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Steinbach M, Neupane K, Aziz M, Lee-Smith W, Julian K, Godara A, McClune B, Kelkar AH, Sborov D, Mohyuddin GR. Multiple Myeloma in Young Patients: A Scoping Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:15-22. [PMID: 37722944 DOI: 10.1016/j.clml.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
Data on the disease course, presenting features, outcomes, and prognosis of younger patients with multiple myeloma (MM) are lacking. Younger patients with MM have historically been considered to have better outcomes primarily based on better tolerance of treatment and lack of medical comorbidities, but the specific age range of this population has not been uniformly defined. Given the lack of consistent data reporting in patients considered to be young MM patients, we performed a scoping review to highlight the research currently available to start drawing conclusions about these patients and highlight unmet areas of need to focus on further investigation. We searched Embase, Cochrane Central Register of Controlled Trials, CINAHL Plus, Web of Science, and the OVID version of MEDLINE including broad terms that embody the concept of young patients with MM. Our final review included 201 studies which were then categorized according to age group, number of patients, outcomes, and comparators to older patients, along with location and database when available. We have chosen to categorize 3 age groupings: <50: young adults with MM (YA MM), 50 to 65: mid-life adults with multiple myeloma (ML MM) and 65+: older adults with multiple myeloma (OA MM). This review demonstrates the heterogeneity that exists in defining and describing young patients with MM, highlights the lack of studies specifically addressing the unique needs of younger patients, and emphasizes areas of future research unique to this population.
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Affiliation(s)
- Mary Steinbach
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.
| | - Karun Neupane
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH
| | - Wade Lee-Smith
- Mulford Health Science Library, University of Toledo, Toledo, OH
| | - Kelley Julian
- Department of Pharmacy, Huntsman Cancer Hospital, Salt Lake City, UT
| | - Amandeep Godara
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Brian McClune
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | - Douglas Sborov
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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Elgabry G, Spencer L, Siddiqi H, Ojha S, Wandroo F. A Report of a Symptomatic Progressive Myeloma during Pregnancy and Postpartum Period from Asymptomatic State. Hematol Rep 2023; 15:305-311. [PMID: 37218823 DOI: 10.3390/hematolrep15020031] [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: 12/13/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023] Open
Abstract
Multiple myeloma is a plasma cell malignancy that is most commonly observed in males in the sixth and seventh decade of life. The clinical scenario of multiple myeloma with concurrent pregnancy is considered to be very rare. We detail here the case of a young female with known IgG kappa multiple myeloma who was found to have a steady elevation of her IgG kappa paraprotein during pregnancy and symptomatic progression in the postpartum period. She delivered a healthy baby at 40 weeks gestation. We present a review of all reported cases of known multiple myeloma progressing during pregnancy and in the postpartum period, the treatments given, and their outcomes. The report also provides suggestions for diagnosis and management of myeloma during pregnancy in order to have an outcome of successful uncomplicated pregnancy with healthy offspring.
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Affiliation(s)
- Gehad Elgabry
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
| | - Lydia Spencer
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
| | - Hisam Siddiqi
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
| | - Soumya Ojha
- Department of Haematology, University Hospital Birmingham NHS Trust, Birmingham B15 2GW, UK
| | - Farooq Wandroo
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
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Magen H, Simchen MJ, Erman S, Avigdor A. Diagnosis and management of multiple myeloma during pregnancy: case report, review of the literature, and an update on current treatments. Ther Adv Hematol 2022; 13:20406207211066173. [PMID: 35083030 PMCID: PMC8785339 DOI: 10.1177/20406207211066173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
The simultaneous occurrence of pregnancy and multiple myeloma (MM) is rare. The challenge of diagnosing MM during pregnancy is demonstrated in the case presented here. Despite the rarity of concurrent MM and pregnancy, this possibility should be considered in patients with signs and symptoms that may be attributed to MM so as not to delay the diagnosis and decision about pregnancy continuation and initiation of an appropriate and safe therapy to the mother and fetus. Treating physicians should be aware of the potential effects of MM therapies on the fetus and pregnancy outcomes.
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Affiliation(s)
- Hila Magen
- Head of Multiple Myeloma Unit, Hematology Department, Chaim Sheba Medical Center, 2 Derech Sheba, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal J. Simchen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shira Erman
- Hematology Department, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Abraham Avigdor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Department, Chaim Sheba Medical Center, Ramat Gan, Israel
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Garg A, Aggarwal M, Kashyap R. Pregnancy and Its Successful Outcome in a Patient with Multiple Myeloma. J Obstet Gynaecol India 2020; 71:78-81. [PMID: 33814803 DOI: 10.1007/s13224-019-01296-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022] Open
Abstract
Multiple myeloma is a B-cell neoplastic disorder and represents 1% of all cancers and 13% of hematological malignancies. It is predominantly a disease of elderly, and less than 3% of all cases are below the age of 40 years. We present the case of a 29-year-old lady with multiple myeloma who had spontaneous conception during maintenance therapy and subsequently a successful pregnancy outcome. She gave birth to a healthy female infant through normal vaginal delivery and subsequently could remain off therapy for 5 years. Since the patient had a history of abortions and stillbirth, it was a precious pregnancy and we could successfully salvage both the mother and the baby. Young female patients of myeloma who are in remission can be encouraged to start a family during their reproductive years with the support of a comprehensive care team of hematologists/oncologists and obstetricians.
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Affiliation(s)
- Akanksha Garg
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
| | - Monika Aggarwal
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, 110001 India
| | - Rajesh Kashyap
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
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Murgia F, Marinaccio M, Cormio G, Loizzi V, Cicinelli R, Bettocchi S, Cicinelli E. Pregnancy related cancer in Apulia. A population based linkage study. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100025. [PMID: 31404420 PMCID: PMC6687370 DOI: 10.1016/j.eurox.2019.100025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/25/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
Objective Despite a quite large number of papers in literature, the current incidence of pregnancy associated cancer still remains uncertain. Moreover, different inclusion criteria and time intervals considered after delivery make these data poorly comparable. The aim of this study was to investigate the incidence of PACs in Apulia, an Italian region, while stressing differences or similarities with other populations. Study design We collected 682,173 pregnancies from national discharge forms, regarding hospitals in Apulia from January 2003 to December 2015. Our aim was not only to obtain the raw incidence of PACs but also to estimate the odds ratio (OR) for some potential risk predictors such as calendar year, age, nationality and pregnancy outcome using a logistic model. Women were sorted into different groups by age (<30, 30–34, 35–39, >=40) and by nationality (Italian or foreign nationals). Each pregnancy had two possible outcomes: delivery or abortion. Results We achieved a final cohort of 867 PACs: therefore, the raw incidence is 127.1 per 100,000 pregnancies. Breast cancer was the most common cancer (37.7 cases per 100,000 pregnancies) and as a typical feature in our population thyroid cancers followed it by incidence (22.3 per 100,000 pregnancies). Cervical cancer is, as expected, the first gynaecological cancer by incidence(3.8 per 100,000). Younger women have the lowest risk for PACs (64.5 per 100,000, OR = 1) while the highest risk for PACs was for women aged >=40 years (OR = 4.29, p < 0.05). Considering calendar years, we observed an increased OR from 2006 to 2009 (OR = 1.39 and OR = 1.41 respectively) without spotting a trend throughout the whole decade. Conclusions The ranking of each tumour by incidence more or less reflects its demographics in reproductive age females in western countries and the incidence for any cancer is expected to grow as the rate of first deliveries in older women continues to rise. We reported noticeable differences regarding the incidence of some cancers (such as thyroid cancer) with previous literature, reflecting an epidemiologic feature of our cohort. Women older than 40 years have a more than fourfold risk for oncologic diagnosis during pregnancy, and this finding is of pivotal clinical and social importance because of the tendency of women living in developed countries to postpone childbearing.
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Affiliation(s)
- Ferdinando Murgia
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
| | - Marco Marinaccio
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
| | - Gennaro Cormio
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
| | - Vera Loizzi
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
| | - Rossana Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
| | - Stefano Bettocchi
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
| | - Ettore Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70124, Bari, Italy
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Jurczyszyn A, Olszewska-Szopa M, Vesole AS, Vesole DH, Siegel DS, Richardson PG, Paba-Prada C, Callander NS, Huras H, Skotnicki AB. Multiple Myeloma in Pregnancy--A Review of the Literature and a Case Series. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 16:e39-45. [PMID: 26847816 DOI: 10.1016/j.clml.2015.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022]
Abstract
Multiple myeloma (MM) typically affects older patients with a median age at diagnosis of 67 to 70 years and only 3% of cases are diagnosed before the age of 40. Moreover, MM is more common in men. Therefore, pregnancy rarely occurs in patients with MM and only 37 cases of MM in pregnancy have been reported in the literature. Herein we report an additional 5 cases. The diagnosis of MM might be problematic in this context because some of the symptoms and signs, such as back pain and anemia, can be attributed to pregnancy. Furthermore, if the patient wishes to continue her pregnancy, therapeutic options are currently limited. The list of agents that can be safely administered in pregnant women includes glucocorticoids. Moreover, any continuation of pregnancy has obvious long-term psychosocial repercussions for the patient and her family because of the currently incurable nature of MM. The reported cases of MM in pregnancy represent a spectrum of clinical manifestations. The selection of efficacious and safe treatments is challenging, especially if continuation of pregnancy is desired. Although some authors postulate that pregnancy might lead to progression of MM, data are limited and no consensus on this point has been reached.
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Affiliation(s)
- Artur Jurczyszyn
- Department and Clinic of Haematology, Jagiellonian University Medical College, Krakow, Poland.
| | - Magdalena Olszewska-Szopa
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Medical University, Wroclaw, Poland
| | - Adam S Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | - David H Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ and Georgetown University, Department of Medicine, Washington, DC
| | - David S Siegel
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | | | | | - Natalie S Callander
- Carbone Cancer Center, Department of Medicine, University of Wisconsin, Madison, WI
| | - Hubert Huras
- Department and Clinic of Obstetrics and Perinatology, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksander B Skotnicki
- Department and Clinic of Haematology, Jagiellonian University Medical College, Krakow, Poland
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Cabañas-Perianes V, Macizo M, Salido E, Blanquer M, Araico F, Melero-Amor A, Garcia-Candel F, Muñoz-Garcia MI, Martinez-Villanueva M, Muñoz-Esparza C, Guzmán-Aroca F, Pérez-López R, Moraleda JM. 'Management multiple myeloma during pregnancy: a case report and review'. Hematol Oncol 2014; 34:108-114. [PMID: 25491088 DOI: 10.1002/hon.2184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) is a hematologic neoplasm characterized by plasma tumor cell proliferation in the bone marrow. It's a rare malignancy before a 40-year-old and it is extremely uncommon during pregnancy. We report the case of a 37-year-old woman with a newly diagnosed IgG λ MM (Durie-Salmon stage IIIA, International Staging System II and good prognosis cytogenetic) at the 27th week of her pregnancy. Our management during pregnancy, the delivery, and initiation of anti-myeloma treatment with bortezomib, lenalidomide, and dexamethasone are published. There are a few reviews reporting the most common features and management of MM during pregnancy. We perform a comprehensive review of all 32 cases reported between 1965 and 2014 in which a MM was diagnosed during pregnancy including score, cytogenetic results, labor characteristics, and response to therapy. About 53% of pregnant women did not start treatment before partum. Cesarean section was the most common form of delivery (82%). About 88% of newborns were healthy, although most of them were premature (73%). Management of a MM diagnosed during pregnancy should be based on the presence of myeloma-related organ damage to secure survival of the mother without fetal adverse effects related to treatment. Serial fetal ultrasound may be helpful in order to avoid complications. The cesarean section may be preferred depending on maternal and fetus prognosis. Whole-body diffusion-weighted imaging minimal response could be an appropriate technique to discard plasmacytomas during pregnancy in critical situations such as the appearance of symptoms of spinal cord compression. Therapeutic choices should be agreed with the pregnant after a thorough discussion of the prognostic factors of the disease and the potential risk for the fetus and the patient. While awaiting partum, dexamethasone is a non-toxic treatment. Triple therapy including a proteasome inhibitor should be started quickly after delivery. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Maribel Macizo
- Department of Obstetrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Eduardo Salido
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Miguel Blanquer
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Fernando Araico
- Department of Obstetrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Antonia Melero-Amor
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | | | | | - Carmen Muñoz-Esparza
- Department of Internal Medicine, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Raúl Pérez-López
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Jose Maria Moraleda
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
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Lavi N, Horowitz NA, Brenner B. An Update on the Management of Hematologic Malignancies in Pregnancy. WOMENS HEALTH 2014; 10:255-66. [DOI: 10.2217/whe.14.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hematological malignancies during pregnancy are rare, which results in the absence of large prospective studies. The diagnosis is often delayed due to the symptom similarity to those of pregnancy and the recommendation to avoid imaging studies during gestation. Management of hematological malignancies during pregnancy poses challenges both to the patient and the medical team, given the therapy-attributable risks for mother and fetus and the need to consider patient's preferences regarding pregnancy continuation. Chemotherapy during the first trimester is associated with an increased risk for fetal demise and congenital malformations, while these risks diminish as pregnancy progresses. We hereby present a review of updated literature on the management of hematologic malignancies (Hodgkin and non-Hodgkin lymphomas, acute leukemia, multiple myeloma, chronic myeloid leukemia and myeloproliferative neoplasms) during pregnancy.
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Affiliation(s)
- Noa Lavi
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Netanel A Horowitz
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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