Association between left ventricular function and paraprotein type in patients with multiple myeloma

Arginase Inhibition Mitigates Bortezomib-Exacerbated Cardiotoxicity in Multiple Myeloma

BACKGROUND

Multiple myeloma (MM) is associated with increased cardiovascular morbidity and mortality, while MM therapies also result in adverse cardiac effects. Endothelial dysfunction and impaired nitric oxide (NO) pathway is their possible mediator.

OBJECTIVE

Since MM is associated with increased arginase expression, resulting in the consumption of ʟ-arginine, precursor for NO synthesis, our aim was to test if cardiotoxicity mediated by MM and MM therapeutic, bortezomib (a proteasome inhibitor), can be ameliorated by an arginase inhibitor through improved endothelial function.

METHODS

We used a mouse Vĸ*MYC model of non-light chain MM. Cardiac function was assessed by echocardiography.

RESULTS

MM resulted in progressive left ventricular (LV) systolic dysfunction, and bortezomib exacerbated this effect, leading to significant impairment of LV performance. An arginase inhibitor, OAT-1746, protected the heart against bortezomib- or MM-induced toxicity but did not completely prevent the effects of the MM+bortezomib combination. MM was associated with improved endothelial function (assessed as NO production) vs. healthy controls, while bortezomib did not affect it. OAT-1746 improved endothelial function only in healthy mice. NO plasma concentration was increased by OAT-1746 but was not affected by MM or bortezomib.

CONCLUSIONS

Bortezomib exacerbates MM-mediated LV systolic dysfunction in a mouse model of MM, while an arginase inhibitor partially prevents it. Endothelium does not mediate either these adverse or beneficial effects. This suggests that proteasome inhibitors should be used with caution in patients with advanced myeloma, where the summation of cardiotoxicity could be expected. Therapies aimed at the NO pathway, in particular arginase inhibitors, could offer promise in the prevention/treatment of cardiotoxicity in MM.

Comparing the efficacy of different dexamethasone regimens for maintenance treatment of multiple myeloma in standard-risk patients non-eligible for transplantation

BACKGROUND

Multiple myeloma (MM) is a plasma cell malignancy, while MM outcomes have significantly improved due to novel agents and combinations, MM remains an incurable disease. The key goal of treatment in MM is to achieve a maximal response and the subsequent consolidation of response after initial therapy. Many studies analyzed an improved progression-free survival (PFS) following lenalidomide alone maintenance versus placebo or observation after autologous stem cell transplant (ASCT) in patients with NDMM. In the SWOG S0777 clinical trial, patients newly diagnosed with MM (NDMM) without ASCT received lenalidomide plus low-dose dexamethasone (DXM) maintenance until progressive disease, where PFS and overall survival (OS) were significantly improved. In the present study, we assessed the efficacy and toxicity of the different doses of DXM combined with lenalidomide for maintenance treatment of NDMM for transplant noneligible patients in the standard-risk group.

AIM

To investigate the efficacy and adverse effects of different administration modes of DXM combined with lenalidomide for maintenance treatment of MM in standard-risk patients ineligible for transplantation.

METHODS

A total of 96 MM patients were enrolled in this study, among whom 48 patients received maintenance treatment that consisted of oral administration of 25 milligrams (mg) of lenalidomide from days 1-21 and 40 mg of DXM on days 1, 8, 15, and 22 (DXM 40 mg group), repeated every 4 wk. Another group was treated with oral administration of 25 mg of lenalidomide from days 1-21 and 20 mg of DXM on days 1-2, 8-9, 15-16, and 22-23 (DXM 20 mg group), which was also repeated every 4 wk.

RESULTS

The median PFS was 37.25 mo in the DXM 40.00 mg group and 38.17 mo in the DXM 20 mg group (P = 0.171). The median OS was 50.78 mo in the DXM 40 mg group and 51.69 mo in the DXM 20 mg group (P = 0.171). Fourteen patients in the DXM 40 mg group and 6 patients in the DXM 20 mg group suffered from adverse gastrointestinal reactions after the oral administration of the DXM tablet (P = 0.044). Ten patients suffered from abnormal glucose tolerance (GTA), impaired fasting glucose (IFG), or diabetes mellitus in the DXM 40 mg group during our observation time compared to 19 patients with GTA, IFG, or DM in the DXM 20 mg group (P = 0.033). Abnormal β-crosslaps or higher were found in 5 patients in the DXM 40 mg group and 12 patients in the DXM 20 mg group (P = 0.049). Insomnia or an increase in insomnia compared to the previous condition was evident in 2 patients in the DXM 40 mg group after maintenance treatment for more than 6 mo compared to 11 patients in the DXM 20 mg group (P = 0.017).

CONCLUSION

The DXM 40 mg group exhibited efficacy similar to that of the DXM 20 mg group. However, the DXM 40 mg group had significantly decreased toxicity compared with the DXM 20 mg group in the long term.

Effect of evidence-based nursing combined with exercise rehabilitation in patients with acute myocardial infarction after percutaneous coronary intervention

OBJECTIVE

To explore the effect of evidence-based nursing combined with exercise rehabilitation on cardiac function indices, self-care ability and incidence of adverse reactions in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).

METHODS

In this retrospective study, the medical records of 200 AMI patients undergoing PCI in Ganzhou People's Hospital from June 2020 to September 2021 were retrospectively analyzed, and the patients were divided into a control group (n=100) and a study group (n=100) according to the nursing methods after PCI. The cardiac function index, 6-minute walking distance (6MWD), behavioral self-management, physiological index, angina questionnaire and postoperative complications were compared between the two groups.

RESULTS

After intervention, the study group exhibited significantly higher left ventricular ejection fraction and lower pro-B-type natriuretic peptide index than the control group (P<0.05). At 1, 3 and 6 months postoperative, the study group exhibited significantly longer 6MWD than the control group (P<0.05). At 3 and 6 months postoperative, the total Coronary Artery Disease Self-Management Scale scores except for emotional management were significantly higher in the study group than those in the control group (P<0.05). At 3- and 6-month postoperative visits, systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, triglyceride and low-density lipoprotein in the study group were significantly lower than those in control group (P<0.05). The study group showed higher scores of Seattle Angina Questionnaire and lower incidence of complications than the control group (P<0.05).

CONCLUSION

Evidence-based nursing combined with exercise rehabilitation can ameliorate cardiac function and physiological indices, increase treatment compliance and satisfaction, reduce the incidence of postoperative complications, and improve the quality of life in patients with AMI after PCI.

Effects of comprehensive care in patients with multiple myeloma with cardiac dysfunction

OBJECTIVE

To explore the effect of comprehensive care on cardiac and renal function indices, treatment compliance, self-care ability and quality of life in patients with multiple myeloma combined with cardiac dysfunction.

METHODS

A total of 53 patients diagnosed with multiple myeloma combined with cardiac dysfunction admitted to our hospital were enrolled and divided into the control group (n=25) and the experimental group (n=28) by the method of random number table. Patients in the control group were given routine nursing care, while patients in the experimental group were given comprehensive care on the basis of the routine nursing care of the control group. The changes in cardiac and renal function indices, treatment compliance, self-care ability, and quality of life were observed after intervention of different nursing methods in the two groups.

RESULTS

The levels of left ventricular ejection fraction, brain natriuretic peptide, N-terminal pro-brain natriuretic peptide, glomerular filtration rate, serum creatinine, and uric acid in the experimental group were significantly improved after intervention, showing significant differences between the two groups (P<0.05). The treatment compliance in the experimental group (92.86%) was significantly higher than that in the control group (68%). The scores of self-care ability and quality of life in the experimental group were significantly higher than those in the control group after intervention (P<0.05).

CONCLUSION

Comprehensive care can significantly help to improve cardiac and renal functions, treatment compliance, self-care ability and quality of life in patients with multiple myeloma combined with cardiac dysfunction, which is of great clinical significance.

Capillary electrophoresis analysis of N-glycosylation changes of serum paraproteins in multiple myeloma

Multiple myeloma (MM) is an immedicable malignancy of the human plasma cells producing abnormal antibodies (also referred to as paraproteins) leading to kidney problems and hyperviscosity syndrome. In this paper, we report on the N-glycosylation analysis of paraproteins from total human serum as well as the fragment crystallizable region (F_c ) and fragment antigen binding (F_ab ) κ/λ light chain fractions of papain digested immunoglobulins from multiple myeloma patients. CE-LIF detection was used for the analysis of the N-glycans after endoglycosidase (PNGase F) mediated sugar release and fluorophore labeling (APTS). While characteristic N-glycosylation pattern differences were found between normal control and untreated, treated and remission stage multiple myeloma patient samples at the global serum level, less distinctive changes were observed at the immunoglobulin level. Principal component analysis adequately differentiated the four groups (control and three patient groups) on the basis of total serum N-glycosylation analysis. 12 N-glycan features showed statistically significant differences (p <0.05) among various stages of the disease in comparison to the control at the serum level, while only six features were identified with similar significance at the immunoglobulin level, including the analysis of the partitioned F_c fragment as well as the F_ab κ and F_ab λ chains.

Optimal maintenance and consolidation therapy for multiple myeloma in actual clinical practice

Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice.