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Fazio M, Del Fabro V, Parrinello NL, Allegra A, Markovic U, Botta C, Accardi F, Vincelli ID, Leotta S, Elia F, Esposito B, Garibaldi B, Sapuppo G, Orofino A, Romano A, Palumbo GA, Di Raimondo F, Conticello C. Multiple Myeloma in 2023 Ways: From Trials to Real Life. Curr Oncol 2023; 30:9710-9733. [PMID: 37999125 PMCID: PMC10670159 DOI: 10.3390/curroncol30110705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
Multiple myeloma is a chronic hematologic malignancy that obstinately tends to relapse. Basic research has made giant strides in better characterizing the molecular mechanisms of the disease. The results have led to the manufacturing of new, revolutionary drugs which have been widely tested in clinical trials. These drugs have been approved and are now part of the therapeutic armamentarium. As a consequence, it is essential to combine what we know from clinical trials with real-world data in order to improve therapeutic strategies. Starting with this premise, our review aims to describe the currently employed regimens in multiple myeloma and compare clinical trials with real-life experiences. We also intend to put a spotlight on promising therapies such as T-cell engagers and chimeric antigen receptor T-cells (CAR-T) which are proving to be effective in changing the course of advanced-stage disease.
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Affiliation(s)
- Manlio Fazio
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Vittorio Del Fabro
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Nunziatina Laura Parrinello
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Alessandro Allegra
- Division of Haematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Uroš Markovic
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Fabrizio Accardi
- Department of Hematology I, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy;
| | - Iolanda Donatella Vincelli
- Haematology Unit, Haemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89124 Reggio Calabria, Italy;
| | - Salvatore Leotta
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Federica Elia
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Benedetta Esposito
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Bruno Garibaldi
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Gabriele Sapuppo
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Alessandra Orofino
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Alessandra Romano
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, 95131 Catania, Italy;
| | - Giuseppe A. Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F.Ingrassia”, University of Catania, 95131 Catania, Italy;
| | - Francesco Di Raimondo
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, 95131 Catania, Italy;
| | - Concetta Conticello
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
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Towards Stratified Medicine in Plasma Cell Myeloma. Int J Mol Sci 2016; 17:ijms17101760. [PMID: 27775669 PMCID: PMC5085784 DOI: 10.3390/ijms17101760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
Plasma cell myeloma is a clinically heterogeneous malignancy accounting for approximately one to 2% of newly diagnosed cases of cancer worldwide. Treatment options, in addition to long-established cytotoxic drugs, include autologous stem cell transplant, immune modulators, proteasome inhibitors and monoclonal antibodies, plus further targeted therapies currently in clinical trials. Whilst treatment decisions are mostly based on a patient’s age, fitness, including the presence of co-morbidities, and tumour burden, significant scope exists for better risk stratification, sub-classification of disease, and predictors of response to specific therapies. Clinical staging, recurring acquired cytogenetic aberrations, and serum biomarkers such as β-2 microglobulin, and free light chains are in widespread use but often fail to predict the disease progression or inform treatment decision making. Recent scientific advances have provided considerable insight into the biology of myeloma. For example, gene expression profiling is already making a contribution to enhanced understanding of the biology of the disease whilst Next Generation Sequencing has revealed great genomic complexity and heterogeneity. Pathways involved in the oncogenesis, proliferation of the tumour and its resistance to apoptosis are being unravelled. Furthermore, knowledge of the tumour cell surface and its interactions with bystander cells and the bone marrow stroma enhance this understanding and provide novel targets for cell and antibody-based therapies. This review will discuss the development in understanding of the biology of the tumour cell and its environment in the bone marrow, the implementation of new therapeutic options contributing to significantly improved outcomes, and the progression towards more personalised medicine in this disorder.
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