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Sequencing of nontransplant treatments in multiple myeloma patients with active disease.

The approval of several different classes of drugs in recent years has resulted in a dramatic expansion of treatment options for multiple my … n approach on how to sequence and incorporate these therapies, focusing on patients where high-dose melphalan and autologous stem cell transplant are deferred or not applicable.

Successful Treatment of Gastric Relapse in Multiple Myeloma with Bortezomib after Autologous Hematopoietic Stem Cell Transplantation (autoHSCT).

We report a case of 59-year-old Turkish man with history of mitral valve replacement (MVR) and chronic obstructive pulmonary disease (COPD) who was diagnosed with stage IIIA IgG lambda multiple myeloma (MM) in 1997. He underwent autologous hematopoietic stem cell transplantation after a conditioning regimen with melphalan 200mg per body area (m(2)) in February 2006. On February 2011, he was admitted to the emergency service of university hospital with complaints of hematemesis and melena. Pathological evaluation of gastric biopsy, obtained from a lesion of small gastric curvature, showed the g…

Update on the role of autologous hematopoietic stem cell transplantation in multiple myeloma.

Autologous stem cell transplantation is considered the standard of care for multiple myeloma patients aged < 65 years with no relevant comorbidities. The addition of drugs acting both on bone marrow microenvironment and on neoplastic plasma cells has significantly increased the proportion of patients achieving a complete remission after induction therapy, and these results are mantained after high-dose melphalan, leading to a prolonged disease control. Studies are being carried out in order to evaluate whether short term consolidation or long-term maintenance therapy can result into disease er…

Management of myeloma: an Italian perspective.

Multiple myeloma remains a fatal plasma cell malignancy. However, new insights into the disease biology and immunology have identified molecular mechanisms, underling functional interactions between plasma cells and the bone marrow microenvironment that have become molecular targets of so-called "new drugs" such as thalidomide, lenalidomide, and bortezomib. Recently, the combinations of new drugs with melphalan and prednisone in elderly patients, and with autologous stem cell transplantation in induction and/or maintenance schedules in younger patients have significantly prolonged overall surv…

Autologous bone marrow transplanation for extramedullary plasmacytoma presenting as adrenal incidentaloma.

Extramedullary adrenal plasmacytoma (EMP) involving the adrenal glands is rarely encountered clinically. We report a A 47-year-old male who presented with bilateral adrenal incidentalomas. After confirming EMP, the patient received two consecutive autologous hematopoietic stem cell transplants (HSCT) using high-dose melphalan. Following HSCT, a serial follow-up helical CT revealed a substantial decrease in the size of both adrenal masses. Serial periodic serum protein and urine electrophoresis and immunofixation showed abrogation of a previously noted monoclonal band. At 50 months follow-up th…

Primary systemic amyloidosis.

Primary amyloidosis is a plasma cell dyscrasia in which insoluble immunoglobulin light chain fragments are produced and polymerize into fibr … ement, which is best assessed by echocardiography with Doppler studies. Therapies used include oral melphalan/prednisone and high-dose corticosteroids. High-dose chemotherapy followed by stem cell reconstitution seems to provide the highest reported response rates. Transplant is associated with unique morbidities not seen in the transplantation of patients …

Autologous bone marrow transplantation for intra-abdominal extramedullary plasmacytoma.

A patient with an extramedullary plasmacytoma of the omentum and ovaries is described. In spite of the presence of a very high concentration … lowed by autologous bone marrow transplantation with the BEAM regimen (BCNU, etoposide, cytarabine, melphalan) as conditioning therapy. The patient was still in complete remission 1 year after transplantation. This case demonstrates that an extramedullary plasmacytoma may become manifest as extensive but localized disease with high levels of paraprotein, an …

Primary central nervous system post-transplant lymphoproliferative disorder presenting as cerebral hemorrhage after unrelated bone marrow transplantation.

We present a rare case of cerebral hemorrhage due to Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD). A 58-year-old man with myelodysplastic syndrome received allogeneic hematopoietic stem cell transplantation from an unrelated donor after being conditioned with fludarabine, melphalan, and total body irradiation. Tacrolimus and methotrexate were given for graft-versus-host disease (GVHD) prophylaxis. On day 23, he developed acute GVHD, which was successfully treated with prednisolone (PSL). The tapering of PSL failed because of extensive chronic GVHD inv…

Ecthyma gangrenosum in Saudi Arabia.

We report a diagnosis of ecthyma gangrenosum EG in 4 females of mean age 54.8 range 43-64 years, within 10 months. Severe drug reaction treated with high dose systemic corticosteroids in patient one, acute myelocytic leukemia treated with high dose dexamethasone, and multiple broad-spectrum antibiotics in patient 2 preceded the onset of EG. Patients 3 and 4 had vasculitic purpura and hemodialysis. In addition, patient 3 was receiving multiple broad-spectrum antibiotics plus anti-tuberculosis TB drugs for gastric TB, while patient 4 was on melphalan and high dose systemic corticosteroids. Pseud…

[Heart transplantation and the subsequent treatment of AL amyloidosis].

UNLABELLED: Severe damage to the heart caused by AL amyloid deposits is a contraindication of high-dose chemotherapy with autologous haemato … alganciclovir was discontinued during the haematopoietic stem cell harvest. High-dose chemotherapy (melphalan 100 mg/m2) with autologous haematopoietic stem cell transplantation followed. In the interval from administering melphalan until the rise in neutrophil count over 2 x 109/l, antiviral prophylaxis was discontinued again, the immunosuppressive drug do …

Outcomes and adverse events following intra-arterial chemotherapy for retinoblastoma: A single center study in South India.

BACKGROUND: Intra-arterial chemotherapy (IAC) has become a first-line standard treatment for retinoblastoma (RB). However, studies describing its adverse events are sparse, especially from the developing world. Our study described the outcomes and adverse events from a single center in South India. AIM: To describe the challenges, treatment outcomes, and complications of selective IAC for RB in Indian eyes. METHODS: This study was a single center, retrospective study that included 17 patients with RB who underwent IAC using melphalan (5/7.5 mg) and topotecan (1/2 mg) (n = 12) or melphalan (5…

Impact of Reduced-Intensity Conditioning Regimens on Outcomes in Diffuse Large B Cell Lymphoma Undergoing Allogeneic Transplantation.

Reduced-intensity conditioning (RIC) regimens are frequently used for allogeneic hematopoietic cell transplantation (allo-HCT) in patients w … . Patients received 1 of 3 RIC regimens: fludarabine/i.v. busulfan ~6.4 mg/kg (Flu/Bu), fludarabine/melphalan 140 mg/m2 (Flu/Mel140), or BCNU/etoposide/cytarabine/melphalan (BEAM). Accordingly, the study group was divided into 3 groups: Flu/Bu (n = 151), Flu/Mel140 (n = 296), and BEAM (n = 115). Relative to Flu/Bu, the Flu/Mel140 (hazard ratio [HR], 2.33; 9 …

Durable Chimerism and Long-Term Survival after Unrelated Umbilical Cord Blood Transplantation for Pediatric Hemophagocytic Lymphohistiocytosis: A Single-Center Experience.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder of immune dysregulation characterized by fever, hepatosplenomegaly, … oposide /antithymocyte globulin (ATG) (n = 5), busulfan/cyclophosphamide /ATG (n = 4), or busulfan /melphalan/ATG (n = 1). Four patients received reduced-toxicity conditioning (RTC) with alemtuzumab/fludarabine/melphalan/hydroxyurea ± thiotepa. Cord blood units were mismatched at either 1 (n = 9) or 2 (n = 5) loci and delivered a median total nucleated cell …

Autologous bone marrow transplantation in multiple myeloma: identification of prognostic factors.

Multiple myeloma remains a universally fatal malignancy with a median survival time not exceeding 3 years. A clinical trial was undertaken to determine feasibility and efficacy of marrow-ablative chemoradiotherapy supported by unpurged autologous bone marrow (ABMT) and to define prognostic variables. Total body irradiation and either melphalan or thiotepa were administered to 55 patients (median age 53 years; range 20 to 66 years). The group of 21 patients with resistance to standard melphalan-prednisone and to continuous infusions of vincristine and Adriamycin with high dose dexamethasone (VA…

First-line Therapy in Newly Diagnosed Multiple Myeloma.

UNLABELLED: First-line multiple myeloma treatment has evolved from melphalan-prednisone to quadruplet regimens incorporating proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and autologous stem cell transplantation, yielding significantly improved survival. This review summarizes current approaches to risk stratification and therapy for newly diagnosed multiple myeloma and highlights the emerging role of measurable residual disease-adaptive strategies. We also discuss recent efforts to integrate chimeric antigen receptor T cells and bispecific antibodies into up-…

An Azoreductase-Activated Self-monitoring Prodrug for Chemiluminescence Imaging and Safe Chemotherapy Breast Cancer.

Theranostic prodrugs predominantly rely on fluorogenic responses to convey diagnostic signals during chemotherapeutic activation. While chemiluminescence (CL) detection offers superior signal-to-noise ratios over fluorescence, the utilization of Schaap's as a module in diagnostic prodrugs remains underexplored, limiting advancements in this field. Herein, we present the first Azoreductase (AZR)-activated self-reporting theranostic prodrug utilizing a CL feedback mechanism. This prodrug has azo (-N = N-) bonds, which can serve as an AZR recognition site and link the melphalan analogue and Schaa…

Renal and Extramedullary Involvement Revealing Atypical Multiple Myeloma: A Case Report and a Literature Review.

BACKGROUND: Multiple myeloma (MM) is a plasma cell malignancy with diverse clinical manifestations. Beyond the classic CRAB features (hyperc … in G-kappa MM with pulmonary and pleural extramedullary disease and achieved partial remission with melphalan-dexamethasone, maintaining clinical improvement for 12 months. CONCLUSION: This case illustrated rare, severe extramedullary manifestations of MM with renal dysfunction as a key clinical clue. It underscored the importance of early recognition and …

Автономная трансплантация кровеносных стволовых клеток у пациента с ревматоидным артритом и множественной миеломой: обзор сюжетной литературы.

Ремуатоидный артрит (RA) и множественная миелома (MM) - редкие сосущественные условия, которые создают диагностические и терапевтические проблемы, и, хотя автологическая трансплантация стволовых клеток (auto-HSCT) является стандартом для MM, ее воздействие на сопутствующие RA остается неясным. Мы сообщаем о 50-летней женщине с 10-летней историей РА, которая развила ИгГ-ИМ и прошла автоматический HSCT после индукции VRD и гипердозированного кондиционирования мелфаланом. Серийные оценки показали, что реакция MM углубилась от частичной ремиссии до очень хорошей частичной ремиссии, при этом M бело

Совпадение в аннотации оригинала
Rheumatoid arthritis (RA) and multiple myeloma (MM) are rare coexisting conditions that present diagnostic and therapeutic challenges, and w … history of RA who developed IgG-κ MM and underwent auto-HSCT following VRD induction and high-dose melphalan conditioning. Serial assessments showed that MM response deepened from partial remission to very good partial remission, with M protein declining and the free light chain ratio normalizing, while RA activity markedly improved-rheumatoid factor decre …

Allogeneic transplantation in adverse-risk acute myeloid leukemia: Challenges, strategies, and future directions.

Adverse-risk acute myeloid leukemia (AML) is a therapeutic challenge despite advances in risk stratification. Unmet needs persist in high-ri … onses across genetic subtypes, optimal transplant timing, conditioning regimens (e.g., busulfan- or melphalan-based protocols), and bridging strategies require further refinement. Meanwhile, post-transplant maintenance therapies, such as hypomethylating agents or targeted drugs, are one emerging area under investigation for relapse prevention. In this persp …

Clonal evolution of hematopoietic stem cells after autologous stem cell transplantation.

The impact of exogenous stressors, such as cancer chemotherapies, on the genomic integrity and clonal dynamics of normal hematopoiesis is not well defined. We conducted whole-genome sequencing on 1,276 single-cell-derived hematopoietic stem and progenitor cell (HSPC) colonies from ten patients with multiple myeloma treated with chemotherapies and six normal donors. Melphalan treatment significantly increased the mutational burden, producing a distinctive mutation signature, whereas other chemotherapeutic agents had minimal effects. Consequently, the clonal diversity and architecture of post-tr…