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Multiple Myeloma Presenting as Lower Gastrointestinal Bleeding: A Case Report.

Multiple myeloma (MM) is a malignant hematologic neoplasm that primarily affects the bone marrow and can invade other organs, leading to diverse clinical manifestations. Presentation with gastrointestinal bleeding as the initial symptom is exceptionally rare. We report a case of MM in a 46-year-old man who presented with gastrointestinal bleeding and severe anemia. Routine endoscopic evaluation was inconclusive, but further hematologic and imaging investigations confirmed multiple myeloma. The patient was successfully treated with bortezomib-based chemotherapy and supportive care. This case em

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… Bortezomib and high‐dose steroids are associated with an immunomodulatory drug like thalidomide, lenalidomide, or alkylating agents like cyclophosphamide or melphalan [ 9 ]. This patient responded well to treatment, and his m protein improved. …

Management of Multiple Myeloma in the Middle East: Unmet Needs, Challenges and Perspective.

Multiple myeloma (MM) is a prevalent hematological malignancy. Resource-constrained settings such as the Middle East are particularly burdened by the increasing trends in MM morbidity and mortality in addition to challenges in the management of MM. It thus becomes necessary to identify and address debatable areas of current practice and gaps in the management of MM in the Middle East. With a special focus on the Lebanese situation, the first-line treatment of the very elderly (> 80 years old) is discussed, in addition to the impact of relapse type (biochemical or clinical relapse) on maintenan

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… With the risks of melphalan-based regimens in the very elderly, novel drugs should be considered, if available, either as part of treatment or maintenance therapy. …

Long-term results of the treatment of Hodgkin's lymphoma in a resource-constrained setting: Real-world data from a single center.

BackgroundThe outcomes of Hodgkin´s lymphoma (HL) in México have not been widely reported. Simplified and affordable treatments have been adopted in middle-income countries.AimThe aim was to evaluate long-used therapies for HL in México in a long-term basis.MethodsIn a 34-year time period, 88 patients with HL were treated at a single institution in México. Patients were treated with adriamycin bleomycin vinblastine and dacarbazine (ABVD) or mechlorethamine, vincristine, procarbazine, and prednisone (MOPP). Relapsed or refractory patients were given ifosfamide, carboplatin, and etoposide (ICE)

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… High-dose melphalan (200 mg/m 2 ) was used in autologous transplants; cyclophosphamide, fludarabine, and busulfan were used in allogeneic transplants, which were all from HLA-identical siblings[ 10 ]. …

Validation of the revised myeloma comorbidity index and other comorbidity scores in a multicenter German study group multiple myeloma trial.

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… Daratumumab plus bortezomib, melphalan, and prednisone for untreated myeloma . N Engl J Med . 2018 ; 378 ( 6 ): 518 - 528 . 29231133 10.1056/NEJMoa1714678 9. Facon T Kumar S Plesner T . Daratumumab plus lenalidomide and dexamethasone for untreated myeloma . …

Management of multiple myeloma during COVID-19 pandemic.

At the end of 2019, a novel coronavirus was identified as the cause of pneumonia cases in Wuhan, a city in the Hubei Province of China. On January 30, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern and, in March 2020, began to characterize it as a pandemic. The virus that causes COVID-19 is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) In February 2020, the World Health Organization designated the disease COVID-19, which stands for coronavirus disease 2019.

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… Current re-immunization programs for melphalan-induced inactivation of prior vaccines recommend that vaccination (including: pertussis, diphtheria, tetanus, Hemophilus influenzae, pneumococcal, and hepatitis A and B) begin 12 months after ASCT [30] . …

Clinical outcomes of bortezomib-based therapy in Taiwanese patients with multiple myeloma: A nationwide population-based study and a single-institute analysis.

PurposeIn a retrospective cohort study, we report the current epidemiology of patients with multiple myeloma (MM) and analyze the real-world clinical outcomes of bortezomib-based therapy.Materials and methodsThis retrospective study was mainly designed to evaluate the characteristics, treatment outcomes, and prognostic factors of patients with MM who received bortezomib-based therapy. We identified 5,726 patients in Taiwan with MM newly diagnosed between 2007 and 2015. Confidential data from the National Health Insurance Research Database (NHIRD) was used under strict guidelines, as it was mad

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… Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008;359: 906–917. 10.1056/NEJMoa0801479 …

Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases.

BACKGROUND: Africans have an increased risk for multiple myeloma (MM) compared to other races. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. OBJECTIVE: This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. METHODS: A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. RESULTS: Median age was 58 years, with 29% ≤50 years. One-third presented >12 months after onset of sympt

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… In nearly all cases, patients continued on maintenance therapy, usually melphalan-prednisolone (MP), until plateau. Elderly patients were started on MP, or cyclophosphamide with prednisolone or dexamethasone. …

Практические рекомендации в отношении инфекционных профилактических мероприятий и вакцинации нескольких пациентов, страдающих миэломой.

Инфекции по-прежнему являются одной из основных причин заболеваемости и смертности во множестве миеломы (ММ), обусловленной взаимосвязью между иммунной дисфункцией, вызванной болезнями, и иммунодепрессией, связанной с лечением. Внедрение протеазных ингибиторов, иммуномодуляционных препаратов, моноклонных антител, биконкретных антител и химеорической антигенной рецепторной терапии Т (CAR-T) заметно улучшило выживание при одновременном изменении ландшафта инфекционных рисков. Различные стратегии обращения ставят под угрозу иммунитет в рамках различных механизмов. Обычная химиотерапия и некоторые

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… Cytotoxic drugs : Drugs such as cyclophosphamide, vincristine, doxorubicin, and other cytotoxic agents such as cisplatin, etoposide, and melphalan used in protocols such as PACE and conditioning regimens for autologous stem cell transplant (ASCT) have a myelosuppressive effect by disrupting cell division … Furthermore, treatment with high-dose melphalan prior to ASCT can cause severe mucositis, weaken the mucosal barrier, and create a potential site for bacterial translocation ( 21 ). …

Lost in Translation (LiT): IUPHAR Review 6.

Translational medicine is a roller coaster with occasional brilliant successes and a large majority of failures. Lost in Translation 1 ('LiT1'), beginning in the 1950s, was a golden era built upon earlier advances in experimental physiology, biochemistry and pharmacology, with a dash of serendipity, that led to the discovery of many new drugs for serious illnesses. LiT2 saw the large-scale industrialization of drug discovery using high-throughput screens and assays based on affinity for the target molecule. The links between drug development and university sciences and medicine weakened, but t

Prognostic and functional role of the nuclear export receptor 1 (XPO1) in gastrointestinal cancers: a potential novel target?

In the last decades the survival of metastatic gastrointestinal (GI) cancer patients could have been significantly extended due to the introduction of targeted- and immunotherapy. However, only the minority of patients will experience long-lasting survival. Hence, novel therapeutics are clearly necessary for GI cancer patients. Molecular high-throughput profiling techniques have revealed potential novel targetable molecular alterations, emphasizing the necessity for tailored therapeutic approaches. Nuclear export proteins, particularly Exportin-1 (XPO1), have emerged as promising targets in ca

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… (HDM) before autologous hematopoietic cell transplantation for multiple myeloma Phase I–II NCT02780609 Multiple myeloma Drug: Selinexor Drug: Melphalan Drug: Dexamethasone Procedure: autologous hematopoietic cell transplantation (HCT) Drug: Fosaprepitant COVID-19 prevention and treatment in cancer; … (HDM) before autologous hematopoietic cell transplantation for multiple myeloma | Phase I–II | NCT02780609 | Multiple myeloma | Drug: Selinexor Drug: Melphalan Drug: Dexamethasone Procedure: autologous hematopoietic cell transplantation (HCT) Drug: Fosaprepitant | COVID-19 prevention and treatment …

Иммунотерапия Множественной миеломы: Текущий статус как пролог в будущее.

Площадь терапевтических мер по лечению множественной миеломы претерпела сейсмические изменения с начала нынешнего столетия. Это было обусловлено главным образом введением новых классов небольших молекул, таких, как протеазонные блокаторы (например, бортезомиб) и иммуноводители (например, линалидомид), а также иммунотерапевтическими агентами, начиная с anti-CD38 Моноклональная антитела Daratumumab 2015. В последнее время в арсенал лекарств, доступных для борьбы с этим злоумышленником, добавились и другие иммунотерапии. В их число входят продукты биконкретных теклистамб, талькетамаб и эльранатам

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… Alkylating agents (melphalan and/or cyclophosphamide), often in combination with corticosteroids, were the treatment of choice for MM starting in the 1950s. This standard regimen was augmented by autologous stem cell transplantation (ASCT) in the mid-1980s. … For example, a study of tisagenlecleucel, an anti-CD19 CAR, combined with ASCT and melphalan, provided poor clinical benefit to a group of ten MM subjects ( NCT02135406 ) [ 160 ]. …

High-dose intravenous vitamin C, a promising multi-targeting agent in the treatment of cancer.

Mounting evidence indicates that vitamin C has the potential to be a potent anti-cancer agent when administered intravenously and in high doses (high-dose IVC). Early phase clinical trials have confirmed safety and indicated efficacy of IVC in eradicating tumour cells of various cancer types. In recent years, the multi-targeting effects of vitamin C were unravelled, demonstrating a role as cancer-specific, pro-oxidative cytotoxic agent, anti-cancer epigenetic regulator and immune modulator, reversing epithelial-to-mesenchymal transition, inhibiting hypoxia and oncogenic kinase signalling and b

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… | high | 75 g, two times/week | 57 | Tumor response Lung | NCT02905591 [ 134 ] | Single group, Phase 2 | Ascorbate + chemoRT (radiation therapy + paclitaxel + carboplatin) | Chemo-RT | high | 75 g, 3 times/week | 46 | Progression rate Lymphoma | NCT03602235 [ 135 ] | Single group, Phase 1 | VitC + melphalan … [ 137 ] | Randomized, Phase 2 | Arm 1: Ascorbate + chemotherapy Arm 2: Chemotherapy alone (gemcitabine + nab-paclitaxel) | Chemo | high | 75 g, three times/weekly for 4 weeks | 65 | Overall survival Pancreatic | NCT04150042 [ 138 ] | Single group, Phase 1 | VitC + chemotherapy/stem cell treatment (melphalan …

Recurrent Pleural Effusions in an Elderly Female Patient With Renal Amyloidosis.

Amyloidosis is a rare and severe disease process that is often systemic in nature. Clinical presentations of patients include involvement of various organ systems such as the kidneys, heart, and lungs. As such, presentations of amyloidosis can be peculiar and can greatly mimic other conditions, making diagnosis very difficult. Delays in diagnosis or misdiagnoses can lead to significant morbidity and great potential for multi-organ dysfunctions. We describe the case of an elderly female patient without a known cardiac history who presented to the emergency department with increasing shortness o

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… Following this, further management depends on the patient’s ability to take high-dose (200 mg/m 2 ) melphalan followed by autologous hematopoietic cell transplantation (HCT). …

Зарегистрированные пациентом результаты качества жизни до и после аналоговой гематопоиетической трансплантации стволовых клеток при множественном склерозе.

: Автономная трансплантация стволовых клеток (AHSCT) представляет собой терапевтическое вмешательство в случае множественного склероза (MS), которому в последнее десятилетие уделяется повышенное внимание. Воздействие этой меры на качество жизни (QoL) пациентов, имеющих MS, остается неясным. ЦЕЛЬ: Цель этого исследования заключалась в изучении воздействия AHSCT на QoL у пациентов с MS с использованием оценки воздействия множественных склерозов (MSIS-29). МЕТОДЫ: В этом аналитическом ретроспективном когортном исследовании пациенты с повторной эмиссией MS, лечившиеся AHSCT в Швеции с 2004 года, к

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… BEAM-ATG comprised carmustine 300 mg/m 2 , etoposide 800 mg/m 2 , cytarabine arabinoside 800 mg/m 2 , melphalan 140 mg/m 2 and ATG from rabbit (rATG) 10 mg/kg. The Cy-ATG protocol was administered for 5 days and included cyclophosphamide 200 mg/kg and rATG 6 mg/kg. …

Temporal variation in oral microbiome composition of patients undergoing autologous hematopoietic cell transplantation with keratinocyte growth factor.

IntroductionAutologous hematopoietic cell transplantation (AHCT) is a well-established treatment for lymphoma. Unintended effects of this therapy include oral mucositis (OM) and gastrointestinal toxicities, resulting in poor clinical outcomes. The gut microbiome has been previously linked to transplant toxicities among allogeneic recipients, but little is known about the effects of AHCT on the oral microbiome.MethodsSeven patients with non-Hodgkin or Hodgkin lymphoma undergoing AHCT with palifermin (keratinocyte growth factor) were included. Buccal swab samples were collected at baseline and 1

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… Methods Study design and eligibly Eligible patients were > 18 years of age, had a diagnosis of non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma with a plan to undergo AHCT after conditioning with BEAM (busulfan, etoposide, cytosine arabinoside, melphalan). …

Management of Primary Plasma Cell Leukemia Remains Challenging Even in the Era of Novel Agents.

Primary plasma cell leukemia (PCL) is a rare and aggressive variant of multiple myeloma (MM). PCL is characterized by peripheral blood involvement by malignant plasma cells and an aggressive clinical course leading to poor survival. There is considerable overlap between MM and PCL with respect to clinical, immunophenotypic, and cytogenetic features, but circulating plasma cell count exceeding 20% of peripheral blood leukocytes or an absolute plasma cell count of >2000/mm3 distinguishes it from MM. After initial stabilization and diagnosis confirmation, treatment of PCL in a fit patient typical

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… He underwent HSCT conditioning, with melphalan (200 mg/m 2 (MEL 200)), with engraftment on day +11. The post-HSCT course was complicated with profound physical deconditioning and prolonged hospitalization. …

Chemotherapy-induced pulmonary complications in cancer: Significance of clinicoradiological correlation.

Chemotherapy while revolutionizing cancer management by improving survival and quality of life; is also associated with several adverse effects. Lung is the most common organ affected in chemotherapy-related complications, due to either drug toxicity or more commonly due to infections caused by immunosuppression and less commonly due to immune-mediated injury. Radiology, when used in combination with clinical and lab data, can help reach the specific diagnosis or narrow down the differentials. The common radiological patterns of drug toxicity include pulmonary interstitial and airway infiltrat

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… finding and the commonly implicated drugs Radiopathological finding | Commonly implicated drugs Interstitial infiltrates | bleomycin, methotrexate, taxanes, platins, rituximab, gemcitabine, bortezomib, everolimus, temsorilimus, and gefitinib Diffuse alveolar damage | bleomycin, busulfan, carmustine, melphalan …

Comparison of outcomes after human leukocyte antigen-matched and haploidentical hematopoietic stem-cell transplantation for multiple myeloma.

BackgroundAllogeneic stem-cell transplantation (SCT) is a well-established immunotherapeutic strategy for multiple myeloma (MM) with a potent and often sustained graft-vs.-myeloma effect. This multicenter investigation aimed to analyze the complications and survival of haploidentical SCT in patients with MM, and compare the main outcomes with matched-related donors (MRDs).MethodsHaploidentical and MRD SCT was identified from a cohort of 97 patients with MM who received a myeloablative transplantation in 13 hospitals from May 2001 to December 2017. A matched-pair analysis was designed. For each

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… The myeloablative regimen was defined as a regimen containing total-body irradiation (TBI) with a dose of >6 Gy, >8 mg/kg oral, or >6.4 mg/kg intravenous busulfan (BU) or multiple chemotherapy combinations involving high-dose carmustine, etoposide, cytarabine, and melphalan. [ 19 , 20 ] Response to …

Is it feasible to conduct a randomised controlled trial of pretransplant exercise (prehabilitation) for patients with multiple myeloma awaiting autologous haematopoietic stem cell transplantation? Protocol for the PREeMPT study.

INTRODUCTION: While myeloma is an incurable malignancy, developments in disease management have led to increased life expectancy in recent years. Treatment typically involves stem-cell transplantation. Increased survival rates equate to more patients living with the burden of both the disease and its treatment for increasing number of years, rendering myeloma a long-term condition.Evidence exists to demonstrate the benefits of exercise for patients recovering from stem-cell transplantation, and prehabilitation-exercise before treatment-has been shown to be effective in other disease areas. To

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… regimens delivered as an outpatient or day case given to control disease until maximum response is achieved (usually reflected by a plateau in serum paraprotein). 6–8 This response is then consolidated with autologous stem-cell transplantation, which permits the administration of high-dose myeloablative melphalan …

The High Effect of Chemomobilization with High-Dose Etopside + Granulocyte-Colony Stimulating Factor in Autologous Hematopoietic Peripheral Blood Stem Cell Transplantation: A Single Center Experience.

Autologous hematopoietic stem cell transplantation (auto-HSCT) provides hematopoietic support after high-dose chemotherapy and is the standard of care for patients with multiple myeloma (MM), chemo sensitive relapsed high or intermediate grade non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). However, yields of hematopoietic stem cells vary greatly between patients, and the optimal strategy to mobilize hematopoietic stem cells into peripheral blood for collection has not been defined yet. We investigated the efficacy and safety of chemo mobilization with an intermediate dose etoposide

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… ASCT was performed using melphalan (200 mg/m 2 , reduced to 140 mg/m 2 for patients with comorbid illness) for MM patients or BEAM chemotherapy protocol for HL and NHL patients followed by stem cell infusion. …