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Clinical Controversies in the Management of Smoldering Multiple Myeloma.

Forty years ago this year, smoldering multiple myeloma was defined as a clinical entity that identifies a group of patients with a substantial burden of disease but with a relatively indolent natural history compared with symptomatic disease. Since then, there has been a revolution in the therapeutic options for multiple myeloma. The aim of this article is to describe recent advances in the identification of those patients who are at the highest risk of progression and whether they may benefit from therapy. Treatment of smoldering myeloma is an area of active debate and we present contrasting …

Risk Stratification of Precursors to Multiple Myeloma in 2020.

With advances in the treatment of plasma cell disorders, there have also been improvements in the risk stratification of these diseases. There are currently no screening recommendations for monoclonal gammopathy of unknown significance (MGUS); however, new studies are analyzing the role of screening for patients age 40-75 who are African American or have a family history of multiple myeloma (MM). Patients with smoldering multiple myeloma (SMM) have an increased risk of progression to MM when compared to MGUS. Data have shown that evaluation of bone marrow biopsy, full body MRI and free light c…

Orbital plasmacytoma as the presenting feature in multiple myeloma.

A 50-year-old female patient presented with protrusion of the left eye for 1 month. Examination showed abaxial proptosis, restriction of extraocular movements, and elevated intraocular pressure. Computed tomography of the orbits showed soft tissue enhancing lesion in the superolateral aspect of the left orbit with lytic lesions in calvarium. Fine needle aspiration cytology of the lesion revealed a diagnosis of plasmacytoma with positive CD138 and CD38 immunohistochemical stains. Erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase were elevated. Serum protein elec

Oral health status of patients with multiple myeloma.

ObjectiveTo describe the oral health status of patients with multiple myeloma and compare to a control group.Materials and methodsThe medical history of the studied subjects was obtained from the medical records and through interviews. Trained examiners evaluated the oral mucosa, teeth, periodontium and imaging aspects. The dental status was evaluated by the decayed, missing and filled teeth index. The presence of bone lesions was investigated with cone beam computer tomography images of the jaws.ResultsThe most common oral mucosa features were paleness (31%) and coated tongue (14.3%) in the m…

Quality of life in caregivers of patients with multiple myeloma.

Objectives: This study aimed to assess the relationship between sociodemographic, clinical, and psychological variables with quality of life (QoL) and the moderating role of caregivers' age and caregiving duration in caregivers of patients with Multiple Myeloma.Method: The sample included 118 caregivers who completed questionnaires that assessed psychological morbidity, satisfaction with social support, coping, burden, unmet needs, and QoL.Results: High psychological morbidity, burden and information, financial and emotional unmet needs were associated with lower QoL, while higher satisfaction…

Risk and Response-Adapted Treatment in Multiple Myeloma.

Myeloma therapeutic strategies have been adapted to patients' age and comorbidities for a long time. However, although cytogenetics and clinical presentations (plasmablastic cytology; extramedullary disease) are major prognostic factors, until recently, all patients received the same treatment whatever their initial risk. No strong evidence allows us to use a personalized treatment according to one cytogenetic abnormality in newly diagnosed myeloma. Retrospective studies showed a benefit of a double autologous transplant in high-risk cytogenetics according to the International Myeloma Working

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… Introduction Multiple myeloma (MM) is a plasma cell dyscrasia that is involved in approximately 15% of all hematological malignancies. Most patients are over 65 years old, with a median age at diagnosis of 70 years old [ 1 ]. … Living with the burden of relapse in multiple myeloma from the patient and physician perspective Leuk. Res. 2017 59 75 84 10.1016/j.leukres.2017.05.019 28582636 …

The Anti-CD38 Antibody Therapy in Multiple Myeloma.

Multiple myeloma (MM) is the second-most common hematologic malignancy after diffuse large B-cell lymphoma. Despite the improvement in response and survival rates following the introduction of novel therapies, only a few patients are cured, and the majority of MM patients experience several relapses and receive multiple lines of treatment. Currently, bortezomib and lenalidomide are the core component of treatment both at the time of diagnosis and at the relapse as well as the new proteasome inhibitors (PIs), such as carfilzomib and ixazomib, and the next-generation immunomodulatory drug, pomal…

Methods for reducing delays in the diagnosis of multiple myeloma.

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… A systematic review has shown that patients with multiple myeloma experience long diagnostic intervals, with 50% of patients having waiting times longer than 3 months [ 2 ]. … Multiple myeloma. BMJ. 2012;344:d7953. doi: 10.1136/bmj.d7953. 10. Friese CR, Abel GA, Magazu LS, Neville BA, Richardson LC, Earle CC. Diagnostic delay and complications for older adults with multiple myeloma. Leuk. Lymphoma. 2009;50(3):392–400. doi: 10.1080/10428190902741471. 11. …

The pharmacologic management of multiple myeloma in older adults.

IntroductionMultiple myeloma is a disease predominately affecting older adults. Pivotal to treating older adults is understanding their physiologic differences compared to younger subjects and how the complexity of therapies has an impact upon this patient population.Areas coveredHerein, the authors address the efficacy of chemotherapy regimens, decision-making for older adults, chemotherapy-associated toxicity and the approach to management. This review focuses on the complex treatment of older multiple myeloma patients and management of treatment-related adverse events.Expert opinionBalancin…

Geriatric Assessment in Older Adults with Multiple Myeloma.

BACKGROUND/OBJECTIVES: The incidence of myeloma in older adults is increasing, yet little is known about geriatric impairments in these patients. We aimed to examine the prevalence of geriatric impairments in older adults with myeloma and the association between geriatric assessment and autologous stem cell transplant eligibility. DESIGN: Prospective cohort study. SETTING: Two academic medical centers. PARTICIPANTS: A total of 40 adults 65 years and older with newly diagnosed myeloma were enrolled. MEASUREMENT: Participants completed a primarily self-administered geriatric assessment, incl

New proteasome inhibitors in the treatment of multiple myeloma.

The treatment of patients with relapsed and/or refractory multiple myeloma has improved considerably in the last 15 years, after the introduction of proteasome inhibitors and immunomodulatory drugs. The first clinical trials with new proteasome inhibitors have produced exciting results, particularly those comparing triplet regimens with standard doublet regimens, with a gain in progression-free survival accompanied by an acceptable safety profile and either similar or better health-related quality of life. New proteasome inhibitors hold the potential to fill unmet needs in multiple myeloma man…

Mechanisms and treatment of bone pain in multiple myeloma.

PURPOSE OF REVIEW: Multiple myeloma is a haematological malignancy of differentiated B lymphocytes, known as plasma cells. The disease is common in the UK (incidence of 9 cases per 100 000 people) and the most frequent presentation is bone pain caused by skeletal damage. Patients with myeloma also experience neuropathic pain induced by chemotherapy. The management of pain in multiple myeloma is frequently demanding and often sub-optimally addressed. This review seeks to summarize a rational approach to the management of pain experienced by multiple myeloma patients. RECENT FINDINGS: Bone pain…

Practical Aspects of the Use of Carfilzomib in Multiple Myeloma

Carfilzomib (Kyprolis®, Amgen), a second-generation proteasome inhibitor, is capable of covalent bonding and irreversible inhibition of the 20S proteasome chymotrypsin-like activity. In 2016 this drug was approved in Russia for monotherapy of relapsed refractory multiple myeloma (MM) and in combination with lenalidomide and dexamethasone (KRd) or only with dexamethasone (Kd) for treatment of patients with relapsed MM after at least one line of prior therapy. The present review outlines mechanism, clinical efficacy, and adverse effects of carfilzomib according to the data of a phase II (monothe…

New generation drugs for treatment of multiple myeloma.

Multiple myeloma (MM), a plasma cell malignancy, is characterised by lesions in multiple bones involving transformed, matured post-follicular B cells. The course of the disease involves an initial development of monoclonal gammopathy of undetermined significance (MGUS), followed by smouldering MM, before the full MM disease emerges. Despite novel therapies, MM remains incurable, managed by combination therapies, including proteasome inhibitors (PIs), immunomodulators (IMiDs) and anti-human CD38 (daratumumab). MM patients have an increased risk of thromboembolic events due to combination treatm…

A case of multiple myeloma initially presenting as hematemesis.

A few cases of multiple myeloma with gastrointestinal bleeding have been reported, but hematemesis is rarely encountered as an initial symptom of multiple myeloma. Here we report a case of multiple myeloma with an initial symptom of hematemesis. Gastroscopy revealed ulceration in the angulus of the stomach. Colonoscopy revealed many ulcers in the ascending colon. A definite diagnosis of gastrointestinal amyloidosis was made using tissue biopsy. A definite diagnosis of multiple myeloma was made using bone marrow puncture. Hematemesis may be an initial symptom of multiple myeloma. A diagnosis of…

The expression and role of miR-181a in multiple myeloma.

This study aims to investigate the role of miR-181a in multiple myeloma (MM). Fresh peripheral blood and bone marrows were collected. Expression of miR-181a, BCL-2 mRNA, and NOVA1 mRNA was detected by RT-qPCR. The correlation between miR-181a and clinical features of MM was further analyzed. miR-181a in serum and bone marrow mononuclear cells of MM patients were significantly higher. And, miR-181a level was significantly higher in MM Durie-Salmon stage III than that in stage I+II. miR-181a was positively correlated to Durie-Salmon staging, age, kidney injury, bone injury, β2-MG whereas negativ…

Elotuzumab: A Review in Relapsed and/or Refractory Multiple Myeloma.

Intravenous elotuzumab (Empliciti™), a monoclonal antibody targeting the signalling lymphocytic activation molecule F7 (SLAMF7) glycoprotein, is approved for use in combination with lenalidomide and dexamethasone for the treatment of multiple myeloma in previously-treated adult patients. In the pivotal, multinational, phase III ELOQUENT-2 trial in adults with relapsed and/or refractory multiple myeloma, elotuzumab in combination with lenalidomide and dexamethasone significantly prolonged median progression-free survival (PFS) and increased overall response rate (ORR; co-primary endpoints) comp…