Multiple Myeloma

Multiple myeloma, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies.[5] Often, no symptoms are noticed initially.[1] When advanced, bone pain, bleeding, frequent infections, and anemia may occur.[1] Complications may include amyloidosis.[2]

The cause is unknown.[3] Risk factors include obesity, radiation exposure, family history, and certain chemicals.[4] [9][10] The underlying mechanism involves abnormal plasma cells producing abnormal antibodies which can cause kidney problems and overly thick blood.[1] The plasma cells can also form a mass in the bone marrow or soft tissue.[1] When only one mass is present, it is known as a plasmacytoma, while more than one is known as multiple myeloma.[1] Multiple myeloma is diagnosed based on blood or urine tests finding abnormal antibodies, bone marrow biopsy finding cancerous plasma cells, and medical imaging finding bone lesions.[5] Another common finding is high blood calcium levels.[5]

Multiple myeloma is considered treatable, but generally incurable.[2] Remissions may be brought about with steroids, chemotherapy, targeted therapy, and stem cell transplant.[2] Bisphosphonates and radiation therapy are sometimes used to reduce pain from bone lesions.[2][5]

Globally, multiple myeloma affected 488,000 people and resulted in 101,100 deaths in 2015.[7][8] In the United States, it develops in 6.5 per 100,000 people per year and 0.7% of people are affected at some point in their lives.[6] It usually occurs around the age of 61 and is more common in men than women.[5] It is uncommon before the age of 40.[5] Without treatment, typical survival is seven months.[2] With current treatments, survival is usually 4–5 years.[2] This gives a five-year survival rate around 49%.[6] The word myeloma is from the Greek myelo- meaning “marrow” and -oma meaning “tumor”.[11]

References

  1. ^ Jump up to:
    a b c d e f g “Plasma Cell Neoplasms (Including Multiple Myeloma)—Patient Version”. NCI. Archived from the original on 27 July 2016. Retrieved 8 August 2016.
  2. ^ Jump up to:
    a b c d e f g h i “Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version”. NCI. July 29, 2016. Archived from the original on 4 July 2016. Retrieved 8 August 2016.
  3. ^ Jump up to:
    a b c World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.13. ISBN 9283204298.
  4. ^ Jump up to:
    a b World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 2.3 and 2.6. ISBN 9283204298.
  5. ^ Jump up to:
    a b c d e f g h Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC (July 2009). “Multiple myeloma”. Lancet. 374 (9686): 324–39. doi:10.1016/S0140-6736(09)60221-X. PMID 19541364.
  6. ^ Jump up to:
    a b c d e “SEER Stat Fact Sheets: Myeloma”. NCI Surveillance, Epidemiology, and End Results Program. Archived from the original on 27 July 2016. Retrieved 8 August 2016.
  7. ^ Jump up to:
    a b c GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). “Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015″. Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  8. ^ Jump up to:
    a b c GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). “Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015″. Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  9. ^ “Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment”. National Cancer Institute. Retrieved 28 November 2017.
  10. ^ Ferri, Fred F. (2013). Ferri’s Clinical Advisor 2014 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 726. ISBN 0323084311.
  11. ^ Diepenbrock, Nancy H. (2011). Quick Reference to Critical Care. Lippincott Williams & Wilkins. p. 292. ISBN 9781608314645. Archived from the original on 2016-08-21.

Memo. 2018;11(1):59-64. doi: 10.1007/s12254-018-0383-3. Epub 2018 Feb 21.

Short overview on the current standard of treatment in newly diagnosed multiple myeloma.

Willenbacher E1, Balog A2, Willenbacher W1,3.

Author information

Abstract

The treatment of newly diagnosed multiple myeloma has changed dramatically over the past 20 years, from near uniform application of chemotherapy to a patient performance status- and risk-based approach. Furthermore, initiation of treatment criteria have evolved from a pure end-organ damage-based definition to include risk factors of transformation to frank myeloma. Besides, the mainly cytogenetically defined Multiple Myeloma (MM) risk status, transplant eligibility of patients still serves primarily to allocate patients within a rational treatment algorithm. While all transplant-eligible MM patients should receive a triplet induction therapy followed by autologous transplantation and, in most cases, lenalidomide maintenance, other therapeutic elements (e. g., other maintenance strategies, consolidation, tandem transplantation,..) have to be decided on an individualized appraisal of risk and toxicities. Standard-risk patients should never be undertreated, as they derive the highest relative benefit from using the best available registered therapies. However, high-risk patients should be preferentially treated inside clinical trials testing additive innovative treatments, as the improvement in the prognosis of this group of patients by standard therapies has been underwhelming. Furthermore, the evaluation process of non-transplant-eligible patients should always comprise an evaluation of performance status, frailty, and comorbidities (e. g., a comprehensive geriatric assessment) to facilitate the allocation of individualized therapies.

Expert Rev Hematol. 2018 Oct 19. doi: 10.1080/17474086.2018.1538777. [Epub ahead of print]

Triplet therapies – the new standard of care for multiple myeloma: how to manage common toxicities.

Paner A1, Okwuosa TM2, Richardson KJ1, Libby EN3.

Author information

Abstract

Multiple three drug combination regimens have been approved for the treatment of multiple myeloma in the last few years. Triplets have become the new standard of care for transplant eligible and ineligible patients with newly diagnosed as well as relapsed multiple myeloma. Novel agents have a unique profile of side effects. The management of toxicities is important to maintain quality of life and maximize treatment duration and benefit. Areas covered: This article reviews efficacy data, incidence of key adverse events and provide recommendations and expert opinion regarding how to manage common toxicities in triplet therapies. Relevant publications and abstracts were searched in PubMed, ASH, ASCO and EHA meetings. Guidelines from IMWG, NCCN, ESMO and ASCO, published trial protocols and prescribing information were used to formulate recommendations for the management of toxicities. Expert Commentary: Side effects are a critical factor guiding the selection of optimal chemotherapy regimens for multiple myeloma. The majority of toxicities encountered with triplet therapies are reversible and can be readily managed with supportive care and dose modifications.

Multiple Myeloma clinical trials at UC Davis
7 research studies open to new patients

  • A Multicenter Access and Distribution Protocol for Unlicensed Cryopreserved Cord Blood Units (CBUs)

    “Assessing new blood cells growth after transplant using cord blood units that do not meet FDA guidelines but meet NMDP guidelines”

    open to all eligible people

    This study is an access and distribution protocol for unlicensed cryopreserved cord blood units (CBUs) in pediatric and adult patients with hematologic malignancies and other indications.

    Sacramento, California and other locations

  • A Study of the Safety and Pharmacokinetics (movement through the body) of Experimental Medicine ABBV-075 For Advanced Solid Tumors

    open to eligible people ages 18 years and up

    This is a Phase 1, first-in-human, dose escalation study in participants with advanced solid tumors to determine the pharmacokinetics, maximum tolerated dose and the recommended Phase 2 dose of ABBV-075 at different monotherapy dosing schedules. In…

    Sacramento, California and other locations

  • Collection of Tissue Samples for Cancer Research

    “Collection of samples (cancerous tissue, normal tissue, blood) and related medical information for use in cancer research”

    open to eligible people ages up to 110 years

    Background: -Patients who are being evaluated and/or treated at the NIH Clinical Center (pediatric and adult) and adult patients at participating sites will be entered onto this tissue procurement protocol for collection of tissue specimens.…

    Iowa City, Iowa and other locations

  • Experimental combination medicine in treatment of newly diagnosed Multiple Myeloma

    “Study of experimental combination bortezomib, lenalidomide, and dexamethasone in Treating Patients With Newly Diagnosed Multiple Myeloma”

    open to eligible people ages 18 years and up

    This randomized phase III trial studies bortezomib, lenalidomide, and dexamethasone to see how well they work compared to carfilzomib, lenalidomide, and dexamethasone in treating patients with newly diagnosed multiple myeloma. Bortezomib and…

    Sacramento, California and other locations

  • Experimental medicine Ixazomib with Pomalidomide, Clarithromycin and Dexamethasone in Treating Patients With Multiple Myeloma

    “Study looking at experimental combination of drugs to treat multiple myeloma”

    open to eligible people ages 18 years and up

    This phase I/II trial studies the side effects and best dose of clarithromycin when given together with ixazomib citrate, pomalidomide, and dexamethasone and to see how well it works in treating patients with multiple myeloma that has not responded…

    Sacramento, California and other locations

  • First in-Human Trial of the Experimental Drug AMG 176 in Relapsed or Refractory (re-occurring) Cancer of the Blood Systems

    “This study will look at which doses of the study drug AMG 176 are safe for people to take.”

    open to eligible people ages 18-85

    At least one dose level of AMG 176 will achieve acceptable safety and tolerability in subjects with relapsed or refractory multiple myeloma and subjects with relapsed or refractory acute myeloid leukemia

    Sacramento, California and other locations

  • Targeted therapy directed by genetic testing in treating patients with advanced solid tumors, lymphomas, or multiple myeloma

    “Will identifying genetic abnormalities in tumor cells help doctors plan better, more personalized treatment for cancer patients?”

    open to eligible people ages 18 years and up

    This phase II MATCH trial studies how well treatment that is directed by genetic testing works in patients with solid tumors or lymphomas that have progressed following at least one line of standard treatment or for which no agreed upon treatment…

    Sacramento, California and other locations

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