1,721,193 research outputs found
Steps towards a multiple myeloma cure?
Full text linkMultiple 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
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
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
Fluorescence in situ hybridization: uses and limitations
No full textThe development of molecular hybridization techniques such as fluorescence in situ hybridization (FISH) has had a major Impact on efforts to detect and characterize the genetic changes that give rise to human tumors. With probes designed to Identify specific chromosomes and chromosomal regions, FISH is used routinely by cytogenetics and pathology laboratories to identify recurring chromosomal abnormalities associated with hematologic malignant diseases. In many cases FISH analysis provides increased sensitivity, in that cytogenetic abnormalities have been found In samples that appeared to be normal by morphologic and conventional cytogenetic examination. The combination of cytogenetic, FISH, and molecular analyses provides a powerful approach for diagnosing and subclassifying malignant diseases into clinically and biologically relevant subgroups, In selecting appropriate therapy, and in monitoring the efficacy of therapeutic regimens
Tp53 disruptions: Is there a marker of poor prognosis in chronic lymphoproliferative disorders?
Full text linkOral low-dose fludarabine and cyclophosphamide with rituximab as initial treatment for elderly patients with chronic lymphoproliferative disorders.
No full textThe role of tumor-associated macrophages in hematologic malignancies
Full text linkThe 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
“Friends and foes” of multiple myeloma measurable/minimal residual disease evaluation by next generation flow
Full text linkNext Generation Flow (NGF) represents a gold standard for the evaluation of Minimal Residual Disease (MRD) in Multiple Myeloma (MM) patients at any stage of treatment. Although the assessment of MRD is still not universally employed in clinical practice, numerous studies have demonstrated the strength of MRD as a reliable predictor of long-term outcome, and its potential to supersede the prognostic value of CR. The possibility to acquire millions of events, in combination with the use of standard reagents and a good expertise in the analysis of rare populations, led to high chance of success and a sensitivity of 10-6 that is superimposable to the one of Next Generation Sequencing molecular techniques. Some minor bias, correlated to the protocols applied, to the quality of samples and to the high heterogeneity of plasma cells phenotype, may be overcome using standard protocols and having at disposition personnel expertise for MRD analysis. With the use of NGF we can today enter a new phase of the quantification of residual disease, switching from the definition of “minimal” residual disease to “measurable” residual disease. This review takes account of the principle “friends and foes” of Myeloma “Measurable” Residual Disease evaluation by NGF, to give insights into the potentiality of this technique. The optimization of the quality of BM samples and the analytic expertise that permits to discriminate properly the rare pathologic clones, are the keys for obtaining results with a high clinical value that could be of great impact and relevance in the future
- …
