462 research outputs found
Steps towards a multiple myeloma cure?
No full textMultiple myeloma survival has increased in last 20 years because of new treatments, better clinical management due to novel diagnostic tools such as imaging, and better understanding of the disease, biologically and genetically. Novel drugs have been introduced that act with different therapeutic mechanisms, but so have novel therapeutic strategies such as consolidation and maintenance after autologous stem cell transplant. Imaging (such as PET-CT and MRI) has been applied at diagnosis and after therapy for minimal residual disease monitoring. Multiparametric flow and molecular NGS may detect, with high-sensitivity, residual monoclonal plasma cells in the bone marrow. With this novel therapeutic and biological approach, a considerable fraction of multiple myeloma patients can achieve durable remission or even MGUS-like regression, which can ultimately lead to disease disappearance. The big dogma, “Myeloma is an incurable disease”, is hopefully fading
Cutaneous myeloma and bortezumib
No full textWe read with great interest the recent paper by Siniscalchi et al. [1] in which they described a 69-year-old woman with a cutaneous relapse of multiple myeloma (MM) after six cycles of MPT regimen (melphalan, prednisone, and thalidomide) and thalidomide maintenance therapy. They reported a complete response after four cycles of bortezomib (B) and dexamethasone, suggesting a possible employment in cutaneous plasmacytomas
Lenalidomide maintenance in myeloma
No full textWe strongly agree with Rajkumar
(Haematological cancer: Lenalidomide
maintenance—perils of a premature
denouement. Nat. Rev. Clin. Oncol. 9,
372–374; 2012)1 that it is premature to
recommend lenalidomide maintenance
to all patients with myeloma, but we would
also like to underline other aspects of
the problem not discussed in the recent
commentary article.
It is our assertion that not every patient
with myeloma needs maintenance therapy.
In addition to considering the risk–benefit
ratio for a patient during maintenance
therapy, we are convinced that the wellknown
concept of disease plateau—which
was established decades before the novelagent
era in myeloma2—is also applicable
in the setting of maintenance ther apy.
Furthermore, a small percentage of patients
(15%, but this could improve with novel
agents used in the pre- transplant setting)
after autologous stem-cell transplantation
(ASCT) achieve disease-free survival or
progression-free survival of longer than
10 years.3 For those patients, any maintenance
therapy is useless or, even worse,
harmful
Tp53 disruptions: Is there a marker of poor prognosis in chronic lymphoproliferative disorders?
No full textHyperlipidemia in a myeloma patient after bortezomib treatment
No full textWe read with great interest the article by Gotoh et al. [1], inwhich they reported about a multiple myeloma patient refractory to VAD therapy who developed hyperlipidemia (total cholesterol, TC, 388 mg/dl and triglycerides, TG, 411 mg/dl) and multiple lipoma after two courses of Bortezomib, dexamethasone. We would like to share some experience and raise few questions about it
The role of tumor-associated macrophages in hematologic malignancies
No full textThe tumor microenvironment includes dendritic cells, T-cytotoxic, T-helper, reactive B-lymphoid cells and macrophages; these reactive cells could interplay with malignant cells and promote tumor growth and survival. Among its cellular components, tumor-associated macrophages (TAM) represent a component of the innate immune system and play an important role, especially in hematologic malignancies. Depending on the stimuli that trigger their activation, TAM are polarized towards form M1, contributing to antitumor responses, or M2, associated with tumor progression. Many studies demonstrated a correlation between TAM, disease progression and the patient’s outcome in lymphoproliferative neoplasms, such as Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), even if with conflicting results. A critical hurdle to overcome is surely represented by the heterogeneity in the choice of the optimal markers and methods used for TAM analysis (gene-expression profile vs. immunohistochemistry, CD163vs. CD68vs. CD163/CD68 double-positive cells). TAM have been recently linked to the development and progression of multiple myeloma and leukemia, with a critical role in the homing of malignant cells, drug resistance, immune suppression and angiogenesis. As such, this review will summarize the role of TAM in different hematologic malignancies, focusing on the complex interplay between TAM and tumor cells, the prognostic value of TAM and the possible TAM-targeted therapeutic strategies
Maintenance Therapy in Multiple Myeloma: Novel Concepts in Clinical Practice from Recent Clinical Trials
No full textThe introduction of novel drugs in multiple myeloma therapy has changed disease survivals in last 15 years. Besides to be more effective in this disease new agents have been utilized in novel strategies such as consolidation and maintenance therapy. Lenalidomide has been one of the favourite in clinical trials because of its oral administration, and bortezomib has been utilized too after the drug has been proved to be effective subcutaneously. Advances in the understanding of disease biology and genetics could give a risk stratification to identify those patients who can benefit more and to better drive maintenance therapy in the future
Minimal residual disease in multiple myeloma: an important tool in clinical trials
No full text: Minimal residual disease (MRD) detection represents a great advancement in multiple myeloma. New drugs are now available that increase depth of response. The International Myeloma Working Group recommends the use of next-generation flow cytometry (NGF) or next-generation sequencing (NGS) to search for MRD in clinical trials. Best sensitivity thresholds have to be confirmed, as well as timing to detect it. MRD has proven as the best prognosticator in many trials and promises to enter also in clinical practice to guide future therapy. © 2022 Bentham Science Publishers
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