Multiple myeloma causes, risk factors, and prevention. Promising new agents for multiple myeloma drug development for this type of bone marrow cancer has been gaining momentum, with two new proteasome inhibitor approvals in the last year alone and a number of new treatments in latestage pipeline. Diagnosed with myeloma in 2001, maddie runners celebrate in front of philadelphias hunter says events like please touch museum. We report a case of multiple myeloma that developed in a male patient after 28 years of fulfilling a diagnosis of scleroderma. Ixazomib citrate, lenalidomide, dexamethasone, and. Multiple myeloma is a cancer that develops in the bone marrow, the spongy tissue found in the center of most bones. Clinicians need to be aware of the range of factors involved in managing the treatment and supportive care of patients with multiple myeloma.
Insight update on multiple myeloma the european hematology association is hosting its conference in stockholm, sweden this week, so watch for updates from on the myeloma crowd site. Multiple myeloma is a hematologic malignancy characterized by the clonal proliferation of plasma cells in the bone marrow and, usually, the presence of a monoclonal ig in the blood andor urine. Multiple myeloma accounts for approximately 10% of hematologic malignancies. Multiple myeloma mm is a debilitating malignancy that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance mgus to plasma cell leukemia. International myeloma foundation headquarters 12650 riverside drive, suite 206 north hollywood, ca 91607, usa tel. The patient was positive for cgs 343 mgl, reference range 060 mgl. It became clear that there was a need to conduct collaborative research and produce consensus guidelines for the myeloma. For decades the diagnosis of multiple myeloma required the presence of endorgan damage. Article pdf available in asian pacific journal of cancer prevention. International myeloma working group research collaboration.
Mutation of nras but not kras significantly reduces myeloma. It is characterised by a clonal population of bone marrow plasma cells which secrete a monoclonal. December 710, 20 new orleans, louisiana updates in multiple myeloma cco independent conference coverage of the 20 annual. This is a comprehensive, stateoftheart guide to the diagnosis, treatment, and biology of multiple myeloma and related plasma disorders. The risk of developing multiple myeloma goes up as people get older.
In 2014, the international myeloma working group imwg expanded the definition of mm to include a category of myeloma defining biomarkers. Mgus m protein myeloma defining events smoldering myeloma m protein. Healthy plasma cells help fight off infection by producing antibodies, molecules that fight against viruses. A risk factor is anything that changes a persons chance of getting a disease such as cancer. The food and drug administration fda has approved three new drugs for the treatment of multiple myeloma that has returned after prior therapy.
The bone marrow produces red blood cells, which carry oxygen throughout the body. One of the drugs is the first approved cancer therapy to target the cd38 protein pictured. Clonal heterogeneity and mrd testing in multiple myeloma. Minimal residual disease in multiple myeloma multiple myeloma pathophysiology and epidemiology multiple myeloma mm is a plasma cell malignancy in which abnormal, clonal plasma cells proliferate and accumulate within the bone marrow. International myeloma working group updated criteria for. Trends in overall survival and costs of multiple myeloma. Circulating rna may provide prognostic tool for multiple myeloma 7 december 2014 the molecular mail sent by multiple myeloma cells provides clues to how well patients with the. Cassiopeia is the first study showing the clinical benefit of daratumumab plus standard of care in transplanteligible patients with newly diagnosed multiple myeloma. It arises from red marrow due to the monoclonal proliferation of plasma cells and manifests in a wide range of radiographic abnormalities. Daratumumab, lenalidomide, and dexamethasone for multiple. Circulating rna may provide prognostic tool for multiple myeloma.
Multiple myeloma medstar franklin square medical center. The multiple myeloma research foundation and gns healthcare. Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Lenalidomide and dexamethasone in myeloma n engl j med 371. Call your doctor at once if you have chest pain, pounding heartbeats, shortness of breath even with mild exertion or while lying down, swelling of your hands or feet, feeling like you might pass out, wheezing, gasping for breath, cough with foamy mucus, or blue colored appearance of your lips and skin. Methods asco and cancer care ontario convened an expert panel.
Minimal residual disease mrd has emerged as one of the most relevant prognostic factors in mm and should be included in a new definition of complete response cr. Multiple myeloma is a disease in which a neoplastic proliferation of plasma cells produces a monoclonal immunoglobulin. These updated esmo clinical practice guidelines cover the diagnosis and pathologymolecular biology, staging and risk assessment and response evaluation of multiple myeloma. The fda recently approved three new drugs to treat multiple myeloma. Ascites as the presenting symptom of multiple myeloma in a. Aim the danish national multiple myeloma registry dmmr is a populationbased clinical quality database established in january 2005. Edited and written by a multidisciplinary group of recognized authorities from the mayo clinic, it presents clear guidelines on diagnosis and therapy and covers all aspects of multiple myeloma.
While increased production of monoclonal immunoglobulins is to be expected in patients who have this disease, unusually high concentrations of serum immunoglobulins can result in multiple laboratory interferences, including the prozone effect. In 2015, an estimated 28,850 new cases of multiple myeloma. Multiple myeloma mm is one of the most common hematological malignancies. How we approach smoldering multiple myeloma journal of. Myeloma, also called multiple myeloma, is a cancer of the plasma cells. Multiple myeloma is seldom cured, although treatment can relieve symptoms, induce remission, and prolong life. Response criteria for multiple myeloma, revised table based on the new criteria by international myeloma working group. Guidelines for serum free light chain analysis in multiple myeloma and related disorders 2009 these guidelines discuss published data that provides evidence for the utility and application of sflc. Little realworld evidence is available to describe the recent trends in treatment costs and outcomes for patients with multiple myeloma mm.
International myeloma working group updated criteria for the ncbi. Smoking is a risk factor for lung cancer and many other cancers. Plasma cells help you fight infections by making antibodies that recognize and attack germs. If thrombocytopenia is a side effect of anti myeloma. Risk factors for multiple myeloma american cancer society. Multiple myeloma mm is an aggressive malignant neoplasm of plasma cells that accumulates in the. Dec 07, 2014 the molecular mail sent by multiple myeloma cells provides clues to how well patients with the disease are likely to respond to treatment, according to a study being presented at the annual.
Imwg criteria for the diagnosis of mm inl myeloma fn. It became clear that there was a need to conduct collaborative research and produce consensus guidelines for the myeloma community. As treatment begins to bring your myeloma under control, your bone marrow is often able to recover and will start producing normal amounts of platelets and other blood cells. Several reports have demonstrated associations between scleroderma and cancer and between multiple myeloma and autoimmune diseases. The first consensus guideline was published in 2003 and the first annual brainstorming summit was organized in barcelona in 2010. The high dose chemotherapy treats the multiple myeloma. Myelomarelated kidney disease genitourinary disorders. Comparison of bortezomib, cyclophosphamide, and dexamethasone. In germany there are around 6500 new cases of multiple myeloma each year and it is the third most commonly occurring disease of the blood after leukemia and nonhodgkin lymphoma. Lenalidomide and dexamethasone in transplantineligible. When cancerous plasma cells build up in the bones and bone marrow the spongy center of bones where blood is made, they crowd the healthy. Imwg criteria for the diagnosis of myeloma and guidelines for.
Developing an effective treatment strategy for refractoryrelapsed rr mm represents a major challenge. Findings raised the possibility of multiple myeloma. Nccn clinical practice guidelines in oncology nccn. A relatively small randomized prospective study has shown benefit. A series of special tests are performed to find a donor who is a match for you. Panobinostat for treating multiple myeloma in people who have received at least one prior therapy id663. Despite enormous advances, management of multiple myeloma mm remains challenging. Purpose to provide evidencebased recommendations on the treatment of multiple myeloma to practicing physicians and others. International myeloma working group imwg criteria for the diagnosis of multiple myeloma. One update is being presented from takeda oncology on their insight study to better understand how myeloma treatments are being administered in the clinic. Few papers have also reported the concurrence of scleroderma and multiple myeloma.
For example, exposing skin to strong sunlight is a. Although the tumor cells remain primarily within the bone marrow, they can cause a number of complications, including localized bone destruction, anemia, decreased immunity to infection, and kidney damage. Multiple myeloma accounts for around 1% of all cancers worldwide and 1015% of all hematological neoplasms. Imwg criteria for the diagnosis of myeloma and guidelines for the diagnostic workup of myeloma criteria for a diagnosis of myeloma followed by the examinations, tests, and imaging studies that are recommended by the working group for the diagnosis of myeloma and related organ dysfunction. Management of relapsed and refractory multiple myeloma. Gender men are slightly more likely to develop multiple myeloma than women. It is almost invariably preceded by premalignant stages of monoclonal gammopathy of undetermined significance mgus and smoldering mm smm, although not all cases of mgus will eventually progress to mm. In germany there are around 6500 new cases of multiple myeloma. The international myeloma working group imwg emerged from the imfs scientific advisory board which was established in 1995. Prognostic value of expression of cd45 and cd49d in newly. The diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end.
Snowden4, john ashcroft5, kwee yong6, gordon cook7, sylvia. Most people diagnosed with this cancer are at least 65 years old. Updated diagnostic criteria and staging system for multiple myeloma. Patients with multiple myeloma overproduce monoclonal ig light chains bence jones proteins. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Multiple myeloma is a rare cancer characterized by a proliferation of malignant plasma cells. Clonal heterogeneity and mrd testing in multiple myeloma june 24, 2016 sham mailankody, mbbs assistant attending physician myeloma service, memorial sloankettering cancer center new york.
Insight update on multiple myeloma the myeloma crowd. Jan 06, 2017 ixazomib citrate, lenalidomide, dexamethasone, and daratumumab in treating patients with newly diagnosed multiple myeloma the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. International myeloma working group updated criteria for the diagnosis of multiple myeloma. It is important for clinicians to discuss practical patient examples and the rationale for the various treatment choices based on expert experience and recent data from trials to aid the decisionmaking process for clinicians treating patients with myeloma. Drug for multiple myeloma demonstrated to significantly. Theses recommendations are excerpted from palumbo a et. An allogeneic transplant uses donor bone marrow or stem cells to replace the cells destroyed by the cancer treatment. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Increased incidence has been reported in people exposed to radiation. Minimal residual disease assessment in multiple myeloma by. Institut universitaire du cancer toulouse, france mrd metaanalysis in myeloma nikhil munshi, md lipper myeloma. International myeloma working group imwg updated the diagnostic criteria for mm to add three specific biomarkers that can be used to diagnose. Multiple myeloma accounts for 1% of all cancers and approximately 10% of all haematological malignancies. A clinical case study published in the november issue of clinical chemistry involving a patient with multiple myeloma ends with an unexpected finding.
Mutation of nras but not kras significantly reduces myeloma sensitivity to singleagent bortezomib therapy. Therefore, the patient was diagnosed with multiple myeloma and began treatment with melphalan, prednisone and bortezomib. The primary aim of the database is to ensure that diagnosis. Mm is the second most common haematological cancer after lymphoma. Multiple factors impact the decision to treat or which regimen to use at mm. Phase 12 study of daratumumab, lenalidomide, and dexamethasone for relapsed multiple myeloma. Natural killer nk cell therapy for multiple myeloma patients. The correlation between antiphospholipid syndrome and.
Multiple myeloma is a monoclonal gammopathy and is the most common primary malignant bone neoplasm in adults. The updated criteria for the diagnosis of myeloma represent a paradigm shift in the approach to myeloma and have considerable impact on the management of the disease. The multiple myeloma research foundation mmrf was established in 1998 as a 501c3 nonprofit organization by twin sisters karen andrews and kathy giusti, soon after kathys diagnosis with. It is almost invariably preceded by premalignant stages of. Initial results from a large, randomized clinical trial for patients with multiple myeloma, a cancer of the blood and bone marrow, showed that patients who received the oral drug lenalidomide revlimid, also known as cc50 following a blood stem cell transplant had their cancer kept in check longer than patients who received a placebo. Multiple myeloma mm, also known as symptomatic plasma cell myeloma, is a plasma cell malignancy. Romiplostim in increasing low platelet counts in patients. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Exploratory trial of a biepitopic car ttargeting b cell. In 2015, an estimated 28,850 new cases of multiple myeloma were. Multiple myeloma is the malignant counterpart of longlived plasma cells with a strong tropism for bone and bone marrow. Six out of 10 patients 60% and ten out of 12 patients 83% treated by bd and vcd regimen, respectively, underwent subsequent asct. Using the truven health marketscan research databases. Treatment guidelines for newly diagnosed multiple myeloma.
The danish national multiple myeloma registry clep. Multiple myeloma treatment centers nebraska medicine omaha, ne. Three new therapies approved for multiple myeloma national. Multiple myeloma mm is a cancer of the plasma cells in the bone marrow bm. About 10% to 20% of patients with newly diagnosed myeloma will not have any symptoms. International myeloma working group guidelines wikilite. Genetic factors and viral infection may also influence the risk of developing multiple myeloma. Panobinostat for treating multiple myeloma after at least 2.
It stands for the national comprehensive cancer network, a nonprofit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Less than 1% of cases are diagnosed in people younger than 35. Sep 12, 2017 while the outcomes of patients diagnosed with multiple myeloma have significantly improved, there continues to be a need for new therapeutic approaches. As maddie says, im living a great life, and i have myeloma. As is the case with many other cancers, there has been great interest in the possibility of harnessing the power of the immune system to attack the myeloma cells. Not only is nebraska medicine a leader in multiple myeloma, but our doctors are constantly evaluating and updating the guidelines for myeloma care and treatment. Thrombocytopenia as a complication of the myeloma itself normally begins to improve with anti myeloma treatment. In this trial, 17 rr mm patients, who had previously experienced multiple. Building 6800 cork airport business park kinsale road, cork t12 cdf7 email contact us here tel. Multiple myeloma is a cancer that develops in plasma cells, a type of white blood cell. Exposure to radiation, organic chemicals such as benzene, herbicides, and insecticides may play a role. Prognostic value of 1p deletion for multiple myeloma.
Three patients received twice weekly vcd alone, while nine patients received twice weekly vcd followed by once weekly vcd. The cause of mm is unknown, risk factors include age, radiation, agricultural exposures and familial risk. A 40yearold male known to be a hepatitis c hcv carrier was diagnosed with systemic lupus erythematosus sle in 1999. Dvtd before and after autologous stemcell transplantation improved depth of response and progressionfree survival with acceptable safety.
1129 287 165 1446 1404 848 53 991 104 990 1470 1397 25 1030 665 1267 868 420 100 1535 1150 1346 7 1003 1321 243 833 729 1066 428 1223 448 1195 295 883 232 1320 363 1176 141 248 795 579 106 961 1070