Background:Bone lytic lesion in Multiple myeloma are the most commonly presented symptoms which require treatment with bisphosphonates (BPs). BPs are providing supportive care, reducing the rate of skeletal morbidity but evidently not abolishing it, the criteria for stopping their administration have to be different from those used for classic antineoplastic drugs, and they should not be stopped when metastatic bone disease is progressing. Osteonecrosis of the jaw (ONJ) has been associated recently with the use of BPs.Aim:The aim of these study is to evaluate the incidence of ONJ in patients with MM treated with mixed biphosphonates.Patients and methods:We analyzed total 296 myeloma patients (150 male and 146 female). Mostly effected age group with 58,1% is age more than 60 years up to 88 years, diagnosed in our institution in the period 2005-2015. We used intravenous or oral forms of biphosphonates such as pamidronate, ibandronate, clodronate and zolendronic acid. The patients were evaluated for ONJ.Results:The incidence of ONJ in our group of patients treated with Bps was 4,6% from our group of 260 patients 87,8% received BPs therapy and patients which haven’t received BPs 12,2%. From this group, 95,4% (248) didn’t show ONJ, and 4,6% (12) showed ONJ. The period of this treatment with BPs is an important risk factor for development of ONJ, average duration of BPs therapy in patients which show adverse effects is 26.8±13.7 months, from the total number of 12 patients that developed ONJ adverse effects, we have 8 patients which received treatment with Zolendronic acid and the remaining 4 patients which were treated with other BPs combinations without Zolendronic acid.Conclusions:All patients treated for MM must continue with the therapy with Zolendronic acid and Pamidronate, each patient must be individually treated according to his response of the treatment (dose, frequency and duration of therapy).
Treatment of multiple myeloma has undergone profound changes in the past years thanks to the increased understanding of the biology of the disease and the new treatment options. New drugs and effective approaches are currently available for the treatment of multiple myeloma, including immunomodulatory agents, proteasome inhibitors and autologous stem cell transplantation. Areas covered: We have described the recent updated criteria to start treatment in multiple myeloma and summarized clinical data from major studies including most recent agents. Particularly, results with pomalidomide, carfilzomib, ixazomib, monoclonal antibodies such as elotuzumab, daratumumab, and checkpoint inhibitors have been reported. Both transplant and non-transplant settings have been covered. Expert commentary: Despite the successful improvement in overall survival and time to relapse, multiple myeloma still remains incurable. Therefore, there is still an unmet need for new treatment strategies with novel mechanisms of action, like monoclonal antibodies, novel immunomodulators, and novel proteasome inhibitors. Implementation of these novel drugs in rationally designed therapies with a good balance of efficacy and safety should be carefully considered in order to improve outcome.
a lower risk of RT than patients treated in second or further lines of treatment (p value < 0.023). This was not significant in patients with p53 disruption. Patients with RT had a higher number of previous treatments (2.1), compared with patients without RT (0.6). The difference was also significant (p 0.013) in our main cohort, but we did not found significant differences in the p53 disrupted population. Summary/Conclusion: In our cohort, p53 disruption has the main biological impact in the RT, as it is described in several studies. We observed also that patient treated with chemoimmunotherapy before BCR or BCL-2 inhibitor had a higher risk of RT than naïve patients as it is described in recent publications. We also found that patients treated with idelalisib had an increased risk of RT compared to those patients treated with BCR inhibitors.
Introduction. Acute myeloid leukemia (AML) represents an entity well defined among the hematological malignnant diseases from diagnostic and therapeutic point of view. Still, big concern remains for those patients where the induction therapy fails. Classified in the group of refractory AML these patients are with poor prognosis. There are numerous attempts in providing the best surviving results by administration of appropriate therapy. Our center presents its experience in treating patients with refractory AML by administration of FLAG-Ida regimen, followed by hematopoietic stem cell transplanttation, autologous or allogeneic, depending on the availability of HLA matched sibling donor of hematopoietic stem cells. Methods. In patients with refractory AML, administering FLAG-Ida chemotherapy we have achieved complete remission in 22 patients (47%). Average age of the treated group of patients was 36.6 years (17-53). All of them proceeded to high-dose chemotherapy and underwent hematopoietic stem cell transplantation (HSCT). We performed autologous HSCT in 13 patients, and allogeneic HSCT in 9 patients. Median time to HSCT was 6.6 months (4-10), and in most of the patients we used myeloablative conditioning (MAC). Results. The disease-free survival in our group of patients is 74 months (22-148). The longest overall survival was 148 months and was registered in a patient with allogeneic sibling HSCT. We can conclude that FLAG-Ida regimen is an appropriate and suitable salvage chemotherapy protocol for patients with refractory AML especially when it is used in the context of preparation for HSCT.
Acute promyelocytic leukemia (APL) is a subtype of acute leukemia (AL) with distinct cytogenetics, clinical and biological characteristics. APL was considered as one of the most rapidly lethal forms of acute myeloblastic leukemia (AML), but recently, with the introduction of all-trans retinoic acid (ATRA) it has become the most curable subtype of AL. The main difficulty with APL is early death (ED), defined as death because of any cause within 30 days after diagnosis, and it has emerged as the most important cause of treatment failure. Our retrospective-prospective study was realized at the University Clinic for Hematology from January 2004 until December 2020. It included 46 patients with APL, according to FAB and WHO classification with confirmed molecular diagnosis. The following patients’ risk stratification factors were analyzed: age, Sanz risk score, WBC, PL, clinical presentation of the disease, levels of fibrinogen and D-dimers. During the study period, APL was diagnosed in 46 patients, 24 females (52.2%) and 22 males (47.8%), with mean age of 45 years. The overall survival showed that 24 patients (52.1%) were alive and 22 (47.8%) had lethal outcome. Regarding treatment, five patients (10.9%) died before starting the chemo-treatment. But, still, ED was observed in 13 patients (59%), and in 9 patients (40.9%) death occurred 30 days after establishing the diagnosis. The main reasons of mortality were also analyzed. To prevent ED prior to treatment, suspected APL patients should be immediately hospitalized and treated as medical emergency. Keywords: acute promyelocytic leukemia, early death, all-trans retinoic acid
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