Relevant prognostic features of multiple myeloma and the new International Staging System

Gertz, Morie A.

doi:10.1080/10428190601059753

Cited by 9 publications

(5 citation statements)

References 60 publications

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“…Based on the ISS, the median survival of patients with stage I, II, or III disease is estimated at 62, 44, and 29 months, respectively 6. Although serum β 2 -microglobulin and albumin levels combine in the ISS to provide a powerful prognostic tool, a number of independent prognostic markers have been described that may further assist in predicting outcome 17. Many established prognostic markers allowing identification of high-risk patients early in the disease course have been derived from studies of conventional chemotherapy and include age, β 2 -microglobulin level, World Health Organization (WHO) performance status, serum calcium, interleukin-6 (IL-6) level, bone marrow plasma cell labeling index, and morphological features 18,19.…”

Section: Disease Overviewmentioning

confidence: 99%

Lenalidomide in multiple myeloma: an evidence-based review of its role in therapy

Richardson

Mitsiades²,

Laubach³

et al. 2009

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Introduction: Multiple myeloma (MM) is a relatively common and incurable hematological malignancy. Currently, there is no single standard therapy, with choice of treatment dependent on individual patient factors. Lenalidomide is an immunomodulatory drug with potent antitumor, antiangiogenic, immunomodulatory, and proapoptotic activity in MM. Aims: To evaluate the evidence for the use of lenalidomide in its current indication in relapsed or refractory MM, and additionally its investigational use for the treatment of newly diagnosed MM. Evidence review: In patients with relapsed and refractory MM, adding lenalidomide to high-dose dexamethasone significantly improves response rates and time-to-progression, relative to high-dose dexamethasone alone. This translates into a significant extension of overall survival (with a median extension of 9.1 months in a pivotal phase III study). Outcome is independent of patient age, number of previous therapies, type of previous therapy (including thalidomide or autologous stem cell transplantation), renal impairment, and β 2 -microglobulin level. Evidence suggests that combining lenalidomide with low-dose dexamethasone improves outcomes in patients with newly diagnosed disease and is superior to lenalidomide combined with highdose dexamethasone. Myelosuppression is the predominant toxicity observed, although some studies have shown high incidences of venous thromboembolism in the absence of prophylactic antithrombotic anticoagulation therapy. There is currently only limited evidence regarding the health economics of lenalidomide. Role in therapy:The encouraging results obtained with lenalidomide alone and in combination with dexamethasone in patients with relapsed or refractory MM have led to its adoption as a recommended therapy in patients who have received at least one prior treatment. Emerging evidence supports the ongoing investigation of lenalidomide in combination with low-dose dexamethasone, and in other combinations including bortezomib, for use both in relapsed, refractory, and newly diagnosed MM.

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Section: Disease Overviewmentioning

confidence: 99%

Lenalidomide in multiple myeloma: an evidence-based review of its role in therapy

Richardson

Mitsiades²,

Laubach³

et al. 2009

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“…Clinical and biochemical staging systems are used to assess patients with MM at presentation; but as the underlying disease differs in each individual,7 molecular cytogenetic prognostic indicators are increasingly important for stratifying patients into risk categories for individualised treatment 8 9. Karyotype and fluorescence in situ hybridization (FISH) analyses have been used to investigate these molecular cytogenetics prognostic factors, but more readily available, robust and inexpensive technologies would have clinical utility and facilitate exploration of the functional basis of a patient’s disease 10…”

mentioning

confidence: 99%

Genomic aberrations and immunohistochemical markers as prognostic indicators in multiple myeloma

Yeung

Chang

2007

J Clin Pathol

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As patients with multiple myeloma (MM) have a variable clinical course, predictive markers would help determine the appropriate treatment strategy. Clinical staging is commonly used to predict outcome, but tumour marker expression and the underlying genetic changes are increasingly used to assess the biological aggressiveness of the disease. Recent studies have demonstrated the utility of immunohistochemistry in detecting prognostic markers, including fibroblast growth factor receptor 3, cyclin D1, c-maf and p53, which have been associated with various genetic aberrations, including t(4;14), t(11;14), t(14;16) and del(17p). While t(4;14), t(14;16) and del (17p) have been documented to confer a poor prognosis, t(11;14) appears to be a neutral or even favourable factor in some studies. CD56, CD33, CD20 and CXCR4 are promising surface markers due to their roles in MM progression, but further studies of larger cohorts are necessary to assess their prognostic relevance. In this review, the biological function and clinical relevance of the main prognostic markers in MM is discussed, and also the role of immunohistochemistry in the stratification of patients into appropriate risk categories.

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“…PET/CT could be done in place of MR imaging, because it has been shown that a normal PET/ CT reliably predicted stable MGUS in a study of 98 patients. 13 Likewise, patients with the generalized form of myeloma should only have a generalized decrease in bone mineral density (often documented by bone densitometry) without discrete focal lytic lesions. If focal lesions are found, these patients should be placed in the category of typical multiple myeloma.…”

Section: Imaging Workupmentioning

confidence: 99%

“…25 Complete response by MR imaging is predictive of better outcome and is more meaningful than response of laboratory values. 13 Response of spine disease on MR imaging is best determined using the bone marrow evolution index described by Lecouvet et al (Table 4). 26 Findings related to the number and size of lesions are combined with changes in lesion enhancement and the bone marrow background to determine improved, stable, or worsening disease status.…”

Section: Update On Imaging Techniquesmentioning

confidence: 99%

Myeloma Update

Mulligan¹

2007

Semin Musculoskelet Radiol

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Myeloma is the most common primary bone malignancy and one of the most common hematologic malignancies. Research on myeloma constantly produces new information on genetic factors, imaging techniques, and treatment complications among others that is of use to patients, referring physicians, and radiologists. This update emphasizes new developments regarding imaging techniques for diagnosis, staging, and follow-up of myeloma patients. Advances in whole body radiography, whole body computed tomography, whole body magnetic resonance imaging, and whole body nuclear techniques (including sestamibi and positron emission tomography) are discussed.

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Relevant prognostic features of multiple myeloma and the new International Staging System

Cited by 9 publications

References 60 publications

Lenalidomide in multiple myeloma: an evidence-based review of its role in therapy

Lenalidomide in multiple myeloma: an evidence-based review of its role in therapy

Genomic aberrations and immunohistochemical markers as prognostic indicators in multiple myeloma

Myeloma Update

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