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smouldering myeloma

Kenneth C Anderson
There has been great progress in the management and patient outcome in multiple myeloma due to the use of novel agents including immunomodulatory drugs and proteasome inhibitors; nonetheless, novel agents remain an urgent need. The three promising Achilles heals or vulnerabilities to be targetted in novel therapies include: protein degradation by the ubiquitin proteasome or aggresome pathways; restoring autologous antimyeloma immunity; and targeting aberrant biology resulting from constitutive and ongoing DNA damage in tumour cells...
2016: Cancer Treatment and Research
Sanjay de Mel, Yunxin Chen, Sathish Kumar Gopalakrishnan, Melissa Ooi, Constance Teo, Daryl Tan, Min Li Claire Teo, Allison Cy Tso, Lian King Lee, Chandramouli Nagarajan, Yeow Tee Goh, Wee Joo Chng
Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM...
September 9, 2016: Singapore Medical Journal
Salomon Manier, Karma Z Salem, Jihye Park, Dan A Landau, Gad Getz, Irene M Ghobrial
Multiple myeloma (MM) is a genetically complex disease that evolves from pre-malignant stages, such as monoclonal gammaopathy of undetermined significance and smouldering multiple myeloma, and progresses to symptomatic MM; this continuum provides a unique framework to study the sequential genomic evolution of MM. In the past 5 years, results from large-scale whole-exome sequencing studies have provided new insights into the clonal heterogeneity and evolution of the disease. Moreover, the recurrent co-occurrence of genomic events helps to dissect the genomic complexity underlying tumour progression...
August 17, 2016: Nature Reviews. Clinical Oncology
A Schattner, F Nissim, A Berrebi
A 56-year-old patient was found to have smouldering myeloma which remained asymptomatic and untreated for 13 years. Localised osteolytic lesions then appeared, which responded to local irradiation. Six years later, an increased serum M-protein became evident (IgG$LD, 3 gr/dl) associated with 35% plasma cells in the bone marrow, which necessitated melphalan/prednisone therapy. A prolonged complete remission was achieved lasting 6 years. Thereafter, the patient developed a myelodysplastic syndrome with leukopenia and refractory anemia and he finally died of pulmonary disease...
1991: Leukemia & Lymphoma
María-Victoria Mateos, Miguel-Teodoro Hernández, Pilar Giraldo, Javier de la Rubia, Felipe de Arriba, Lucía López Corral, Laura Rosiñol, Bruno Paiva, Luis Palomera, Joan Bargay, Albert Oriol, Felipe Prosper, Javier López, José-María Arguiñano, Nuria Quintana, José-Luis García, Joan Bladé, Juan-José Lahuerta, Jesús-F San Miguel
BACKGROUND: The standard of care for smouldering multiple myeloma is observation. We did the QuiRedex study to compare early treatment with lenalidomide plus dexamethasone with observation in patients with high-risk smouldering multiple myeloma. Here we report the long-term follow-up results of the trial. METHODS: We did this open-label, randomised, controlled phase 3 study at 19 centres in Spain and three centres in Portugal. Patients aged 18 years or older with high-risk smouldering multiple myeloma were randomly assigned (1:1), via a computerised random number generator, to receive either early treatment with lenalidomide plus dexamethasone or observation, with dynamic balancing to maintain treatment balance within the two groups...
August 2016: Lancet Oncology
Heinz Ludwig
No abstract text is available yet for this article.
August 2016: Lancet Oncology
William Ian Deighan, Maurice O'Kane, Feargal G McNicholl, David F Keren
Multiple Myeloma (MM) is a malignant plasma cell dyscrasia that is becoming more prevalent in an increasingly ageing population. It is a complex disease with clinical phases ranging from the pre-malignant monoclonal gammopathy of undetermined significance (MGUS) to asymptomatic (smouldering) myeloma and then symptomatic myeloma; the latter occasionally terminating in the clonal proliferation of plasma cells outside the bone marrow. We present a patient whose clonally evolved disease from MGUS to MM demonstrated the presence of an unusual combination of monoclonalimmunoproteins...
May 10, 2016: Annals of Clinical Biochemistry
Julie C Dutoit, Koenraad L Verstraete
Magnetic resonance imaging (MRI) is increasingly being used in the diagnostic work-up of patients with multiple myeloma. Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on MRI are considered having symptomatic myeloma requiring treatment, regardless of the presence of lytic bone lesions. However, bone marrow evaluation with MRI offers more than only morphological information regarding the detection of focal lesions in patients with MM...
August 2016: Insights Into Imaging
Neha Korde, Yong Zhang, Kelsey Loeliger, Andrea Poon, Olga Simakova, Adriana Zingone, Rene Costello, Richard Childs, Pierre Noel, Samuel Silver, Mary Kwok, Clifton Mo, Neal Young, Ola Landgren, Elaine Sloand, Irina Maric
Pure red cell aplasia (PRCA) is a rare disorder characterized by inhibition of erythroid precursors in the bone marrow and normochromic, normocytic anaemia with reticulocytopenia. Among 51 PRCA patients, we identified 12 (24%) patients having monoclonal gammopathy, monoclonal gammopathy of undetermined significance or smouldering multiple myeloma, with presence of monoclonal protein or abnormal serum free light chains and atypical bone marrow features of clonal plasmacytosis, hypercellularity and fibrosis. Thus far, three patients treated with anti-myeloma based therapeutics have responded with reticulocyte recovery and clinical transfusion independence, suggesting plasma cells play a key role in the pathogenesis of this specific monoclonal gammopathy-associated PRCA...
June 2016: British Journal of Haematology
Jens Hillengass, Judith Ritsch, Maximilian Merz, Barbara Wagner, Christina Kunz, Thomas Hielscher, Hendrik Laue, Tobias Bäuerle, Christian M Zechmann, Anthony D Ho, Heinz-Peter Schlemmer, Hartmut Goldschmidt, Thomas M Moehler, Stefan Delorme
This prospective study aimed to investigate the prognostic significance of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) as a non-invasive imaging technique delivering the quantitative parameters amplitude A (reflecting blood volume) and exchange rate constant kep (reflecting vascular permeability) in patients with asymptomatic monoclonal plasma cell diseases. We analysed DCE-MRI parameters in 33 healthy controls and 148 patients with monoclonal gammopathy of undetermined significance (MGUS) or smouldering multiple myeloma (SMM) according to the 2003 IMWG guidelines...
July 2016: British Journal of Haematology
Lee Smith, Orla McCourt, Malgorzata Henrich, Bruce Paton, Kwee Yong, Jane Wardle, Abigail Fisher
OBJECTIVES: Multiple myeloma is the second most common haematological cancer. A growing body of literature is emerging that investigates the role physical activity plays in all stages of multiple myeloma (prevention and survivorship) and to date no attempt has been made to collate and understand this literature. Therefore, this scoping review aims to (1) outline what is already known about physical activity in all stages of multiple myeloma (2) map the literature on physical activity and multiple myeloma and (3) identify future directions for research...
2015: BMJ Open
Karuna Luthra, Abhay Bhave, R D Lele
UNLABELLED: A variety of diagnostic tools including biochemistry, radiological imaging bone marrow studies and recently metabolic imaging with FDG PET are used for assessment of disease extent in myeloma. AIM: To evaluate the role of metabolic imaging with Tc99m Sestamibi (Mibi) SPECT-CT in Multiple myeloma. MATERIALS AND METHODS: Patients in various stages of Myeloma were scanned after 20mCi Tc99m Sestamibi was injected i/v. Whole body planar scans were obtained with a dual head gamma camera and SPECT-CT imaging was done...
September 2014: Journal of the Association of Physicians of India
Guy Pratt, Stella Bowcock, Andrew Chantry, Gordon Cook, Graham Jackson, Maggie Lai, Eric Low, Nicola Mulholland, Roger Owen, Neil Rabin, Karthik Ramasamy, John A Snowden, Matthew Streetly, Ashutosh Wechalekar, Kwee Yong, Jenny Bird
In November 2014 the International Myeloma Working Group (IMWG) revised the definition of multiple myeloma, such that asymptomatic patients with newly diagnosed multiple myeloma without any of the traditional 'CRAB' (hypercalcaemia, renal impairment, anaemia, bone disease) end organ damage criteria but with one of three new criteria would be recommended to start treatment. Previously, the standard of care for such patients was expectant management. These three new criteria are: greater than 60% clonal plasma cells on bone marrow biopsy, a serum free light chain (sFLC) ratio of >100 (the involved sFLC must be >100 mg/l) and greater than one unequivocal focal lesion on advanced imaging (low dose whole body computerized tomography, magnetic resonance imaging, (18) F fluorodeoxyglucose positron emission tomography)...
October 2015: British Journal of Haematology
J Wight, A Stillwell, E Morris, B Grant, H C Lai, I Irving
BACKGROUND: Magnetic resonance imaging (MRI) is the most sensitive method for detecting focal spinal disease (FSD) in multiple myeloma (MM). It is unclear whether whole spine MRI (WS-MRI) should be employed as a screening test at diagnosis of MM. AIM: To determine the utility of screening WS-MRI at diagnosis of MM. METHODS: A retrospective analysis of data from January 2008 to January 2013 at the Townsville Hospital was performed. At this centre, WS-MRI is used routinely in all newly diagnosed MM...
July 2015: Internal Medicine Journal
Christoph Röllig, Stefan Knop, Martin Bornhäuser
Multiple myeloma is a malignant disease characterised by proliferation of clonal plasma cells in the bone marrow and typically accompanied by the secretion of monoclonal immunoglobulins that are detectable in the serum or urine. Increased understanding of the microenvironmental interactions between malignant plasma cells and the bone marrow niche, and their role in disease progression and acquisition of therapy resistance, has helped the development of novel therapeutic drugs for use in combination with cytostatic therapy...
May 30, 2015: Lancet
Robert A Kyle, Dirk R Larson, Terry M Therneau, Angela Dispenzieri, L Joseph Melton, Joanne T Benson, Shaji Kumar, S Vincent Rajkumar
BACKGROUND: Bence Jones proteinuria is a disorder that is defined by the excretion of monoclonal light-chain protein. About 15-20% of patients with multiple myeloma secrete monoclonal light chains only, without expression of the normal immunoglobulin heavy chain, which constitutes light-chain multiple myeloma. The definition, prevalence, and progression of these premalignant phases of light-chain multiple myeloma have not been fully characterised. We aimed to identify a subset of patients with idiopathic Bence Jones proteinuria who had a high risk of progression to light-chain multiple myeloma analogous to that seen in patients with smouldering multiple myeloma...
October 1, 2014: Lancet Haematology
Elisa Buti, Egrina Dervishi, Giulia Ghiandai, Anduela Mjeshtri, Nunzia Paudice, Alessandro Terreni, Anna Caldini, Chiara Nozzoli, Enrico Eugenio Minetti, Franco Bergesio
We report our experience with five patients, with dialysis dependent AKI and multiple myeloma (MM). Two of them were already suffering from a mild degree of renal insufficiency, one was on follow-up for smouldering MM and two had a relapse of symptomatic MM. Median concentration of the involved FLC (iFLC) was 15104 mg/L (range 1196-24384). All patients underwent three times per week HCO-HD for 6 hour sessions using Theralite 2100 (median 10, range 6-13 sessions) with one having further twelve sessions of 4 hours using SUPRA device (Bellco)...
November 2014: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
S Vincent Rajkumar, Meletios A Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar, Jens Hillengass, Efstathios Kastritis, Paul Richardson, Ola Landgren, Bruno Paiva, Angela Dispenzieri, Brendan Weiss, Xavier LeLeu, Sonja Zweegman, Sagar Lonial, Laura Rosinol, Elena Zamagni, Sundar Jagannath, Orhan Sezer, Sigurdur Y Kristinsson, Jo Caers, Saad Z Usmani, Juan José Lahuerta, Hans Erik Johnsen, Meral Beksac, Michele Cavo, Hartmut Goldschmidt, Evangelos Terpos, Robert A Kyle, Kenneth C Anderson, Brian G M Durie, Jesus F San Miguel
This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients...
November 2014: Lancet Oncology
J Hillengass, J Stoll, C M Zechmann, C Kunz, B Wagner, C Heiss, M Sumkauskaite, T M Moehler, H P Schlemmer, H Goldschmidt, S Delorme
OBJECTIVES: The current analysis investigated the prognostic significance of gadopentetate dimeglumine on survival and renal function in patients with monoclonal plasma cell disorders. METHODS: In this study 263 patients who had received gadopentetate dimeglumine within a prospective trial investigating dynamic contrast-enhanced magnetic resonance imaging (MRI) were compared with 335 patients who had undergone routine, unenhanced MRI. RESULTS: We found no significant prognostic impact of the application of contrast agent on progression-free survival in patients with either monoclonal gammopathy of undetermined significance, smouldering or symptomatic myeloma and no significant prognostic impact on overall survival in patients with symptomatic myeloma...
March 2015: European Radiology
Julie C Dutoit, Matthias A Vanderkerken, Joris Anthonissen, Frederick Dochy, Koenraad L Verstraete
OBJECTIVES: To evaluate DWI of the bone marrow in the differentiation of monoclonal gammopathy of undetermined significance (MGUS), smouldering myeloma (SMM) and multiple myeloma (MM). METHODS: The retrospective study includes 64 patients with MGUS, 27 with SMM, 64 with new MM and 12 controls. Signal intensity (SI) of spinal SE-MRI and DWI (b0-1000) as well as apparent diffusion coefficients (ADC) were measured in the T10 and L3. Qualitative assessment of b-images was performed by one experienced radiologist...
November 2014: European Radiology
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