Multiple Myeloma: Defining the High-risk Patient and Determining the Optimal Treatment Strategy

Overview

Journal Curr Hematol Malig Rep

Publisher Current Science

Specialties Hematology
Oncology

Date 2013 Oct 26

PMID 24158405

Citations 3

Authors

Jordan Schecter

Suzanne Lentzsch

Affiliations

Soon will be listed here.

Abstract

Multiple Myeloma (MM) is the second most common hematologic malignancy, with approximately 21,000 new diagnoses each year. The prognosis for MM is variable and depends on several factors. This chapter highlights the clinical and pathological features of multiple myeloma to help define the "high-risk" patient. The authors also review clinical trial data in an effort to delineate the optimal treatment strategy for this group of patients. While more research in this field is needed, the available evidence supports the use of bortezomib as induction therapy and maintenance for high-risk patients with multiple myeloma.

Citing Articles

Predicting cytogenetic risk in multiple myeloma using conventional whole-body MRI, spinal dynamic contrast-enhanced MRI, and spinal diffusion-weighted imaging.

Den Berghe T, Verberckmoes B, Kint N, Wallaert S, De Vos N, Algoet C Insights Imaging. 2024; 15(1):106.

PMID: 38597979 PMC: 11006637. DOI: 10.1186/s13244-024-01672-1.

Nontargeted and targeted metabolomics approaches reveal the key amino acid alterations involved in multiple myeloma.

Yue L, Zeng P, Li Y, Chai Y, Wu C, Gao B PeerJ. 2022; 10:e12918.

PMID: 35186493 PMC: 8840056. DOI: 10.7717/peerj.12918.

Coexistent hyperdiploidy does not abrogate poor prognosis in myeloma with adverse cytogenetics and may precede IGH translocations.

Pawlyn C, Melchor L, Murison A, Wardell C, Brioli A, Boyle E Blood. 2014; 125(5):831-40.

PMID: 25428216 PMC: 4327151. DOI: 10.1182/blood-2014-07-584268.

References

Lloveras E, Sole F, Florensa L, Besses C, Espinet B, Gil M . Contribution of cytogenetics and in situ hybridization to the study of monoclonal gammopathies of undetermined significance. Cancer Genet Cytogenet. 2002; 132(1):25-9. DOI: 10.1016/s0165-4608(01)00511-8. View

Kyle R, Gertz M, Witzig T, Lust J, Lacy M, Dispenzieri A . Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003; 78(1):21-33. DOI: 10.4065/78.1.21. View

Kumar S, Rajkumar S, Dispenzieri A, Lacy M, Hayman S, Buadi F . Improved survival in multiple myeloma and the impact of novel therapies. Blood. 2007; 111(5):2516-20. PMC: 2254544. DOI: 10.1182/blood-2007-10-116129. View

Depil S, Leleu X, Micol J, Berthon C, Lai J, Bauters F . Abnormal cytogenetics and significant bone marrow plasmacytosis are predictive of early progression and short survival in patients with low tumor mass asymptomatic multiple myeloma. Leuk Lymphoma. 2004; 45(12):2481-4. DOI: 10.1080/10428190412331283224. View

Zhan F, Huang Y, Colla S, Stewart J, Hanamura I, Gupta S . The molecular classification of multiple myeloma. Blood. 2006; 108(6):2020-8. PMC: 1895543. DOI: 10.1182/blood-2005-11-013458. View

Reece D, Song K, Fu T, Roland B, Chang H, Horsman D . Influence of cytogenetics in patients with relapsed or refractory multiple myeloma treated with lenalidomide plus dexamethasone: adverse effect of deletion 17p13. Blood. 2009; 114(3):522-5. DOI: 10.1182/blood-2008-12-193458. View

Barlogie B, Pineda-Roman M, van Rhee F, Haessler J, Anaissie E, Hollmig K . Thalidomide arm of Total Therapy 2 improves complete remission duration and survival in myeloma patients with metaphase cytogenetic abnormalities. Blood. 2008; 112(8):3115-21. PMC: 2569166. DOI: 10.1182/blood-2008-03-145235. View

Mateos M, Gutierrez N, Martin-Ramos M, Paiva B, Montalban M, Oriol A . Outcome according to cytogenetic abnormalities and DNA ploidy in myeloma patients receiving short induction with weekly bortezomib followed by maintenance. Blood. 2011; 118(17):4547-53. DOI: 10.1182/blood-2011-04-345801. View

Desikan R, Barlogie B, Sawyer J, Ayers D, Tricot G, Badros A . Results of high-dose therapy for 1000 patients with multiple myeloma: durable complete remissions and superior survival in the absence of chromosome 13 abnormalities. Blood. 2000; 95(12):4008-10. View

10.

Greipp P, San Miguel J, Durie B, Crowley J, Barlogie B, Blade J . International staging system for multiple myeloma. J Clin Oncol. 2005; 23(15):3412-20. DOI: 10.1200/JCO.2005.04.242. View

11.

Fritz E, Ludwig H, Kundi M . Prognostic relevance of cellular morphology in multiple myeloma. Blood. 1984; 63(5):1072-9. View

12.

Siegel D, Martin T, Wang M, Vij R, Jakubowiak A, Lonial S . A phase 2 study of single-agent carfilzomib (PX-171-003-A1) in patients with relapsed and refractory multiple myeloma. Blood. 2012; 120(14):2817-25. PMC: 4123387. DOI: 10.1182/blood-2012-05-425934. View

13.

Greipp P, Katzmann J, OFallon W, Kyle R . Value of beta 2-microglobulin level and plasma cell labeling indices as prognostic factors in patients with newly diagnosed myeloma. Blood. 1988; 72(1):219-23. View

14.

Avet-Loiseau H, Attal M, Campion L, Caillot D, Hulin C, Marit G . Long-term analysis of the IFM 99 trials for myeloma: cytogenetic abnormalities [t(4;14), del(17p), 1q gains] play a major role in defining long-term survival. J Clin Oncol. 2012; 30(16):1949-52. DOI: 10.1200/JCO.2011.36.5726. View

15.

Barlogie B, Anaissie E, van Rhee F, Haessler J, Hollmig K, Pineda-Roman M . Incorporating bortezomib into upfront treatment for multiple myeloma: early results of total therapy 3. Br J Haematol. 2007; 138(2):176-85. DOI: 10.1111/j.1365-2141.2007.06639.x. View

16.

Neben K, Lokhorst H, Jauch A, Bertsch U, Hielscher T, van der Holt B . Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. Blood. 2011; 119(4):940-8. DOI: 10.1182/blood-2011-09-379164. View

17.

Avet-Loiseau H, Leleu X, Roussel M, Moreau P, Guerin-Charbonnel C, Caillot D . Bortezomib plus dexamethasone induction improves outcome of patients with t(4;14) myeloma but not outcome of patients with del(17p). J Clin Oncol. 2010; 28(30):4630-4. DOI: 10.1200/JCO.2010.28.3945. View

18.

San Miguel J, Schlag R, Khuageva N, Dimopoulos M, Shpilberg O, Kropff M . Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008; 359(9):906-17. DOI: 10.1056/NEJMoa0801479. View

19.

Egan J, Shi C, Tembe W, Christoforides A, Kurdoglu A, Sinari S . Whole-genome sequencing of multiple myeloma from diagnosis to plasma cell leukemia reveals genomic initiating events, evolution, and clonal tides. Blood. 2012; 120(5):1060-6. PMC: 3412329. DOI: 10.1182/blood-2012-01-405977. View

20.

Barlogie B, Tricot G, Anaissie E, Shaughnessy J, Rasmussen E, van Rhee F . Thalidomide and hematopoietic-cell transplantation for multiple myeloma. N Engl J Med. 2006; 354(10):1021-30. DOI: 10.1056/NEJMoa053583. View