Feasibility and Efficacy of Local Radiotherapy With Concurrent Novel Agents in Patients With Multiple Myeloma

Shin, S.; Chouake, Robert J.; Sanfilippo, Nicholas J; Rapp, Timothy; Cook, Perry; Formenti, Silvia C.; Mazumder, Amitabha; Silverman, Joshua

doi:10.1016/j.clml.2014.07.010

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…Some concerns regarding depletion of the bone marrow reserve after concurrent chemotherapy and radiotherapy exist. A smaller study, including 39 patients with myeloma receiving radiotherapy alone or radiotherapy with concurrent novel agents-based chemotherapy, concluded that concurrent treatment with radiotherapy and systemic treatment was safe regarding hematologic toxicity and was well tolerated in the majority of patients (87.5%) [101].…”

Section: Radiotherapymentioning

confidence: 99%

Multiple Myeloma Associated Bone Disease

Rasch

Lund

Asmussen

et al. 2020

Cancers

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The lytic bone disease is a hallmark of multiple myeloma, being present in about 80% of patients with newly diagnosed MM, and in more during the disease course. The myeloma associated bone disease (MBD) severely affects the morbidity and quality of life of the patients. MBD defines treatment demanding MM. In recent years, knowledge of the underlying pathophysiology has increased, and novel imaging technologies, medical and non-pharmaceutical treatments have improved. In this review, we highlight the major achievements in understanding, diagnosing and treating MBD. For diagnosing MBD, low-dose whole-body CT is now recommended over conventional skeletal survey, but also more advanced functional imaging modalities, such as diffusion-weighted MRI and PET/CT are increasingly important in the assessment and monitoring of MBD. Bisphosphonates have, for many years, played a key role in management of MBD, but denosumab is now an alternative to bisphosphonates, especially in patients with renal impairment. Radiotherapy is used for uncontrolled pain, for impeding fractures and in treatment of impeding or symptomatic spinal cord compression. Cement augmentation has been shown to reduce pain from vertebral compression fractures. Cautious exercise programs are safe and feasible and may have the potential to improve the status of patients with MM.

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Section: Radiotherapymentioning

confidence: 99%

Multiple Myeloma Associated Bone Disease

Rasch

Lund

Asmussen

et al. 2020

Cancers

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“…Additionally, medical oncologists may more comfortably continue systemic therapy during LDRT for low-risk disease sites, thereby avoiding treatment breaks, given reports of the safety of concurrent therapy. 14 , 15 Indeed, 18% of patients receiving LDRT received concurrent systemic therapy. Even if the pain response duration were shorter with LDRT than HDRT, LDRT could potentially spare a subset of patients from a higher total RT dose.…”

Section: Discussionmentioning

confidence: 99%

Effective Pain Control With Very Low Dose Palliative Radiation Therapy for Patients With Multiple Myeloma With Uncomplicated Osseous Lesions

Price

Niedzwiecki

Oyekunle

et al. 2021

Advances in Radiation Oncology

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Background: Osteolytic lesions are present in 75% of patients with multiple myeloma (MM) and frequently require palliation with radiation therapy (RT). Prior case series of patients with MM with bone pain undergoing palliative RT suggests doses ≥12 Gy (equivalent dose in 2Gy fractions, EQD2) provide excellent bone pain relief. However, recent advances in care and novel biologic agents have significantly improved overall survival and quality of life for patients with MM. We hypothesized that lower-dose RT (LDRT, EQD2 <12 Gy) offers an effective alternative to higher-dose RT (HDRT, EQD2 ≥12 Gy) for palliation of painful, uncomplicated MM bone lesions. Methods: We retrospectively identified patients with MM treated with RT for uncomplicated, painful bone lesions and stratified by EQD2 ≥/< 12 Gy. Clinical pain response (CPR) rates, acute and late toxicity, pain response duration, and retreatment rates between LDRT and HDRT groups were analyzed. Results: Thirty-five patients with 70 treated lesions were included: 24 patients (48 lesions) treated with HDRT and 11 patients (22 lesions) with LDRT. Median follow-up was 14 and 16.89 months for HDRT and LDRT, respectively. The median dose of HDRT treatment was 20 Gy versus 4 Gy in the LDRT group. The CPR rate was 98% for HDRT and 95% for LDRT. There was no significant difference in any-grade acute toxicity between the HDRT and LDRT cohorts (24.5% vs 9.1%, X 2 P = .20). Pain recurred in 10% of lesions (12% HDRT vs 9.5% LDRT). Median duration of pain response did not significantly differ between cohorts (P = .91). Five lesions were retreated, 2 (9.5%) in the LDRT cohort, and 3 (6.3%) in the HDRT cohort. Conclusion: In this study, LDRT effectively palliated painful, uncomplicated MM bony lesions with acceptable CPR and duration of palliation. These data support prospective comparisons of LDRT versus HDRT for palliation of painful, uncomplicated MM bony lesions.

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“…Die Wirkstoffklassen der Proteasominhibitoren und Immunmodulatoren stellen meist die Eckpfeiler der Myelomtherapie dar [36]. Die bisher publizierten Daten mehrerer Phase-I-Studien und kleinerer Auswertungen zeigen, dass die Kombination von Systemtherapien (Chemotherapien, Proteasominhibitoren oder anderer neuerer Agenzien) mit einer Strahlentherapie ohne Toxizitätssteigerung einhergeht und gut toleriert wird [37][38][39][40]. Eine Studie konnte sogar ein verbessertes serologisches Ansprechen unter der Kombinationstherapie aufweisen [40].…”

Section: Kombinationstherapieunclassified

“…Die bisher publizierten Daten mehrerer Phase-I-Studien und kleinerer Auswertungen zeigen, dass die Kombination von Systemtherapien (Chemotherapien, Proteasominhibitoren oder anderer neuerer Agenzien) mit einer Strahlentherapie ohne Toxizitätssteigerung einhergeht und gut toleriert wird [37][38][39][40]. Eine Studie konnte sogar ein verbessertes serologisches Ansprechen unter der Kombinationstherapie aufweisen [40]. Dennoch wird aufgrund vereinzelter Fallberichte einer vermehrten gastrointestinalen Toxizität unter Kombination von Bortezomib mit einer Radiotherapie empfohlen, bei größeren Bestrahlungsvolumina im Bereich des Abdomens zurückhaltend zu sein [41,42].…”

Section: Kombinationstherapieunclassified

Nutzen der Radioonkologie beim solitären Plasmozytom oder multiplen Myelom

König

Herfarth

2021

Radiologe

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QR-Code scannen & Beitrag online lesen Zusammenfassung Hintergrund: Die Therapie des solitären Plasmozytoms (SP) und multiplen Myeloms (MM) setzt eine enge Zusammenarbeit unterschiedlicher medizinischer Disziplinen voraus. Dieser Artikel befasst sich mit dem Stellenwert der Strahlentherapie beim MM und SP. Ziel: Überblick über lokale radioonkologische Therapien beim SP und MM. Material und Methoden: Es erfolgte eine systematische Literaturrecherche und Zusammenfassung der aktuellen Datenlage zum Thema. Ergebnisse: Eine kurativ dosierte Radiatio mit oder ohne Operation stellt die Primärtherapie des SP dar. Dosiskonzepte variieren je nach Risikofaktoren (v. a. Größe) und Art des Befalls (extramedullär vs. medullär). Trotz hoher lokaler Kontrollraten persistiert ein relevantes Risiko für den Übergang in ein MM. Beim Vorliegen eines MM findet die Radiotherapie (RT) v. a. im Rahmen der Palliation ihr Anwendungsgebiet. Insbesondere bei stabilitätsgefährdeten oder schmerzhaften Osteolysen sowie bei Myelonkompression kann mittels lokaler Radiotherapie ein gutes Ergebnis bei geringer Toxizität erreicht werden. Auch hier sollte die Dosierung und Fraktionierung solch einer Radiotherapie insbesondere vom primären Therapieziel und Allgemeinzustand des Patienten abhängig gemacht werden. Schlussfolgerung: Trotz primär systemtherapeutischer Therapieansätze benötigen ca. 40 % aller Patienten mit MM eine Strahlentherapie im Krankheitsverlauf, welche dann meist mit palliativen Therapiezielen gute Ergebnisse erreichen kann. Beim SP hingegen stellt die Radiotherapie die primäre und kurativ-intendierte Therapieoption dar.

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Feasibility and Efficacy of Local Radiotherapy With Concurrent Novel Agents in Patients With Multiple Myeloma

Cited by 15 publications

References 31 publications

Multiple Myeloma Associated Bone Disease

Multiple Myeloma Associated Bone Disease

Effective Pain Control With Very Low Dose Palliative Radiation Therapy for Patients With Multiple Myeloma With Uncomplicated Osseous Lesions

Nutzen der Radioonkologie beim solitären Plasmozytom oder multiplen Myelom

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