Predictors of inferior clinical outcome in patients with standard‐risk multiple myeloma

Badar, Talha; Srour, Samer A.; Bashir, Qaiser; Shah, Nina; Alatrash, Gheath; Hosing, Chitra; Popat, Uday; Nieto, Yago; Orłowski, Robert Z.; Champlin, Richard E.; Qazilbash, Muzaffar H.

doi:10.1111/ejh.12826

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…Even in the era of monoclonal antibodies and proteasome inhibitors, the prognosis in MM with extramedullary disease still remains poor (12,13). In a retrospective study assessing elotuzumab-based regimens for the treatment of extramedullary MM, progression-free survival and overall survival were short (3.8 and 12.9 months, respectively) (14).…”

Section: Discussionmentioning

confidence: 99%

Daratumumab‑resistant multiple myeloma with extramedullary disease successfully treated with combination elotuzumab, pomalidomide and dexamethasone: A case report

Sakashita,

Sahara,

Aoki

et al. 2024

Oncol Lett

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Despite the emergence of monoclonal antibodies, the prognosis of patients with multiple myeloma (MM) with extramedullary disease remains poor. The present report describes a rare case of daratumumab-refractory MM that was successfully treated with elotuzumab, pomalidomide and dexamethasone. A 66-year-old male patient diagnosed with MM was treated with bortezomib, lenalidomide and dexamethasone, followed by high-dose chemotherapy and autologous stem cell transplantation. Thereafter, the patient was treated with lenalidomide and dexamethasone as maintenance therapy. This was changed to daratumumab, bortezomib and dexamethasone when new paraskeletal lesions were identified, resulting in marked tumor shrinkage. After 15 months, an increase in serum monoclonal protein levels, development of a skeletal lesion in the right second rib and extramedullary disease of the right thoracic mediastinal lymph nodes were noted. Treatment with elotuzumab, pomalidomide and dexamethasone (EPd) resulted in expeditious symptomatic improvement and regression of the lesions. Notably, during daratumumab, bortezomib and dexamethasone treatment, lymphocyte counts gradually increased to a level at which elotuzumab was sufficiently effective. EPd might be a promising strategy for the treatment of patients with relapsed extramedullary MM while on daratumumab treatment.

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Section: Discussionmentioning

confidence: 99%

Daratumumab‑resistant multiple myeloma with extramedullary disease successfully treated with combination elotuzumab, pomalidomide and dexamethasone: A case report

Sakashita,

Sahara,

Aoki

et al. 2024

Oncol Lett

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“…Lack of any signi cant differences in progression-free survival based on inpatient outpatient transplantation status suggests that this parameter has no impact on the actual underlying biology of the multiple myeloma and that time to progression is driven by traditionally recognized parameters such as of age sex, and stage. [1] The discrepancy between PFS and OS suggest a continued impact of lack of caregiver beyond transplant. Patient's hospitalized for transplantation for lack of caregiver may have a shorter survival based on related factors such as lack of subsequent transportation for chemotherapy intensive regimens and they may of necessity receive oral based chemotherapy treatments that reduces the number of visits required for therapy compared to parenterally administered medications which often require twice weekly administration.…”

Section: Discussionmentioning

confidence: 99%

Lack of a caregiver is associated with shorter survival in myeloma patients undergoing autologous stem cell transplantation

Gertz

Warsame

Muchtar

et al. 2022

Leukemia & Lymphoma

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Introduction: There is evidence that lack of a social network is a link to inferior outcomes in cancer patients. Mayo clinic performs all its stem cell transplants for multiple myeloma patients as an outpatient. This requires a full-time chaperone or caregiver for the duration of the transplant. Patients who do not have a caregiver are hospitalized for the duration of the transplant. In this study we compared outcomes between patients hospitalized for the entire transplant and those who have a caregiver and are initially managed as an outpatient.Materials and methods: All patients with multiple myeloma transplanted at the Mayo Clinic in Rochester Minnesota between 1/1/2000 and 12/31/2019 were included for analysis. Patient had to have been transplanted within 12 months of the original diagnosis. The de nition of inpatient transplantation was hospitalization prior to day 0 of transplantation for conditioning and continued hospitalization until evidence of neutrophil engraftment occurred.Results: There were 41 patients who were considered inpatient transplants and 2103 that were outpatient transplants. The patients were well balanced for age, sex, serum creatinine, and international stage at diagnosis. For inpatient transplants the median days in the hospital was 21 (interquartile range 18 to 28). For outpatient transplants the median number of days in the hospital was 0 (interquartile range 0 to 6). Relapse free survival was not signi cantly different between the 2 groups, but overall survival was 95 versus 58 months favoring those that had transplantation as an outpatient (p=.0008).Conclusion: There appears to be in association between myeloma patients that lack a caregiver and require inpatient stem cell transplantation and overall survival.

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“…Background: Extramedullary Disease (EMD) has a well-recognized unfavourable prognostic significance independently from any other adverse risk factor, both at diagnosis and in relapsed refractory phase (45). In many studies, EMD was associated with a shorter OS and PFS, with an inferior outcome observed even in standard-risk patients in comparison to patients without EMD, despite the availability of therapeutic combinations with proven clinical efficacy, such as reported in Total Therapy 3 protocols and, more recently, with novel agents-based induction (46)(47)(48). A significant advantage was observed with double ASCT intensification, probably according to high-risk cytogenetic features reported in almost 40% of EMD patients that can benefit from tandem over single procedure (49).…”

Section: Extramedullary Diseasementioning

confidence: 99%

Experts’ consensus on the definition and management of high risk multiple myeloma

et al. 2023

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High risk multiple myeloma (HRMM) at diagnosis is currently recognized according to the Revised International Staging System (R-ISS) which was set up in 2015. Since then, new clinical and biological prognostic factors have been developed, which could implement the definition of High Risk (HR) category. We conducted a survey in order to identify which additional parameters, both clinical and biological, are considered more useful for the clinical practice and to evaluate if the management of Multiple Myeloma (MM) should change on the basis of the risk category. A questionnaire, consisting of 8 statements, was submitted to 6 Italian experts, from the European Myeloma Network (EMN) Research Italy, using the Delphi method. The colleagues were asked to answer each question using a scale between 0 and 100. If a statement did not reach at least 75 out of 100 points from all the participants, it was rephrased on the basis of the proposal of the experts and resubmitted in a second or further round, until a consensus was reached among all. From the first round of the survey a strong consensus was reached regarding the opportunity to revise the R-ISS including chromosome 1 abnormality, TP53 mutation or deletion, circulating plasma cells by next generation flow and extramedullary plasmacytomas. No consensus was reached for the definition of “double hit” MM and for the application in clinical practice of treatment strategies based on the risk category. In the second round of the Delphi questionnaire, “double-hit” MM was recognized by the association of at least two high-risk cytogenetic or molecular abnormalities. Moreover, the experts agreed to reserve an intensified treatment only to specific conditions, such as plasma cell leukaemia or patients with multiple extramedullary plasmacytomas, while they admitted that there are not sufficient real word data in order to modify treatment on the basis of MRD assessment in clinical practice. This survey suggests that the definition of HRMM should be implemented by additional clinical and biological risk factors, that will be useful to guide treatment in the future.

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Predictors of inferior clinical outcome in patients with standard‐risk multiple myeloma

Cited by 7 publications

References 32 publications

Daratumumab‑resistant multiple myeloma with extramedullary disease successfully treated with combination elotuzumab, pomalidomide and dexamethasone: A case report

Daratumumab‑resistant multiple myeloma with extramedullary disease successfully treated with combination elotuzumab, pomalidomide and dexamethasone: A case report

Lack of a caregiver is associated with shorter survival in myeloma patients undergoing autologous stem cell transplantation

Experts’ consensus on the definition and management of high risk multiple myeloma

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