International Myeloma Working Group recommendations for global myeloma care

Ludwig, Heinz; Miguel, Jesús San; Dimopoulos, Meletios Α.; Palumbo, Antônio; García‐Sanz, Ramón; Powles, R; Lentzsch, Suzanne; Chen, W Ming; Hou, Jian; Jurczyszyn, Artur; Romeril, Kenneth; Hájek, Roman; Terpos, Evangelos; Shimizu, Kazuyuki; Joshua, Douglas; Hungria, Vânia; Morales, A Rodriguez; Ben‐Yehuda, Dina; Sondergeld, Pia; Zamagni, Elena; Durie, Brian G.M.

doi:10.1038/leu.2013.293

Cited by 177 publications

(148 citation statements)

References 103 publications

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“…Because of the variabilities involved in measuring the β migrating IgA M-spikes when using relatively low resolution gel techniques, Katzmann et al do not measure symmetric IgA β M-spikes smaller than 20 g/L (2.0 g/dL) [52]. Recognizing these issues, the 2014 IMWG guidelines recommend measurement of total IgA rather than the M-protein spike to follow patients with β-migrating IgA M-proteins [53].…”

Section: Detection and Measurement Of M-proteins In Serum By Protein mentioning

confidence: 99%

Challenges of measuring monoclonal proteins in serum

Keren

Schroeder

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The measurement of monoclonal protein (M-protein) is vital for stratifying risk and following individuals with a variety of monoclonal gammopathies. Direct measurement of the M-protein spike by electrophoresis and immunochemical measurements of specific isotypes or free light chains pairs has provided useful information about the quantity of M-protein. Nonetheless, both traditional electrophoresis and immunochemical methods give poor quantification with M-proteins smaller than 10 g/L (1 g/dL) when in the presence of polyclonal immunoglobulins that co-migrate with the M-protein. In addition, measurements by electrophoresis of M-proteins migrating in the β-and α-regions are contaminated by normal serum proteins in those regions. The most precise electrophoretic method to date for quantification involves exclusion of the polyclonal immunoglobulins by using the tangent skimming method on electropherograms, which provides a 10-fold improvement in precision. So far, however, tangent measurements are limited to γ migrating M-proteins. Another way to improve M-protein measurements is the use of capillary electrophoresis (CE). With CE, one can employ immunosubtraction to select a region of interest in the β region thereby excluding much of the normal proteins from the M-protein measurement. Recent development of an immunochemical method distinguishing heavy/light chain pairs (separately measuring IgGK and IgGL, IgAK and IgAL, and IgMK and IgML) provides measurements that could exclude polyclonal contaminants of the same heavy chain with the uninvolved light chain type. Yet, even heavy/light results contain an immeasurable quantity of polyclonal heavy/ light chains of the involved isotype. Finally, use of liquid chromatography-tandem mass spectrometry (LC-MS/MS) looms on the horizon as a means to provide more consistent and sensitive measurements of M-proteins.

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Section: Detection and Measurement Of M-proteins In Serum By Protein mentioning

confidence: 99%

Challenges of measuring monoclonal proteins in serum

Keren

Schroeder

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Management recommendations were taken from available guidelines, such as those developed by the International Myeloma Working Group [3][4][5] , the European Myeloma Network 6 , the NCCN 1,7 , the British Committee for Standards in Hematology/United Kingdom Myeloma Forum 8 , from…”

Section: Methodsmentioning

confidence: 99%

“…Multiple myeloma shows a wide range of tumor-related co-morbidities 4,9 and the majority of patients receive a number of anti-myeloma drugs and medication to ameliorate tumor-associated or other comorbidities. Thus, it is impossible to clearly attribute a specific side effect to an individual drug.…”

Section: Incidence Of Adverse Eventsmentioning

confidence: 99%

“…Patients with one patient specific risk factor for thromboembolism should receive thromboprophylaxis with aspirin at a dose of 81 to 325 mg, 1,4,8,46 while those with two patient specific or one treatment specific risk factors should be treated either with low molecular weight heparins (LMWH) or warfarin, for at least the first 5 months after start of anti-myeloma therapy (Table 2). 1,4,8,[10][11][12][13][14][15]46 However, there is currently no robust evidence on the optimal duration of thromboprophylaxis, especially in active uncontrolled disease as well as in lenalidomide maintenance therapy. Concomitant administration of erythropoietic agents or other drugs known to increase the risk of thrombosis, such as hormone replacement therapy, should be used with caution.…”

Section: Thromboembolic Complicationsmentioning

confidence: 99%

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Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network

Ludwig

Delforge²,

Facon

et al. 2017

Leukemia

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During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drugs classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.

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“…In these elderly patients, novel agents have undoubtedly revolutionized the treatment paradigm and replaced the former standard melphalan-prednisone (MP) regimen. A sequential approach consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy with novel agents, induces profound cytoreduction and delays relapse [2,3]. Thalidomide is an orally administered immunomodulatory drug, and its role as maintenance after melphalan-prednisone-thalidomide (MPT) induction was evaluated in four trials in elderly patients with MM [4][5][6][7].…”

mentioning

confidence: 99%

Multiple myeloma: is a shift toward continuous therapy needed to move forward?

Guglielmelli¹,

Palumbo²

2015

Expert Review of Hematology

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Multiple myeloma (MM) accounts for 1% of all cancers and 13% of all hematologic malignancies. Melphalan-prednisone plus melphalan-prednisone-thalidomide or melphalan-prednisone-bortezomib are considered the standards of care for newly diagnosed, transplant-ineligible patients with MM (older than 65 years). In newly diagnosed, transplant-eligible patients with MM (younger than 65 years), a novel agent-based induction followed by high-dose therapy and autologous stem cell transplantation, is the standard approach. The availability of novel agents has considerably increased the treatment options of this disease, but almost all patients relapse after achieving a maximal response to first-line therapy. New drugs and new treatment approaches are urgently needed to improve outcome in MM patients Continuous therapy can be a valid option to keep the patient symptom-free and to prolong progression-free survival and overall survival.Almost two-thirds of newly diagnosed patients with multiple myeloma (MM) are older than 65 years of age and ineligible for transplantation [1]. In these elderly patients, novel agents have undoubtedly revolutionized the treatment paradigm and replaced the former standard melphalan-prednisone (MP) regimen. A sequential approach consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy with novel agents, induces profound cytoreduction and delays relapse [2,3]. Thalidomide is an orally administered immunomodulatory drug, and its role as maintenance after melphalan-prednisone-thalidomide (MPT) induction was evaluated in four trials in elderly patients with MM [4][5][6][7]. Two studies evidenced an advantage in terms of progression-free survival (PFS) for patients who received thalidomide maintenance versus those who did not [4,5], whereas a marginally statistically significant overall survival (OS) advantage favoring thalidomide maintenance was detected in one study [5]. Yet, the major concern associated with thalidomide continuous therapy (CT) is neurological toxicity, which reached 46% in the MPT trials, and thus makes thalidomide not an optimal option for maintenance [8]. CT with the proteasome inhibitor bortezomib was evaluated in two trials [9,10]. In one study, bortezomib plus either thalidomide (VT) or prednisone (VP) was given after induction with either bortezomib-melphalanprednisone (VMP) or bortezomib-thalidomide-prednisone, but no statistically significant PFS and OS advantage of one option over the other was detected [9]. In an Italian trial, VT maintenance after VMP-thalidomide (VMPT) was compared with VMP without maintenance. The median PFS was significantly longer with VMPT-VT than with VMP (35.3 vs 24.8 months; p < 0.001) and the 5-year OS was also greater with VMPT-VT (61 vs 51%, p = 0.01). Toxicity was acceptable with grade 3-4 sensory neuropathy reported in 8% of patients receiving VMPT-VT and in 5% of patients receiving VMP [10] Editorial drug lenalidomide was shown to be more effective than its parent dru...

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International Myeloma Working Group recommendations for global myeloma care

Cited by 177 publications

References 103 publications

Challenges of measuring monoclonal proteins in serum

Challenges of measuring monoclonal proteins in serum

Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network

Multiple myeloma: is a shift toward continuous therapy needed to move forward?

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