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Living with relapsed myeloma: Symptoms and self-care strategies.

Aims and objectivesTo explore which symptoms relapsed myeloma patients experience and what self-care strategies are used.MethodsThis was a qualitative study utilising focus group interviews (n = 4) with relapsed myeloma patients (n = 15) and carers (n = 9). The focus groups were analysed and guided by thematic analysis.ResultsThree major themes with subthemes were identified following analysis of the interview data: "difficult symptoms; "self-care" and "feeling vulnerable." These findings indicate the challenges relapsed myeloma patients experience with ongoing symptoms and highlight the impor

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 achiev

Combination of IFN-α/Gm-CSF as a Maintenance Therapy for Multiple Myeloma Patients After Autologous Stem Cell Transplantation (ASCT): A Prospective Phase II Study.

Interferon alpha (IFN-α) has been used as a maintenance therapy after autologous stem cell transplantation (ASCT) for multiple myeloma (MM) patients. In this study, we combined GM-CSF with IFN-α in order to improve IFN tolerance in post-ASCT myeloma patients. Primary aims were to evaluate myelotoxicity and effectiveness of this maintenance therapy. The treatment included 4 × 10(6) units of IFN-α and 125 μg/m(2) of GM-CSF given three times a week for twelve months. Twenty seven patients were enrolled within 120 days after ASCT. One patient discontinued treatment due to thrombocytopenia and seve

Талидомид как спасательный протокол для лечения множественной миеломы у собак: предварительные данные из многоцентрального ретроспективного исследования.

Множественная миелома (ММ) в собаках, как правило, обрабатывается сочетанием алкилирующих агентов и кортикостероидов. Однако отказ от лечения или нетерпимость, зачастую из-за кумулятивной токсичности, могут ограничить долгосрочную эффективность этих протоколов. Талидомид, иммуномодулятивный и антиангиогенный препарат, широко используемый в организме человека, по-прежнему в значительной степени не изучен в ветеринарной онкологии. В этом исследовании ретроспективно оценивалась клиническая эффективность и безопасность талидомида как спасательная терапия у собак с MM, которые отвергали стандартное

Исследование по вопросу о факторах риска и стратегиях лечения глубокого веинского тромбоза у пациентов с множественной миеломой.

Множественная миелома (ММ) — злокачественная опухоль, появляющаяся из плазменных клеток, и в последние годы в нашей стране наблюдается значительная тенденция к росту ее распространения. Венозный тромбоэмболизм (VTE) является относительно распространенным осложнением у нескольких пациентов с миэломой (MM). Венозный тромбоэмболизм включает в себя тромбоз глубокой вены (ДВТ) и легочную эмболию (ПЕ), при этом во время лечения пациенты подвергаются высокому риску ДВТ. Исследования показали, что прокоагуляционное состояние MM, подстрекательская реакция и использованные терапевтические препараты знач

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… Light-chain paraproteins with lupus anticoagulant activity. Am J Hematol . 1999;62(2):99–102. doi: 10.1002/(SICI)1096-8652(199910)62:2<99::AID-AJH6>3.0.CO;2-N 26. Carr ME, Dent RM, Carr SL. Abnormal fibrin structure and inhibition of fibrinolysis in patients with multiple myeloma. …

Воздействие непрерывного лечения леналидомидома на людей, живущих с множественным исследованием по оценке качества услуг в одном центре миэломы.

PMOPSE: Непрерывное лечение линалидомида после аутологической трансплантации стволовых клеток способствует повышению уровня свободного развития и общей выживаемости вновь диагностированных пациентов с множественными миеломами и является стандартом ухода в Соединенном Королевстве с марта 2021. Однако имеется мало информации о ее воздействии на повседневную жизнь пациентов. Эта оценка услуг была направлена на качественную оценку пациентов, проходящих курс лечения линалидомидом в раковом центре в Лондоне, с тем чтобы эта служба могла лучше соответствовать потребностям и ожиданиям пациентов.МЕТОДЫ

Prognostic impact of resistance to bortezomib and/or lenalidomide in carfilzomib-based therapies for relapsed/refractory multiple myeloma: The Kyoto Clinical Hematology Study Group, multicenter, pilot, prospective, observational study in Asian patients.

BackgroundCombinatory strategies with carfilzomib (CFZ), a second-generation proteasome inhibitor, plus dexamethasone (DEX) with or without lenalidomide (LEN) have shown promising efficacy for patients with relapsed/refractory multiple myeloma (RRMM) in pivotal clinical trials. However, their effects on patients who were resistance to bortezomib (BTZ) and/or LEN have not been fully evaluated in a daily practice setting.AimsTo evaluate the real-world efficacy and safety of CFZ-based treatments; that is, CFZ with LEN plus DEX (KRD therapy) and CFZ with DEX (KD therapy), in Asian patients, we con

Multiple myeloma: an overview of management.

Multiple myeloma represents 2% of all new cancer diagnoses in the United Kingdom and accounts for 2% of all cancer deaths. In the past few decades, there have been huge improvements in life expectancy which have been driven by novel therapeutic agents, autologous stem cell transplants and intensified supportive care. This review will discuss the pathogenesis of multiple myeloma, current management approaches and the direction of future treatments. In addition, this review will highlight the high burden of symptoms that patients experience and therefore the great benefits that can be gained fro

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study.

BackgroundIn Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting.MethodsWe carried out a cross-sectional retrospective c

Secondary antibody deficiencies in the modern era: emerging trends, diagnostic pitfalls, and advances in personalised management.

Secondary antibody deficiencies (SADs) are a significant but frequently under-recognised group of acquired immunodeficiencies. They may arise in various clinical settings, including haematological malignancies, immunosuppressive therapies, and protein-losing conditions. SADs are associated with an increased risk of recurrent and severe infections, hospitalisation, and impaired quality of life. Despite this, diagnostic and treatment pathways remain inconsistent across healthcare settings and regions. Recent advances in the use of structured clinical data, including electronic health records and

Carfilzomib prescribing patterns and outcomes for relapsed or refractory multiple myeloma: a real-world analysis.

Despite the widespread use of carfilzomib (K) in relapsed/refractory multiple myeloma (RRMM), there is no consensus on optimal K dose in milligrams per square meter (mg/m2) or dosing schedule. We assessed three modern K prescribing patterns in RRMM using a large United States electronic health record-derived database. Our final cohort (n = 486) included 136 patients (28.0%) who received K 56 mg/m2 once weekly (K56-1x), 86 (17.7%) who received 56 mg/m2 twice weekly (K56-2x), and 264 (54.3%) who received 70 mg/m2 once weekly (K70-1x). Between 2016 and 2023, once-weekly dosing became more common:

Post-progression outcomes following BCMA-directed CAR T-cell therapy in myeloma: impact of extramedullary and paramedullary disease.

IntroductionBCMA-directed CAR T-cell therapies have improved outcomes in relapsed and refractory multiple myeloma (MM); however, the majority of patients relapse within 1 to 3 years following treatment. Managing disease progression after CAR T-cell therapy remains a major challenge, particularly in aggressive subtypes including extramedullary disease (EMD) and paramedullary disease (PMD). Real-world data on progression patterns post-CAR T cell therapy and the impact of EMD or PMD on outcomes of patients who relapsed post-CAR T-cell therapy remain scarce.MethodsIn this single-center, retrospect

Lenalidomide in the treatment of anti-myelin-associated glycoprotein neuropathy: A phase 1 study to identify the maximum tolerated dose.

BackgroundAnti-myelin-associated glycoprotein (MAG) neuropathy is a debilitating demyelinating polyneuropathy with no approved therapies. Our primary objective was to ascertain lenalidomide safety and maximum tolerated dose (MTD) in anti-MAG neuropathy.MethodsThis phase 1b, open-label, single-arm, dose-finding trial was conducted from 2019 through 2022. The original design included a dose-escalation/extension phase followed by a dose-expansion phase. Three doses of lenalidomide were evaluated: 10, 15, and 25 mg. The main outcome was the MTD.ResultsEleven patients enrolled (10 men), with a mean

Comparison of infectious complications with BCMA-directed therapies in multiple myeloma.

B-cell-maturation-antigen (BCMA)-directed therapies are highly active for multiple myeloma, but infections are emerging as a major challenge. In this retrospective, single-center analysis we evaluated infectious complications after BCMA-targeted chimeric-antigen-receptor T-cell therapy (CAR-T), bispecific-antibodies (BsAb) and antibody-drug-conjugates (ADC). The primary endpoint was severe (grade ≥3) infection incidence. Amongst 256 patients, 92 received CAR-T, 55 BsAb and 109 ADC. The incidence of severe infections was higher with BsAb (40%) than CAR-T (26%) or ADC (8%), including grade 5 inf

Development and Internal Validation of a Risk Prediction Model to Identify Myeloma Based on Routine Blood Tests: A Case-Control Study.

Myeloma is one of the hardest cancers to diagnose in primary care due to its rarity and non-specific symptoms. A rate-limiting step in diagnosing myeloma is the clinician considering myeloma and initiating appropriate investigations. We developed and internally validated a risk prediction model to identify those with a high risk of having undiagnosed myeloma based on results from routine blood tests taken for other reasons. A case-control study, based on 367 myeloma cases and 1488 age- and sex-matched controls, was used to develop a risk prediction model including results from 15 blood tests.

Chemotherapy-based versus chemotherapy-free stem cell mobilization (± plerixafor) in multiple myeloma patients: an Italian cost-effectiveness analysis.

Given the availability and efficacy of the mobilizing agent plerixafor in augmenting hematopoietic progenitor cell mobilization with granulocyte colony-stimulating factor (G-CSF), there is a strong case for comparing the cost-effectiveness of mobilization with G-CSF + cyclophosphamide versus G-CSF alone. This study investigated the cost and effectiveness (i.e., successful 4 million-CD34+ collection) of G-CSF alone versus high-dose cyclophosphamide (4 g/m2) + G-CSF mobilization (± on-demand plerixafor) in patients with multiple myeloma (MM) eligible for autograft in Italy. A decision tree-suppo

How I treat microangiopathic hemolytic anemia in patients with cancer.

Microangiopathic hemolytic anemia (MAHA) with thrombocytopenia, suggests a thrombotic microangiopathy (TMA), linked with thrombus formation affecting small or larger vessels. In cancer patients, it may be directly related to the underlying malignancy (initial presentation or progressive disease), to its treatment, or a separate incidental diagnosis. It is vital to differentiate incidental thrombotic thrombocytopenia purpura or atypical hemolytic uremic syndrome in cancer patients presenting with a TMA, as they have different treatment strategies, and prompt initiation of treatment impacts outc

Trends in Incidence and Mortality of Waldenström Macroglobulinemia: A Population-Based Study.

Background: The incidence of Waldenström macroglobulinemia (WM) has increased in certain groups over several decades in the United States. It is unclear whether the increasing incidence is associated with mortality trends. Methods: The incidence and incidence-based mortality (IBM) rates were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (1980-2016) with SEER*Stat software. The secular trends stratified by demographic characteristics were analyzed by joinpoint regression. Results: The incidence of WM showed an initial rapid increase from 1980 to 1993 {annual perc

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… Introduction Waldenström macroglobulinemia (WM), a very rare indolent and incurable non-Hodgkin lymphoma (NHL), is characterized by the infiltration of bone marrow and other tissues by lymphoplasmacytic and plasma cells and the presence of circulating immunoglobulin M (IgM) paraproteins in the serum …

A concise revised Myeloma Comorbidity Index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients.

With growing numbers of elderly multiple myeloma patients, reliable tools to assess their vulnerability are required. The objective of the analysis herein was to develop and validate an easy to use myeloma risk score (revised Myeloma Comorbidity Index) that allows for risk prediction of overall survival and progression-free survival differences in a large patient cohort. We conducted a comprehensive comorbidity, frailty and disability evaluation in 801 consecutive myeloma patients, including comorbidity risks obtained at diagnosis. The cohort was examined within a training and validation set.

Pomalidomide in the treatment of multiple myeloma: design, development and place in therapy.

Multiple myeloma is a very heterogeneous disease with variable survival. Despite recent progress and the widespread use of new agents, patients with relapsed and refractory disease have a poor outcome. Immunomodulatory drugs play a key role in both the front-line and the relapsed/refractory setting. The combination of pomalidomide (POM) and dexamethasone is safe and effective in relapsed and refractory patients, even in those with high-risk cytogenetic features. Furthermore, it can be used in most patients without the need to adjust according to the degree of renal failure. In order to further