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Uesugi Y, Ikeda D, Fukumoto A, Tabata R, Miura D, Narita K, Takeuchi M, Matsue K. Use of the Second Revision of the International Staging System for prognostic stratification of multiple myeloma patients in real-world clinical practice and the importance of sub-groups, including age. Haematologica 2024; 109:1593-1597. [PMID: 38031801 PMCID: PMC11063863 DOI: 10.3324/haematol.2023.284173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
Not available.
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Affiliation(s)
- Yuka Uesugi
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba.
| | - Daisuke Ikeda
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
| | - Ami Fukumoto
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
| | - Rikako Tabata
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
| | - Daisuke Miura
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
| | - Kentaro Narita
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
| | - Masami Takeuchi
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
| | - Kosei Matsue
- Division of Hematology/Oncology, Kameda Medical Center, Kamogawa, Chiba
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2
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Abduh MS. An overview of multiple myeloma: A monoclonal plasma cell malignancy's diagnosis, management, and treatment modalities. Saudi J Biol Sci 2024; 31:103920. [PMID: 38283805 PMCID: PMC10818257 DOI: 10.1016/j.sjbs.2023.103920] [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: 07/25/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Multiple Myeloma (MM) is a plasma cell cancer with high mortality and morbidity rates. Its incidence rate has increased by 143% since 1975. Adipokines, cytokines, chemokines, and genetic variations influence the development and progression of MM. Chromosomal translocations cause mutations associated with MM. The pathogenesis of MM is complicated by novel issues like miRNAs, RANKL, Wnt/DKK1, Wnt, and OPG. Conventional diagnosis methods include bone marrow biopsy, sPEP or uPEP, sIFE and uIFE, and sFLC assay, along with advanced techniques such as FISH, SNPA, and gene expression technologies. A novel therapeutic strategy has been developed recently. Chemotherapy, hematopoietic stem cell transplantation, and a variety of drug classes in combination are used to treat patients with high-risk diseases. Alkylating agents, PIs, and IMiDs have all been developed as effective treatment options for MM in recent years. This review overviews the current recommendations for managing MGUS, SMM, MM, SP and NSMM and discusses practices in diagnosing and treating MM.
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Affiliation(s)
- Maisa Siddiq Abduh
- Immune Responses in Different Diseases Research Group, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
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3
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Kaweme NM, Changwe GJ, Zhou F. Approaches and Challenges in the Management of Multiple Myeloma in the Very Old: Future Treatment Prospects. Front Med (Lausanne) 2021; 8:612696. [PMID: 33718400 PMCID: PMC7947319 DOI: 10.3389/fmed.2021.612696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
The increasing incidence of geriatric patients with multiple myeloma has elevated concerns in clinical practice. While the introduction of novel therapeutic agents has substantially improved outcomes in younger patients with myeloma, poorer outcomes remain in older patients. Managing older patients requires a multidisciplinary team approach to consider factors that may influence both treatment selection and outcomes. Aging is associated with remodeling of vital organs, physiological downregulations of basal metabolism, susceptibility to multiple comorbidities with ultimate frailty, thereby contributing to the underrepresentation and exclusion of very old patients from clinical trials. Therefore, timely confirmation of a precise diagnosis is crucial for prompt initiation of treatment if the desired outcome is to be achieved. Adequate and judicious assessment using comprehensive geriatric assessment tools minimizes toxicities and treatment discontinuation. Initiating treatment with combinational therapy requires knowledge of indications and anticipated outcomes, as well as individualized therapy with appropriate dose-adjustment. Individualized therapy based on good clinical acumen and best practices obverts unwanted polypharmacy, preventing iatrogenic harm. This review will therefore address the approaches and challenges faced in managing myeloma in geriatric patients aged 80 years and older, highlighting recommended therapeutic strategies and future prospective regimens.
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Affiliation(s)
| | | | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, China
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4
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Dimopoulos MA, Lonial S, White D, Moreau P, Weisel K, San-Miguel J, Shpilberg O, Grosicki S, Špička I, Walter-Croneck A, Magen H, Mateos MV, Belch A, Reece D, Beksac M, Spencer A, Oakervee H, Orlowski RZ, Taniwaki M, Röllig C, Einsele H, Matsumoto M, Wu KL, Anderson KC, Jou YM, Ganetsky A, Singhal AK, Richardson PG. Elotuzumab, lenalidomide, and dexamethasone in RRMM: final overall survival results from the phase 3 randomized ELOQUENT-2 study. Blood Cancer J 2020; 10:91. [PMID: 32887873 PMCID: PMC7474076 DOI: 10.1038/s41408-020-00357-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
Prolonging overall survival (OS) remains an unmet need in relapsed or refractory multiple myeloma (RRMM). In ELOQUENT-2 (NCT01239797), elotuzumab plus lenalidomide/dexamethasone (ERd) significantly improved progression-free survival (PFS) versus lenalidomide/dexamethasone (Rd) in patients with RRMM and 1–3 prior lines of therapy (LoTs). We report results from the pre-planned final OS analysis after a minimum follow-up of 70.6 months, the longest reported for an antibody-based triplet in RRMM. Overall, 646 patients with RRMM and 1–3 prior LoTs were randomized 1:1 to ERd or Rd. PFS and overall response rate were co-primary endpoints. OS was a key secondary endpoint, with the final analysis planned after 427 deaths. ERd demonstrated a statistically significant 8.7-month improvement in OS versus Rd (median, 48.3 vs 39.6 months; hazard ratio, 0.82 [95.4% Cl, 0.68–1.00]; P = 0.0408 [less than allotted α of 0.046]), which was consistently observed across key predefined subgroups. No additional safety signals with ERd at extended follow-up were reported. ERd is the first antibody-based triplet regimen shown to significantly prolong OS in patients with RRMM and 1–3 prior LoTs. The magnitude of OS benefit was greatest among patients with adverse prognostic factors, including older age, ISS stage III, IMWG high-risk disease, and 2–3 prior LoTs.
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Affiliation(s)
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | | | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, IDISNA, CIBERONC, Pamplona, Spain
| | - Ofer Shpilberg
- Institute of Haematology, Assuta Medical Centers, Tel Aviv, Israel
| | | | - Ivan Špička
- Charles University in Prague and General Teaching Hospital, Prague, Czech Republic
| | | | - Hila Magen
- Department of Hematology Chaim Sheba Medical Center, Ramat-Gan, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria-Victoria Mateos
- University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Andrew Belch
- Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
| | - Donna Reece
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Andrew Spencer
- Alfred Health-Monash University, Melbourne, VIC, Australia
| | | | | | | | - Christoph Röllig
- Universitätsklinikum der Technischen Universität, Dresden, Germany
| | | | - Morio Matsumoto
- National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Ka Lung Wu
- Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerp, Belgium
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5
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DuMontier C, Loh KP, Bain PA, Silliman RA, Hshieh T, Abel GA, Djulbegovic B, Driver JA, Dale W. Defining Undertreatment and Overtreatment in Older Adults With Cancer: A Scoping Literature Review. J Clin Oncol 2020; 38:2558-2569. [PMID: 32250717 PMCID: PMC7392742 DOI: 10.1200/jco.19.02809] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The terms undertreatment and overtreatment are often used to describe inappropriate management of older adults with cancer. We conducted a comprehensive scoping review of the literature to clarify the meanings behind the use of the terms. METHODS We searched PubMed (National Center for Biotechnology Information), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms undertreatment or overtreatment with regard to older adults with cancer. We included all types of articles, cancer types, and treatments. Definitions of undertreatment and overtreatment were extracted, and categories underlying these definitions were derived through qualitative analysis. Within a random subset of articles, C.D. and K.P.L. independently performed this analysis to determine final categories and then independently assigned these categories to assess inter-rater reliability. RESULTS Articles using the terms undertreatment (n = 236), overtreatment (n = 71), or both (n = 51) met criteria for inclusion in our review (n = 256). Only 14 articles (5.5%) explicitly provided formal definitions; for the remaining, we inferred the implicit definitions from the terms' surrounding context. There was substantial agreement (κ = 0.81) between C.D. and K.P.L. in independently assigning categories of definitions within a random subset of 50 articles. Undertreatment most commonly implied less than recommended therapy (148; 62.7%) or less than recommended therapy associated with worse outcomes (88; 37.3%). Overtreatment most commonly implied intensive treatment of an older adult in whom the harms of treatment outweigh the benefits (38; 53.5%) or intensive treatment of a cancer not expected to affect an older adult in his/her remaining lifetime (33; 46.5%). CONCLUSION Undertreatment and overtreatment of older adults with cancer are imprecisely defined concepts. We propose new, more rigorous definitions that account for both oncologic factors and geriatric domains.
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Affiliation(s)
- Clark DuMontier
- Brigham and Women’s Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tammy Hshieh
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Jane A. Driver
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Veterans Affairs Boston Healthcare System, New England Geriatric Research Education and Clinical Center, Boston, MA
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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6
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Freeman CL, Mikhael J. COVID-19 and myeloma: what are the implications for now and in the future? Br J Haematol 2020; 190:173-178. [PMID: 32428242 PMCID: PMC7276733 DOI: 10.1111/bjh.16815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
The pandemic has affected every aspect of myeloma care. Immediate focus is minimising risk of contracting coronavirus disease 2019 (COVID-19) and the sequelae of infection. However, what does the future hold for our patients? What lessons will be taken forward to tackle myeloma in the fiscally constrained future? If we embrace the challenges that will emerge in the post-pandemic environment, the treatment delivered to patients could be more cost-effective and better tailored than before. Healthcare delivery post-COVID-19 will not return to how it was, and now is the time to invest in novel strategies to deliver the best possible outcomes for patients.
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Affiliation(s)
- Ciara L. Freeman
- Centre for Lymphoid Cancer and Division of Medical OncologyBC Cancer and the University of British ColumbiaVancouverBCCanada
| | - Joseph Mikhael
- Applied Cancer Research and Drug DiscoveryTranslational Genomics Research InstituteCity of Hope Cancer CenterDuarteCAUSA
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7
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João C, Geraldes C, Neves M, Mariz M, Trigo F. Management of older and frail patients with multiple myeloma in the Portuguese routine clinical practice: Deliberations and recommendations from an expert panel of hematologists. J Geriatr Oncol 2020; 11:1210-1216. [PMID: 32601004 DOI: 10.1016/j.jgo.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/03/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022]
Abstract
The management of older patients with Multiple Myeloma (MM) is particularly challenging due to the highly heterogeneous nature of this population, both in terms of physical and cognitive functioning. Older patients may be divided into fit, intermediate and frail, with variable abilities to tolerate treatments. A careful and correct assessment of the frailty status is thus paramount for the success of therapy and for improving outcomes. With the aging of the European population, the number of older patients with MM is rapidly growing. We hereby present the deliberations and recommendations from an expert panel of Portuguese hematologists conducted to discuss the management of this population, including how to stratify and treat older patients with MM according to their frailty status. The use of frailty tools is critical for the development of individualized risk-adapted treatment strategies and to minimize the risk of under or overtreatment. Aggressive therapies should be used in fitter patients to improve survival outcomes, while frail patients should generally be treated with less toxic approaches to control symptoms while minimizing toxicity. In intermediate-fit patients, low-dose triplets are recommended to achieve a balance between improving survival and maintaining quality of life. The management of older patients with MM should be performed by a multidisciplinary team in view of their advanced age and high prevalence of comorbidities. The inclusion of older and frail patients in future clinical trials investigating treatment regimens for MM is crucial to evaluate treatment feasibility and to improve clinical decision making in this population.
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Affiliation(s)
- Cristina João
- Hemato-Oncology Unit, Champalimaud Centre for the Unknown, Lisboa, Avenida Brasília, 1400-038, Portugal; Nova Medical School, Lisboa, Portugal - Campo Mártires da Pátria 130, 1169-056, Portugal.
| | - Catarina Geraldes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal - Praceta, Rua Professor Mota Pinto, 3004-561, Portugal.
| | - Manuel Neves
- Hemato-Oncology Unit, Champalimaud Centre for the Unknown, Lisboa, Avenida Brasília, 1400-038, Portugal.
| | - Mário Mariz
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal - Rua Dr. António Bernardino de Almeida, 4200-072, Portugal.
| | - Fernanda Trigo
- Centro Hospitalar e Universitário São João do Porto, Porto, Portugal - Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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8
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Schoenbeck KL, Wildes TM. Updated Perspectives on the Management of Multiple Myeloma in Older Patients: Focus on Lenalidomide. Clin Interv Aging 2020; 15:619-633. [PMID: 32440105 PMCID: PMC7210019 DOI: 10.2147/cia.s196087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/10/2020] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma is a hematologic malignancy that predominantly affects older adults, with a median age at diagnosis of 70 years old. A mainstay of multiple myeloma treatment is lenalidomide, which is an immunomodulatory drug (IMiD) that changed the treatment paradigm for multiple myeloma. This is particularly true for older adults who do not undergo autologous stem cell transplantation (ASCT). Several pivotal trials summarized in this review demonstrate the efficacy and safety of lenalidomide in older adults with multiple myeloma, including significant improvements in response rates, progression-free survival and overall survival in the first-line and relapsed/refractory settings. Potential adverse effects include venous thromboembolism, cytopenias, and second malignancies and the doses tolerated in real-world older patients are often lower than those utilized in clinical trials enrolling select older patients. Given the heterogeneity of aging, several approaches to measuring frailty have been developed and validated to aid in predicting which older adults may benefit from empiric dose reduction to reduce the risk of toxicity and improve the tolerability of treatment. A number of randomized trials have explored a range of approaches utilizing lenalidomide in older adults in both the up-front and relapsed setting, ranging from attenuated maintenance strategies through quadruplet combination therapies including proteasome inhibitors and monoclonal antibodies. This wealth of literature provides a great number of options, which can make it difficult for a clinician to determine a single optimal recommendation for an individual patient. While lenalidomide is currently part of standard of care, the treatment of multiple myeloma is growing rapidly. There is a need to expand clinical trials participation to older adults with multiple myeloma. Incorporation of validated comprehensive geriatric assessments in clinical trials for multiple myeloma could provide a more accurate depiction of the older patient population and is an area for future exploration.
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Affiliation(s)
- Kelly L Schoenbeck
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tanya M Wildes
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
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Zhang L, Sun S, Wang Y, Mo Y, Xiong F, Zhang S, Zeng Z, Xiong W, Li G, Chen H, Guo C. Gossypol induces apoptosis of multiple myeloma cells through the JUN-JNK pathway. Am J Cancer Res 2020; 10:870-883. [PMID: 32266096 PMCID: PMC7136925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/24/2020] [Indexed: 06/11/2023] Open
Abstract
Multiple myeloma (MM) is one of the most common hematologic neoplastic diseases. Gossypol was once used as a male contraceptive but is considered a novel antitumor agent. This study aimed to reveal the gossypol-induced apoptosis mechanism and its hub genes. Gossypol-induced MM cell apoptosis is concentration- and time-dependent. Of a total of 532 differentially expressed genes, 273 genes were upregulated and 259 genes were downregulated in gossypol-treated MM cells. Through KEGG and WGCNA analyses, the apoptosis-associated module was identified, and JUN was identified as the hub gene. The expression of the JUN protein product c-Jun was downregulated in MM cell lines compared to that in normal plasma cells. High-risk MM patients had a lower expression of JUN. High-expression JUN group patients had a lower risk of death. JUN overexpression in MM cells induced potent cell death and growth inhibition by a caspase-dependent apoptotic mechanism. DR5 is one of the upstream receptors of the JNK pathway, and shRNA knockdown of DR5 can partially reverse gossypol-induced apoptosis. A total of 1017 genes were coexpressed with JUN in MM patients. These genes are mainly involved in other JNK-associated signaling pathways, such as the IL6, EGF and PDGF signaling pathways. In conclusion, JUN is identified as the hub gene in gossypol-induced apoptosis, and gossypol can activate caspase-dependent apoptosis through the JNK pathway by targeting c-Jun and other JNK-associated pathways. DR5 and IL6 are also involved in this mechanism.
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Affiliation(s)
- Luyuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- NHC Key Laboratory of Carcinogenesis, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou 310006, Zhejiang, China
| | - Sinan Sun
- Department of General Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefei 230001, Anhui, China
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- NHC Key Laboratory of Carcinogenesis, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
| | - Yongzhen Mo
- NHC Key Laboratory of Carcinogenesis, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South UniversityChangsha 410013, Hunan, China
| | - Fang Xiong
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
| | - Shanshan Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
| | - Zhaoyang Zeng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- NHC Key Laboratory of Carcinogenesis, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South UniversityChangsha 410013, Hunan, China
| | - Wei Xiong
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- NHC Key Laboratory of Carcinogenesis, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South UniversityChangsha 410013, Hunan, China
| | - Guiyuan Li
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- NHC Key Laboratory of Carcinogenesis, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South UniversityChangsha 410013, Hunan, China
| | - Hao Chen
- Department of General Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefei 230001, Anhui, China
| | - Can Guo
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
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10
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Pojero F, Poma P, Spanò V, Montalbano A, Barraja P, Notarbartolo M. Targeting multiple myeloma with natural polyphenols. Eur J Med Chem 2019; 180:465-485. [DOI: 10.1016/j.ejmech.2019.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022]
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11
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Straka C, Knop S, Vogel M, Müller J, Kropff M, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Salwender H, Wandt H, Bassermann F, Gramatzki M, Rösler W, Wolf H, Brugger W, Fischer T, Liebisch P, Engelhardt M, Einsele H. Bortezomib consolidation following autologous transplant in younger and older patients with newly diagnosed multiple myeloma in two phase III trials. Eur J Haematol 2019; 103:255-267. [DOI: 10.1111/ejh.13281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/10/2023]
Affiliation(s)
| | - Stefan Knop
- Medizinische Klinik und Poliklinik II Julius Maximilians Universität Würzburg Würzburg Germany
| | | | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie Klinikum Oldenburg Oldenburg Germany
| | | | - Herbert Sayer
- Klinik für Innere Medizin II [Hämatologie/Onkologie] Universitätsklinikum Jena Jena Germany
| | - Wolfram Jung
- Onkologie Universitätsmedizin Göttingen Göttingen Germany
| | | | | | - Hannes Wandt
- Medizinische Klinik 5 Paracelsus Medizinische Privatuniversität Nürnberg Nürnberg Germany
| | - Florian Bassermann
- Klinikum rechts der Isar, III. Medizinische Klinik Technische Universität München München Germany
| | | | - Wolf Rösler
- Universitätsklinkum Erlangen Erlangen Germany
| | | | | | | | - Peter Liebisch
- Zentrum für Innere Medizin Universitätsklinikum Ulm Ulm Germany
| | | | - Hermann Einsele
- Medizinische Klinik und Poliklinik II Julius Maximilians Universität Würzburg Würzburg Germany
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12
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Park Y, Kim DS, Jeon MJ, Lee B, Yu ES, Kang K, Lee SR, Sung HJ, Nam M, Yoon S, Choi CW, Kang E, Cho D, Kim K, Kim BS, Kim D, Kim SJ. Single‐dose etoposide is an effective and safe protocol for stem cell mobilization in patients with multiple myeloma. J Clin Apher 2019; 34:579-588. [DOI: 10.1002/jca.21734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Yong Park
- Division of Hematology‐Oncology, Department of Internal MedicineAnam Hospital, Korea University School of Medicine Seoul South Korea
| | - Dae Sik Kim
- Division of Hematology‐Oncology, Department of Internal MedicineGuro Hospital, Korea University School of Medicine Seoul South Korea
| | - Min Ji Jeon
- Division of Hematology‐Oncology, Department of Internal MedicineGuro Hospital, Korea University School of Medicine Seoul South Korea
| | - Byung‐Hyun Lee
- Division of Hematology‐Oncology, Department of Internal MedicineAnam Hospital, Korea University School of Medicine Seoul South Korea
| | - Eun Sang Yu
- Division of Hematology‐Oncology, Department of Internal MedicineGuro Hospital, Korea University School of Medicine Seoul South Korea
| | - Ka‐Won Kang
- Division of Hematology‐Oncology, Department of Internal MedicineAnam Hospital, Korea University School of Medicine Seoul South Korea
| | - Se Ryeon Lee
- Division of Hematology‐Oncology, Department of Internal MedicineAnsan Hospital, Korea University School of Medicine Seoul South Korea
| | - Hwa Jung Sung
- Division of Hematology‐Oncology, Department of Internal MedicineAnsan Hospital, Korea University School of Medicine Seoul South Korea
| | - Myung‐Hyun Nam
- Division of Hematology‐Oncology, Department of Laboratory MedicineAnsan Hospital, Korea University School of Medicine Seoul South Korea
| | - Soo‐Young Yoon
- Department of Laboratory Medicine, Guro HospitalKorea University School of Medicine Seoul South Korea
| | - Chul Won Choi
- Division of Hematology‐Oncology, Department of Internal MedicineGuro Hospital, Korea University School of Medicine Seoul South Korea
| | - Eun‐Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Kihyun Kim
- Division of Hematology‐Oncology, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Byung Soo Kim
- Division of Hematology‐Oncology, Department of Internal MedicineAnam Hospital, Korea University School of Medicine Seoul South Korea
| | - Dae‐Won Kim
- Department of Laboratory MedicineAnam Hospital, Korea University School of Medicine Seoul South Korea
| | - Seok Jin Kim
- Division of Hematology‐Oncology, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
- Department of Health Sciences and TechnologySAIHST, Sungkyunkwan University Seoul 06351 South Korea
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Facon T, Anderson K. Treatment approach for the older, unfit patient with myeloma from diagnosis to relapse: perspectives of a European hematologist. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:83-87. [PMID: 30504295 PMCID: PMC6245965 DOI: 10.1182/asheducation-2018.1.83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mrs. A. is a 73-year-old woman who has developed increasing fatigue and lower back pain over the past year. The pain limits her exercise tolerance such that she can now walk only 1 block. She is a retired schoolteacher who does volunteer efforts in her community but has limited her activities due to fatigue. Karnofsky performance status is 70%. She has a history of chronic hypertension treated with a diuretic, adult-onset diabetes mellitus treated with metformin, and hypothyroidism treated with levothyroxine. Initial evaluation reveals anemia, renal dysfunction, an elevated total protein, and an L2 compression fracture on lumbosacral radiographs. Results of initial and subsequent evaluation are shown below, and she is referred to a hematologist for further evaluation, which revealed the following: calcium 9.0 mg/dL, creatinine 3.2 mg/dL with estimated creatinine clearance using the Modification of Diet in Renal Disease equation of 15 mL/min, hemoglobin 9.6 g/dL, total protein 11 g/dL, albumin 3.2 g/dL, immunoglobulin A (IgA) λ M protein 6.8 g/dL, total IgA 7.2 g/dL, IgG 0.4 g/dL, IgM 0.03 g/dL, free κ <0.01 mg/L, free λ 1000 mg/L, free light chain ratio <0.01, β-2-microglobulin 4.2, viscosity 3.0, lactate dehydrogenase 200 U/L, urine protein electrophoresis: 125 mg/dL with 30% M protein, and urine immuno-electrophoresis: λ light chain. Skeletal bone survey showed lytic lesions in femurs and humeri and diffusely in ribs bilaterally as well as compression fractures at T4, T6, and L2. Bone marrow biopsy revealed λ-restricted plasma cells comprising 50% of the bone marrow core. Fluorescence in situ hybridization testing on marrow showed that del(17p) was present in 80% of the plasma cells. Mrs. A. is informed of the diagnosis of multiple myeloma and the need for therapy. She requests consultation with 2 of the leading world experts. However, she wants to be treated near her home and does not want treatment on a clinical trial.
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Affiliation(s)
- Thierry Facon
- Department of Haematology, Centre Hospitalier Universitaire Lille, Lille, France; and
| | - Kenneth Anderson
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Analysis of Availability and Access of Anti-myeloma Drugs and Impact on the Management of Multiple Myeloma in Latin American Countries. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:e43-e50. [PMID: 30297171 DOI: 10.1016/j.clml.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/04/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Latin American countries (LATAMC) represent a large fraction of patients treated for multiple myeloma (MM) worldwide. In order to understand the difficulty of access to anti-myeloma therapy in LATAMC, we designed this study that explores areas involved in the availability of drugs, such as health care systems, approval times, coverage of new agents, old drugs, use of generics, and the first-line treatments. MATERIAL AND METHODS We collected data from 16 countries in 2015. RESULTS The majority of LATAMC (88%; n = 14) had mixed public and private coverage, with patients with MM cared for in public institutions. Although bortezomib and lenalidomide were approved in 100% and 73% in LATAMC, these figures did not translate to real-world practice as one-half of the nations reported unequal access to the new agents (thalidomide, bortezomib, and lenalidomide) in both public and private systems. Conversely, cheaper old drugs, represented by melphalan, were not available commercially in 44% (n = 7) of nations. Thus, first-line MM treatments for old and young patients in public practice were triplets with thalidomide-alkylating agent-steroid, whereas in private practice, treatments involved bortezomib-alkylating agent-steroid. An alarming rate of 30% of the nations reported suboptimal regimens (eg, VAD [vincristine, adriamycin, and dexamethasone]) or the impossibility of transplantation. CONCLUSION Our data indicates that bortezomib and transplant are still an unmet medical necessity in public systems. In the complex puzzle of myeloma drug access in LATAMC, important issues, such as the adjustment of disparities between health systems, the incorporation of new drugs with an economic cost-effectiveness view, and the re-establishment of essential old drugs, can be a platform to the future.
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Abstract
Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The recent introduction of novel drugs and ongoing improvements in supportive care have significantly contributed to overall better management and outcomes for patients with multiple myeloma. Autologous stem-cell transplantation has been a standard part of therapy for myeloma patients for many years, first in younger patients and increasingly in older, and may still be considered in selected older patients with myeloma. In addition, in both newly diagnosed patients and in the relapsed/refractory setting, a number of novel agents tested in large phase III trials have yielded improvements in overall outcomes. As clinical trials under-enrol older patients and have stringent exclusion criteria, the data and results from them may not be generalizable to all older adults. In this review, we examine the treatment options for older adults with myeloma with a specific focus on the currently available data on novel agents in this cohort. The clinical efficacy and unique toxicity profile of each novel agent must be considered prior to the treatment plan in older adults.
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