the importance of targeting the RANK-L pathway for the treatment of MM and prevention of SRE.
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Affiliation(s)
- Ricardo D Parrondo
- Department of Medicine, Hematology-Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Taimur Sher
- Department of Medicine, Hematology-Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
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20
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Mark D, Gilbo P, Meshrekey R, Ghaly M. Local Radiation Therapy for Palliation in Patients With Multiple Myeloma of the Spine. Front Oncol 2019; 9:601. [PMID: 31334121 PMCID: PMC6621643 DOI: 10.3389/fonc.2019.00601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose: The objective of this study was to assess a contemporary cohort of patients with multiple myeloma referred for palliative radiation to the mobile spine for clinical and radiological responses. Materials/Methods: The records of patients treated between 2009 and 2016 with radiotherapy for multiple myeloma of the spine were retrospectively reviewed. Demographics, systemic therapy, radiation dose, number of fractions, radiographic response based upon adapted RECIST criteria, and symptomatic response were recorded. Results: Eighty eight patients and 98 treatment courses were analyzed. All courses were analyzed for symptomatic response and 61 of the treatment courses were available for radiologic follow-up. The median follow-up was 9.7 months with a median radiation dose of 25 Gy (12.5–50 Gy) delivered in a median of 10 fractions (5–25 fractions). Fifty-four percent of patients had a high-risk lesion. Symptomatic response as measured by a decrease of ≤5 points on the pain related scale was 83% and 34% of patients had a decrease of >5 points. Of 35% of patients that had neurologic impairments prior to treatment, improvement was identified 83% of the time. Radiographic response was noted as 13% complete response, 16% partial response, 57% stable disease, and 13% disease progression. Specifically, high-risk lesions treated with radiation alone demonstrated no regression with only 10% demonstrating partial response. Conclusion: This retrospective series of patients treated with palliative intent for multiple myeloma using various dose and fractionation schemes showed favorable symptomatic relief in most patients. Radiographic response did not correlate with clinical response with fewer patients having radiologic disease regression. Longer follow-up is necessary to determine if the lack of radiologic response is associated with clinically relevant recurrent pain.
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Affiliation(s)
- Daniel Mark
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, United States
| | - Philip Gilbo
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, United States
| | - Raymond Meshrekey
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, United States
| | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, United States
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21
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Schulze F, Keperscha B, Appelhans D, Rösen-Wolff A. Immunomodulatory Effects of Dendritic Poly(ethyleneimine) Glycoarchitectures on Human Multiple Myeloma Cell Lines, Mesenchymal Stromal Cells, and in Vitro Differentiated Macrophages for an Ideal Drug Delivery System in the Local Treatment of Multiple Myeloma. Biomacromolecules 2019; 20:2713-2725. [DOI: 10.1021/acs.biomac.9b00475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Felix Schulze
- Department of Pediatrics, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Bettina Keperscha
- Leibniz Institute of Polymer Research Dresden, Hohe Str. 6, 01069 Dresden, Germany
| | - Dietmar Appelhans
- Leibniz Institute of Polymer Research Dresden, Hohe Str. 6, 01069 Dresden, Germany
| | - Angela Rösen-Wolff
- Department of Pediatrics, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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22
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Wang Y, Michiels T, Setroikromo R, van Merkerk R, Cool RH, Quax WJ. Creation of RANKL mutants with low affinity for decoy receptor OPG and their potential anti-fibrosis activity. FEBS J 2019; 286:3582-3593. [PMID: 31081236 PMCID: PMC6852375 DOI: 10.1111/febs.14925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/11/2019] [Accepted: 05/10/2019] [Indexed: 12/21/2022]
Abstract
Fibrosis is characterized by the progressive alteration of the tissue structure due to the excessive production of extracellular matrix (ECM). The signaling system encompassing Receptor Activator of Nuclear factor NF‐κB Ligand (RANKL)/RANK/Osteoprotegerin (OPG) was discovered to play an important role in the regulation of ECM formation and degradation in bone tissue. However, whether and how this signaling pathway plays a role in liver or pulmonary ECM degradation is unclear up to now. Interestingly, increased decoy receptor OPG levels are found in fibrotic tissues. We hypothesize that RANKL can stimulate RANK on macrophages and initiate the process of ECM degradation. This process may be inhibited by highly expressed OPG in fibrotic conditions. In this case, RANKL mutants that can bind to RANK without binding to OPG might become promising therapeutic candidates. In this study, we built a structure‐based library containing 44 RANKL mutants and found that the Q236 residue of RANKL is important for OPG binding. We show that RANKL_Q236D can activate RAW cells to initiate the process of ECM degradation and is able to escape from the obstruction by exogenous OPG. We propose that the generation of RANKL mutants with reduced affinity for OPG is a promising strategy for the exploration of new therapeutics against fibrosis.
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Affiliation(s)
- Yizhou Wang
- Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
| | - Timo Michiels
- Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
| | - Rita Setroikromo
- Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
| | - Ronald van Merkerk
- Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
| | - Robbert H Cool
- Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
| | - Wim J Quax
- Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands
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23
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The selective HDAC6 inhibitor Nexturastat A induces apoptosis, overcomes drug resistance and inhibits tumor growth in multiple myeloma. Biosci Rep 2019; 39:BSR20181916. [PMID: 30782785 PMCID: PMC6430725 DOI: 10.1042/bsr20181916] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 01/25/2023] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy of plasma cells that produce a monoclonal immunoglobulin protein. Despite significant advances in the treatment of MM, challenges such as resistance to therapy remain. Currently, inhibition of histone deacetylases (HDACs) is emerging as a potential method for treating cancers. Numerous HDAC inhibitors are being studied for the use in monotherapy or in conjunction with other agents for MM. In the present study, we investigated the anti-myeloma effect of Nexturastat A (NexA), a novel selective HDAC6 inhibitor. We found that NexA impaired MM cells viability in a dose- and time-dependent manner. NexA also provoked a cell cycle arrest at the G1 phase in MM cells. Furthermore, NexA promoted apoptosis of MM cells via transcriptional activation of the p21 promoter, which may through its ability to up-regulate the H3Ac and H4Ac levels. Additionally, NexA could overcome bortezomib (BTZ) resistance in MM cells, and NexA in combination with BTZ had stronger efficacy. We also confirmed that NexA inhibited tumor growth in murine xenograft models of MM. These interesting findings provided the rationale for the future advancement of this novel HDAC6 inhibitor as a potential therapeutic anti-myeloma agent.
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24
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Yao X, Xu Z, Du X. PKP/PVP combine chemotherapy in the treatment of multiple myeloma patients with vertebral pathological fractures: minimum 3-year follow-up of 108 cases. J Orthop Surg Res 2019; 14:42. [PMID: 30744644 PMCID: PMC6371465 DOI: 10.1186/s13018-019-1078-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Multiple myeloma (MM) is a blood system malignant tumor, which often leads to osteolytic bone destruction, and the vertebral column is the primary site of involvement. However, the efficacy and prognosis of percutaneous kyphoplasty/vertebroplasty (PKP/PVP) for simple vertebral pathological fractures in patients with multiple myeloma are not yet unified. The primary objective of this study was to investigate the efficacy and prognosis of PKP/PVP in the treatment of multiple myeloma patients with vertebral pathological fractures. Methods A total of 108 patients with MM from Beijing Chao-Yang Hospital from 2007 to 2013 were enrolled. Of these, 52 patients underwent PKP/PVP surgery and chemotherapy (surgery group) and 56 received only chemotherapy (chemotherapy group). The age, gender, International Staging System (ISS), fracture location, segment, visual analog scale (VAS), Oswestry Disability Index (ODI), comprehensive treatment satisfaction, stem cell transplantation, overall survival (OS), mortality rate, and the cause of death of patients were recorded; the mean follow-up time was 42.46 months. Results The average age of patients in surgery and chemotherapy groups was 60.8 years and 58.1 years, and the mean survival time was 41.98 months and 43.30 months, respectively. The VAS score at 1 month and last follow-up after treatment in surgery group were significantly lower than those in the chemotherapy group (P < 0.05); the ODI at 1 month after treatment in the surgery group was significantly lower than that in the chemotherapy group (P < 0.05); no significant difference was observed in the 3-year mortality rate between surgery and chemotherapy groups. The number of patients who developed activity disorder in the surgery group was significantly less than that in the chemotherapy group (P < 0.05). The OS of patients in ISS stage III was significantly less than that in ISS stages I and II (P < 0.05). Conclusions PKP/PVP surgery can greatly relieve the pain caused by fractures, reduce the risk of being completely bedridden and pulmonary infection, and improve the quality of life of patients; however, it did not affect mortality rate and overall survival time in patients. Trial registration As this was a retrospective study, it did not require ethical approval; all patients had signed informed consent when they received treatment, and all treatment options were voluntary.
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Affiliation(s)
- Xingchen Yao
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuguan Nanlu, Chaoyang district, Beijing, China
| | - Ziyu Xu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuguan Nanlu, Chaoyang district, Beijing, China
| | - Xinru Du
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuguan Nanlu, Chaoyang district, Beijing, China.
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25
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Chramiec A, Vunjak-Novakovic G. Tissue engineered models of healthy and malignant human bone marrow. Adv Drug Deliv Rev 2019; 140:78-92. [PMID: 31002835 PMCID: PMC6663611 DOI: 10.1016/j.addr.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/14/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022]
Abstract
Tissue engineering is becoming increasingly successful in providing in vitro models of human tissues that can be used for ex vivo recapitulation of functional tissues as well as predictive testing of drug efficacy and safety. From simple tissue models to microphysiological platforms comprising multiple tissue types connected by vascular perfusion, these "tissues on a chip" are emerging as a fast track application for tissue engineering, with great potential for modeling diseases and supporting the development of new drugs and therapeutic targets. We focus here on tissue engineering of the hematopoietic stem and progenitor cell compartment and the malignancies that can develop in the human bone marrow. Our overall goal is to demonstrate the utility and interconnectedness of improvements in bioengineering methods developed in one area of bone marrow studies for the remaining, seemingly disparate, bone marrow fields.
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26
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Patel MS, Ghasem A, Greif DN, Huntley SR, Conway SA, Al Maaieh M. Evaluating Treatment Strategies for Spinal Lesions in Multiple Myeloma: A Review of the Literature. Int J Spine Surg 2018; 12:571-581. [PMID: 30364863 DOI: 10.14444/5070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Vertebral disease is a major cause of morbidity in 70% of patients diagnosed with multiple myeloma (MM). Associated osteolytic lesions and vertebral fractures are well documented in causing debilitating pain, functional restrictions, spinal deformity, and cord compression. Currently, treatment modalities for refractory MM spinal pain include systemic therapy, radiotherapy, cementoplasty (vertebroplasty/kyphoplasty), and radio frequency ablation. Our objectives were to report on the efficacy of existing treatments for MM patients with refractory spinal pain, to determine if a standardized treatment algorithm has been described, and to set the foundation upon which future prospective studies can be designed. Methods A systematic search of the PubMed database was performed for studies relevant to the treatment of vertebral disease in MM patients. A multitude of search terms in various combinations were used, including but not limited to: "vertebroplasty," "kyphoplasty," "radiation," "multiple myeloma," "radiotherapy," and "radiosurgery." Results Our preliminary search resulted in 219 articles, which subsequently resulted in 19 papers following abstract, title, full-text, and bibliography review. These papers were then grouped by treatment modality: radiotherapy, cementoplasty, or combination therapy. Significant pain and functional score improvement across all treatment modalities was found in the majority of the literature. While complications of treatment occurred, few were noted to be clinically significant. Conclusions Treatment options-radiotherapy and/or cementoplasty-for vertebral lesions and pathologic fractures in MM patients demonstrate significant radiographic and clinical improvement. However, there is no consensus in the literature as to the optimal treatment modality as a result of a limited number of studies reporting head-to-head comparisons. One study did find significantly improved pain and functional scores with preserved vertebral height in favor of kyphoplasty over radiotherapy. When not contraindicated, we advocate for some form of cementoplasty. Further prospective studies are required before implementation of a standardized treatment protocol. Level of Evidence 5.
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Affiliation(s)
| | - Alexander Ghasem
- University of Miami, Department of Orthopedic Surgery, Miami, Florida
| | - Dylan N Greif
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Sheila A Conway
- University of Miami, Department of Orthopedic Surgery, Miami, Florida
| | - Motasem Al Maaieh
- University of Miami, Department of Orthopedic Surgery, Miami, Florida
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Olaniyi JA, Shonde-Adebola KB. Immunoglobulin A Myeloma in a Newly Diagnosed Sickle Cell Disease Patient. Int J Appl Basic Med Res 2018; 8:177-180. [PMID: 30123749 PMCID: PMC6082005 DOI: 10.4103/ijabmr.ijabmr_107_17] [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] [Indexed: 11/21/2022] Open
Abstract
Several neoplasms including hematological malignancies occurring in very few patients with sickle cell syndromes have been reported in literature, particularly as survival among these patients and diagnostic accuracy have continued to improve. Multiple myeloma (MM) has rarely been reported in patients with hemoglobin (Hb) S + C. We report a 65-year-old retired banker who was recently diagnosed with HbS + C. This patient developed MM with markedly elevated erythrocyte sedimentation rate, mild anemia, 80% bone marrow plasmacytosis, and elevated serum immunoglobulin A level, while plain X-ray of the lumbosacral spine showed multilevel vertebral collapse.
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Affiliation(s)
- John Ayodele Olaniyi
- Department of Haematology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Koshiaris C, Oke J, Abel L, Nicholson BD, Ramasamy K, Van den Bruel A. Quantifying intervals to diagnosis in myeloma: a systematic review and meta-analysis. BMJ Open 2018; 8:e019758. [PMID: 29934381 PMCID: PMC6020959 DOI: 10.1136/bmjopen-2017-019758] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To quantify the duration of each step of the diagnostic pathway for patients with multiple myeloma from symptom onset to confirmation of diagnosis. DESIGN Systematic review and meta-analysis. DATA SOURCES AND SELECTION CRITERIA The MEDLINE and Embase databases were searched up until January 2018 to identify articles that reported time intervals from onset of symptoms to diagnosis. Articles focusing on children or adolescents and on the asymptomatic form of the disease (monoclonal gammopathies and smouldering myeloma) were excluded. DATA COLLECTION AND DATA ANALYSIS Data were extracted independently by two reviewers. Weighted estimates of the median and IQR were calculated. Risk of bias was assessed using the Aarhus checklist. MAIN RESULTS Nine studies were included. The patient interval (first symptom to first presentation) had a median of 26.3 days (IQR: 1-98, n=465, two studies). Subsequently, the primary care interval (first presentation to first referral) was 21.6 days (IQR: 4.6-55.8, n=326, two studies), the diagnostic interval (first presentation to diagnosis) was 108.6 days (IQR: 33.3-241.7, n=5395, seven studies) and the time to diagnosis (first symptom to diagnosis) interval was 163 days (IQR: 84-306, n=341, one study). No studies reported data for the referral to diagnosis interval. CONCLUSION The review demonstrates that there is scope for significant reductions in the time to myeloma diagnosis. At present, many patients experience a diagnostic interval longer than 3 months until diagnosis is confirmed. REVIEW REGISTRATION Not available. Protocol available in the appendix.
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Affiliation(s)
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Abel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karthik Ramasamy
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
- National Institute for Health Research (NIHR) Biomedical Research Center Blood Theme, Oxford, UK
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Quidet M, Zairi F, Boyle E, Facon T, Vieillard MH, Machuron F, Lejeune JP, Assaker R. Evaluation of the Relevance of Surgery in Patients with Multiple Myeloma Harboring Symptomatic Spinal Involvement: A Retrospective Case Series. World Neurosurg 2018. [PMID: 29530691 DOI: 10.1016/j.wneu.2018.02.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple myeloma spinal involvement can lead to bone fractures and neurologic impairment that can severely alter quality of life. The role of surgery is controversial, given its high morbidity, and the lack of evidence. We hereby aim to evaluate efficacy and safety of surgery in the management of symptomatic spinal lesions in patients with multiple myeloma. METHODS We included all patients operated on for a myeloma-related spinal lesion in our institution between 2007 and 2015. Demographic, clinical, and surgical data were collected as well as hematologic profiles. We retrospectively assessed the surgical success of the procedures, if at 3 months the patient fulfilled the following 4 criteria: pain relief, ability to walk, spinal stability, and no relevant morbidity. RESULTS Thirty-six men and 19 women, with a median age of 62 years, were included. Seventeen patients underwent an emergency intervention, whereas 38 patients underwent elective surgery. At 3 months, 88.2% and 96.1%, respectively, of patients experienced pain relief and were able to walk. Spinal stability was considered satisfactory for 94.1% of patients. We reported 8 major complications in 8 patients. Altogether, 34 patients (61.8%) fulfilled all criteria for surgical success. An International Staging System score of 1 and the absence of previous chemotherapy were significantly associated with surgical success. CONCLUSIONS Management of myeloma-related spine lesions requires a multidisciplinary approach. Surgery rapidly provides both decompression and stabilization. Using a strict patient-specific evaluation, we reported rewarding functional results, with acceptable morbidity. Surgery for multiple myeloma vertebral lesions seems to be a valuable option for carefully selected patients.
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Affiliation(s)
- Mathilde Quidet
- Department of Neurosurgery, Lille University Hospital, Lille, France.
| | - Fahed Zairi
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Eileen Boyle
- Department of Haematology, Lille University Hospital, Lille, France
| | - Thierry Facon
- Department of Haematology, Lille University Hospital, Lille, France
| | | | - François Machuron
- Department of Biostatistics, University of Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - Jean-Paul Lejeune
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Wu M, Cai L, Yan F, Xu K, Sun W, Deng Z, Xie Y. [Applications of one-stage total spondylectomy by anterior and posterior approaches for solitary plasmacytoma of cervical spine]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:195-202. [PMID: 29806412 DOI: 10.7507/1002-1892.201709107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine. Methods Between June 2000 and March 2015, the clinical data, diagnosis, and treatment of 12 patients with SP of cervical spine were retrospectively analyzed. There were 8 males and 4 females, with a mean age of 46 years (range, 28-74 years). The mean disease duration was 8.4 months (range, 3-15 months). There were 2 cases in C 2 segment, 4 cases in C 3, 2 cases in C 4, 1 recurrent case in C 5, C 6, and 3 cases in C 7. According to WBB (Weinstein-Boriani-Biagini) surgical staging system, the tumor mainly occupied the vertebral body areas and expanded outside to 4 or 9 radiating zone in 8 cases, expanded both outsides to 4 or 9 radiating zones in 4 cases; 7 cases of them affected A to D layers, other 5 cases affected B to D layers. Preoperative Frankel system showed grade B in 1 case, grade C in 6 cases, and grade D in 5 cases. One vertebra segment was involved in 11 cases, and 2 vertebra segments were involved in 1 case. The unilateral vertebral artery was involved in 4 cases and bilateral vertebral artery in 1 case. One-stage total spondylectomy by anterior and posterior approaches for SP of cervical spine was applied in all patients, which all received adjuvant radiotherapy postoperatively. The operation time, intraoperative blood loss, complications, Frankel system, and visual analogue scale (VAS) score were recorded and analyzed. Results The operation time was 6.8-9.3 hours (mean, 7.2 hours), and the intraoperative blood loss was 1 100-2 600 mL (mean, 1 600 mL). Esophageal leakage occurred in 1 patient with C 5, C 6 recurrent SP at 1 week after operation and 1 case presented with fat liquefaction of wound, who were cured by symptomatic treatment. Other patients showed no neurological deficit, major vascular injury (especially vertebral artery), phrenic nerve injury, superior laryngeal nerve injury, laryngeal nerve injury, respiratory failure, or other complications. All the 12 patients were followed up 27-98 months (mean, 58 months). The symptoms of spinal cord compression disappeared or improved after operation. At last follow-up, the nerve function was recovered to Frankel grade E in all patients; the VAS score decrease to 1.1±0.7, showing significant difference when compared with preoperative value (6.7±2.7) ( t=2.485, P=0.014). Two patients had local recurrence at 29 months and 37 months after operation respectively, which were treated with adjuvant chemotherapy. One of them finally progressed to multiple myeloma and died of multiple organ failure after 43 months, the other one survived with residual tumor. One case presented with internal fixator loosening and breaking at 4 years after operation, who was performed revision surgery. The other patients had no tumor recurrence or malignant change during the follow-up, no complication such as internal fixator loosening or breaking occurred. Conclusion For patients with SP of cervical spine, surgical intervention is an acceptable treatment option. One-stage total spondylectomy by anterior and posterior approaches can decline the local recurrence and relieve the symptoms of spinal cord compression, so as to improve patients' life quality. However, patients with progression to multiple myeloma should be treated with individualized therapeutic regimen, and the prognosis may be poor.
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Affiliation(s)
- Minhao Wu
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Lin Cai
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071,
| | - Feifei Yan
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Keke Xu
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Wenchao Sun
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Zhouming Deng
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Yuanlong Xie
- Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
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Plasma Cell Dyscrasias in India-2017 Updates. Indian J Hematol Blood Transfus 2018; 34:1-4. [PMID: 29398791 DOI: 10.1007/s12288-017-0910-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022] Open
Abstract
Rapid advances are being made in the field of plasma cell dyscrasias. Many abstracts pertaining to the laboratory aspects, clinical features, treatment modalities and outcome of plasma cell dyscrasias were presented at Hematocon 2017. All the total of 24 abstracts pertaining to plasma cell dyscrasias presented at the Hematocon 2017 were reviewed. Out of them 10 were original research and 14 were case reports/short case series. The key findings of original research studies conducted in India are being summarized. Exciting research in the field of plasma cell dyscrasias is being carried out by various centers in the country. Data presented on various aspects of research in plasma cell disorders is encouraging. Multicentric research in the field plasma cell dyscrasias should be encouraged to highlight the various aspects of disease biology and challenges in management unique to our country.
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Tseeleesuren D, Kant R, Yen CH, Hsiao HH, Chen YMA. 1,2,3,4,6-Penta- O-Galloyl-Beta-D-Glucopyranoside Inhibits Proliferation of Multiple Myeloma Cells Accompanied with Suppression of MYC Expression. Front Pharmacol 2018; 9:65. [PMID: 29472861 PMCID: PMC5810280 DOI: 10.3389/fphar.2018.00065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/18/2018] [Indexed: 11/21/2022] Open
Abstract
Multiple myeloma (MM) still remains an incurable disease, therefore discovery of novel drugs boosts the therapeutics for MM. The natural compound 1,2,3,4,6-Penta-O-galloyl-beta-D-glucopyranoside (PGG) has been shown to exhibit antitumor activities against various cancer cells. Here, we aim to evaluate antitumor effects of PGG on MM cell lines. PGG inhibited the growth of three different MM cell lines in a dose- and time-dependent manner. Cell cycle analysis revealed that PGG treatment caused cell cycle arrest in G1 phase. It also induced apoptosis which was indicated by significant increases of Annexin V positive cells, caspase 3/7 activity, and cleaved caspase 3 expression in PGG treated MM cell. Since MYC is frequently hyperactivated in MM and inhibition of MYC leads to MM cell death. We further demonstrated that PGG decreased MYC expression in protein and mRNA levels and reversed the mRNA expression of MYC target genes such as p21, p27, and cyclin D2. In addition, PGG also reduced protein expression of DEPTOR which is commonly overexpressed in MM. Unexpectedly, PGG antagonized the cytotoxic effect of bortezomib in the combination treatment. However, PGG treatment sensitized MM cells to another proteasome inhibitor MG132 induced cytotoxicity. Moreover, MYC inhibitor JQ1 enhanced the cytotoxic effect of bortezomib on MM cells. Our findings raised concerns about the combinatory use of bortezomib with particular types of chemicals. The evidence also provide useful insights into the combination of MYC and proteasome-inhibitors for MM therapy. Finally, PGG has a therapeutic potential for treatment of MM and further development is mandatory.
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Affiliation(s)
- Duurenjargal Tseeleesuren
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rajni Kant
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Hung Yen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Research Center for Natural Products and Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Hua Hsiao
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ming A Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
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Ring ES, Lawson MA, Snowden JA, Jolley I, Chantry AD. New agents in the Treatment of Myeloma Bone Disease. Calcif Tissue Int 2018; 102:196-209. [PMID: 29098361 PMCID: PMC5805798 DOI: 10.1007/s00223-017-0351-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/19/2017] [Indexed: 12/17/2022]
Abstract
Patients with multiple myeloma develop a devastating bone disease driven by the uncoupling of bone remodelling, excess osteoclastic bone resorption and diminished osteoblastic bone formation. The bone phenotype is typified by focal osteolytic lesions leading to pathological fractures, hypercalcaemia and other catastrophic bone events such as spinal cord compression. This causes bone pain, impaired functional status, decreased quality of life and increased mortality. Early in the disease, malignant plasma cells occupy a niche environment that encompasses their interaction with other key cellular components of the bone marrow microenvironment. Through these interactions, osteoclast-activating factors and osteoblast inhibitory factors are produced, which together uncouple the dynamic process of bone remodelling, leading to net bone loss and focal osteolytic lesions. Current management includes antiresorptive therapies, i.e. bisphosphonates, palliative support and orthopaedic interventions. Bisphosphonates are the mainstay of treatment for myeloma bone disease (MBD), but are only partially effective and do have some significant disadvantages; for example, they do not lead to the repair of existing bone destruction. Thus, newer agents to prevent bone destruction and also promote bone formation and repair existing lesions are warranted. This review summarises novel ways that MBD is being therapeutically targeted.
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Affiliation(s)
- Elizabeth S Ring
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, South Yorkshire, S10 2RX, UK.
| | - Michelle A Lawson
- Sheffield Myeloma Research Team, Department of Oncology and Metabolism, Mellanby Bone Centre, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ingrid Jolley
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, South Yorkshire, S10 2RX, UK
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew D Chantry
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, South Yorkshire, S10 2RX, UK
- Sheffield Myeloma Research Team, Department of Oncology and Metabolism, Mellanby Bone Centre, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Hariri O, Takayanagi A, Miulli DE, Siddiqi J, Vrionis F. Minimally Invasive Surgical Techniques for Management of Painful Metastatic and Primary Spinal Tumors. Cureus 2017; 9:e1114. [PMID: 28446993 PMCID: PMC5403161 DOI: 10.7759/cureus.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with metastatic spinal disease are affected by disabling pain. The treatment of spinal metastases is focused on pain reduction and improvement in quality of life. Until recently, many patients with metastatic spinal disease did not qualify as surgical candidates due to the risks of surgery and length of recovery period. However, recent advances in minimally invasive surgery such as kyphoplasty and vertebroplasty allow patients to safely undergo surgery for pain relief with a short recovery period. The studies reviewed here suggest that vertebral augmentation is successful in reducing pain and disability scores in patients with painful metastases and multiple myeloma and are a safe modality to provide lasting pain relief. As the use of kyphoplasty and vertebroplasty for treatment of vertebral metastases is becoming more common, new combinations of cement augmentation with other techniques such as percutaneous pedicle screws and radiofrequency ablation are being explored. The implementation of kyphoplasty and vertebroplasty, in conjunction with other minimally invasive surgical techniques as well as nonsurgical modalities, may lead to the best palliative management of cancer patients with spinal metastases and help them ultimately achieve a better quality of life.
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Affiliation(s)
- Omid Hariri
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Dan E Miulli
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Javed Siddiqi
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Frank Vrionis
- Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States
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Anitha D, Thomas B, Jan KS, Subburaj K. Risk of vertebral compression fractures in multiple myeloma patients: A finite-element study. Medicine (Baltimore) 2017; 96:e5825. [PMID: 28079810 PMCID: PMC5266172 DOI: 10.1097/md.0000000000005825] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to develop and validate a finite element (FE) model to predict vertebral bone strength in vitro using multidetector computed tomography (MDCT) images in multiple myeloma (MM) patients, to serve as a complementing tool to assess fracture risk. In addition, it also aims to differentiate MM patients with and without vertebral compression fractures (VCFs) by performing FE analysis on vertebra segments (T1-L5) obtained from in vivo routine MDCT imaging scans. MDCT-based FE models were developed from the in vitro vertebrae samples and were then applied to the in vivo vertebrae segments of MM patients (n = 4) after validation. Predicted fracture load using FE models correlated significantly with experimentally measured failure load (r = 0.85, P < 0.001). Interestingly, an erratic behavior was observed in patients with fractures (n = 2) and a more gradual change in FE-predicted strength values in patients without fractures (n = 2). Severe geometric deformations were also observed in models that have already attained fractures. Since BMD is not a reliable parameter for fracture risk prediction in MM subjects, it is necessary to use advanced tools such as FE analysis to predict individual fracture risk. If peaks are observed between adjacent segments in an MM patient, it can be safe to conclude that the spine is experiencing regions of structural instability. Such an FE visualization may have therapeutic consequences to prevent MM associated vertebral fractures.
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Affiliation(s)
- D. Anitha
- Engineering Product Development (EPD), Singapore University of Technology and Design (SUTD), Singapore
| | - Baum Thomas
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Kirschke S. Jan
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Karupppasamy Subburaj
- Engineering Product Development (EPD), Singapore University of Technology and Design (SUTD), Singapore
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Stankovikj S, Martinova K. Acute complications in multiple myeloma. SANAMED 2017. [DOI: 10.24125/sanamed.v12i2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Multiple myeloma is a malignant disorder of plasma cells, characterized by uncontrolled and progressive proliferation of a single clone of plasma cells. The disease leads to progressive morbidity and eventual mortality by lowering resistance to infection and causing significant skeletal destruction with bone pain, pathological fractures and hypercalcemia. Improved understanding of the multiple myeloma biology along with the discovery of novel anti-myeloma agents has led to a better-quality treatment of these patients. However, it still remains an incurable disease for the vast majority of patients, with a median survival 2-3 years. Patients with multiple myeloma frequently develop complications that are reason for early mortality within 60 days of diagnosis. Acute complications such as hyperviscosity syndrome, hypercalcemia, spinal cord compression, early infection, bone disease and renal impairment may be life-threatening. The treatment of these medical emergencies has greatly decreased morbidity and early mortality in patients.
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Acar EA, Demirci U, Pabuşçu Y, Miskioğlu HM, Aydoğdu İ. Pathological Fracture in Odontoid Process in Multiple Myeloma. Turk J Haematol 2016; 34:181-182. [PMID: 27660156 PMCID: PMC5440872 DOI: 10.4274/tjh.2016.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Ufuk Demirci
- Celal Bayar University Faculty of Medicine, Department of Internal Medicine, Manisa, Turkey Phone: +90 505 518 92 20 E-mail:
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Malhotra K, Butler JS, Yu HM, Selvadurai S, D'Sa S, Rabin N, Kyriakou C, Yong K, Molloy S. Spinal disease in myeloma: cohort analysis at a specialist spinal surgery centre indicates benefit of early surgical augmentation or bracing. BMC Cancer 2016; 16:444. [PMID: 27401073 PMCID: PMC4939590 DOI: 10.1186/s12885-016-2495-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/24/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. We explore the impact of time to presentation on the efficacy of spinal treatment modalities. METHODS We retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period. RESULTS Median time from multiple myeloma diagnosis to presentation at our centre was 195 days. Eighty-four patients (45.9 %) were treated with balloon kyphoplasty and the remainder with a thoracolumbar-sacral orthosis as per our published protocol. Patients presenting earlier than 195 days from diagnosis had significant improvements in patient reported outcome measures: EuroQol 5-Dimensions (p < 0.001), Oswestry Disability Index (p < 0.001), and Visual Analogue Pain Score (p < 0.001) at follow-up, regardless of treatment. Patients presenting after 195 days, however, only experienced benefit following balloon kyphoplasty, with no significant benefit from non-operative management. CONCLUSION Vertebral augmentation and thoracolumbar bracing improve patient reported outcome scores in patients with spinal myeloma. However, delay in treatment negatively impacts clinical outcome, particularly if managed non-operatively. It is important to screen and treat patients with MM and back pain early to prevent deformity and improve quality of life.
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Affiliation(s)
- Karan Malhotra
- Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Joseph S Butler
- Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Hai Ming Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, People's Republic of China
| | - Susanne Selvadurai
- Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Shirley D'Sa
- Department of Clinical Haematology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - Neil Rabin
- Department of Clinical Haematology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - Charalampia Kyriakou
- Department of Clinical Haematology, The Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Kwee Yong
- Department of Clinical Haematology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - Sean Molloy
- Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Huang C, Zhao G, Wang L, Zhang H, Wu X, Zhang M, Ma R, Wang L, Liu Y, Liu L. Simultaneous occurrence of Hodgkin's lymphoma and multiple myeloma: A case report and review of the literature. Oncol Lett 2016; 11:4139-4143. [PMID: 27313755 DOI: 10.3892/ol.2016.4503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/04/2016] [Indexed: 12/29/2022] Open
Abstract
Hodgkin's lymphoma (HL) is a type of hematological neoplasm that generally appears alone, with a low incidence. The majority of cases histopathologically present as B-cell lymphoma. Multiple myeloma (MM) is defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin (Ig). The coexistence of HL and MM is rare, however, the present study reports such a case. On May 31, 2012, a 45-year-old man was diagnosed with HL, stage III, 31 months ago. At the same time, computed tomography and magnetic resonance imaging showed osteolytic lesions, a significant increase in IgA λ chains, and multiple myeloma cells on bone marrow aspiration. Following 8 cycles of chemotherapy, the patient received maintenance treatment with thalidomide and dexamethasone. During 2 years of follow-up, the patient has maintained a complete response for HL and a stable disease state for MM. The coexistence of HL and MM is rare. Further study of such cases may explain the associations between these two tumors and aid the production of effective treatment options.
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Affiliation(s)
- Chen Huang
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Guimin Zhao
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Lianjing Wang
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Huichao Zhang
- Department of Inspection, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Xiaolin Wu
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Mingzeng Zhang
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Ruijuan Ma
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Ling Wang
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Lihong Liu
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
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