Modern treatments and future directions for newly diagnosed multiple myeloma patients
Publication date: Available online 23 January 2020Source: Best Practice &Research Clinical HaematologyAuthor(s): Sydney Lu, Assistant Attending, Myeloma ServiceAbstractOver the course of the past decade-plus, the therapy of newly diagnosed multiple myeloma has seen incredible advances in the domains of diagnostic evaluation, active medical therapy, and response evaluation. This manuscript reviews the evaluation and management of newly diagnosed active multiple myeloma, with a focus on major clinical trials and IMWG recommendations. The paper describes a current approach for the initial evaluation and workup of a patient with putative active disease, with consideration towards potential MRD-directed therapeutic approaches and future clinical trials, and then discusses management with a focus on induction regimens with attention primarily to modern three and four-drug combinations for transplant-eligible and transplant-ineligible patients, and those with organ dysfunction. Finally, this article briefly reviews minimal residual disease directed therapy approaches, primarily in the context of whether eligible patients should be referred for high dose chemotherapy and autologous stem cell rescue. Maintenance therapy for both transplant eligible and ineligible patients is discussed elsewhere in this issue.
ConclusionHigh-dose chemotherapy and autologous stem cell transplant using TBC conditioning for both PCNSL and secondary CNS non-Hodgkin lymphoma appears to have encouraging long term efficacy with manageable side effects.
Conclusion Multiple myeloma patients who received HDC/ASCT demonstrated a significant decrease in 18FDG uptake in the supratentorial brain and cerebellum, while patients who received CDC did not demonstrate significant changes in the brain 18FDG uptake.
We retrospectively analyzed 48 CNS lymphoma patients who received HDC/ASCT using TBC conditioning. We found a 2-year PFS and OS rate of 80.5% and 80.1%, respectively. Toxicities included nausea/vomiting, diarrhea, mucositis, and febrile neutropenia. Treatment-related mortality was 8.3% in the first 100 days post-transplant. This data supports the use of consolidative ASCT in PCNSL and secondary CNS lymphoma patients.
Bargou Andreas Rosenwald Thorsten Stühmer Ellen Leich Approximately 20% of multiple myeloma (MM) cases harbor a point mutation in KRAS. However, there is still no final consent on whether KRAS-mutations are associated with disease outcome. Specifically, no data exist on whether KRAS-mutations have an impact on survival of MM patients at diagnosis in the era of novel agents. Direct blockade of KRAS for therapeutic purposes is mostly impossible, but recently a mutation-specific covalent inhibitor targeting KRASp.G12C entered into clinical trials. However, other KRAS hotspot-mutations exist in MM patients, incl...
Patients with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes syndrome are currently treated with therapeutic options for multiple myeloma, and this disease is a treatable disease. Accurate diagnosis and proper treatment in the early stage of the disease are essential to further improve prognosis. This review focuses on diagnosis, treatment and the current status of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes syndrome in Japan. AbstractPolyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome is a rare ...
Paraneoplastic cholestasis is a rare manifestation of Hodgkin ’s lymphoma (HL), especially in the relapsed/refractory setting. Outcomes are generally poor, perhaps related to the narrow therapeutic window of standard chemotherapy drugs in patients with compromised liver function and limited activity of radiotherapy in controlling systemic disease. Here, we p resent the first report of successful treatment of a patient with idiopathic cholestasis in the setting of relapsed HL post autologous stem cell transplant (ASCT) with bridging therapy (cyclophosphamide, methylprednisolone) and sequential nivolumab.
A prospective study of 312 patients [194 with multiple myeloma (MM) and 118 with lymphomas (LYMPH)] receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation (auto-HSCT) was conducted. Ficolins are innate immune defense factors, able to distinguish between “self” “abnormal self,” and “non-self” and contribute to the elimination of the last two by direct opsonization and/or initiation of complement activation via the lectin pathway. Concentrations of ficolin-1, ficolin-2, and ficolin-3 in serially taken serum samples were determined as were the polymorphisms ...
Multiple myeloma (MM) is the most common indication for high dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT). In addition, patients with immunoglobulin light-chain amyloidosis (AL), a related plasma cell disorder, often benefit from ASCT. Objectives: We aimed to compare baseline demographics, peri-transplant mortality, and the incidence of febrile neutropenia and bacteremia between an outpatient transplant cohort at one institution and an inpatient cohort at a second institution.
Due to the curative potential and improvement in progression-free survival (PFS), high dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered the standard of care for several hematologic malignancies such as multiple myeloma, and lymphomas in different treatment stages. However, the process of ASCT typically involves support with blood product transfusion until neutrophil and platelet engraftment occurs. Thus, difficulties arise when ASCT is indicated for Jehovah's witness patients - a religious group known for refusing blood products.
High dose chemotherapy followed by autologous stem cell transplantation (ASCT) offers a cure in the relapsed setting in both Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Additionally, it remains a first-line standard of care in multiple myeloma (MM) patients whom are eligible for ASCT. However, the management of these hematologic malignancies continues to rapidly evolve with non-cytotoxic therapeutic options such as development of new cellular therapies. These developments underscore the importance of monitoring immune reconstitution after ASCT.