Second primary malignancies in multiple myeloma: an overview and IMWG consensus

Musto, Pellegrino; Anderson, Kenneth C.; Attal, Michel; Richardson, Paul G.; Badros, A.; Hou, Jian; Comenzo, Raymond L.; Du, Juan; Durie, Brian G.M.; Miguel, Jesús F. San; Einsele, Hermann; Chen, W.M.; Garderet, Laurent; Pietrantuono, Giuseppe; Hillengaß, Jens; Kyle, Robert A.; Moreau, Philippe; Lahuerta, Juan José; Landgren, Ola; Ludwig, Heinz; Larocca, Alessandra; Mahindra, Anuj; Cavo, Michèle; Mazumder, Amitabha; McCarthy, Philip L.; Nouel, Amara; Rajkumar, S. Vincent; Reiman, Anthony; Riva, Eloísa; Sezer, Orhan; Terpos, Evangelos; Turesson, Ingemar; Usmani, Saad Z.; Weiss, Brendan M.; Palumbo, Antônio

doi:10.1093/annonc/mdw606

Cited by 116 publications

(102 citation statements)

References 86 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…SPM occurred in 5.4% with lenalidomide and 3% with bortezomib. These are consistent with other published reports, which indicate a SPM incidence of about 7-8% with lenalidomide maintenance [15,16,31]. In these reports, patients had a higher propensity for myeloid malignancies.…”

Section: Discussionsupporting

confidence: 93%

Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma

Huang

Phillips

Byrne

et al. 2018

Bone Marrow Transplant

View full text Add to dashboard Cite

Maintenance therapy post-autologous hematopoietic cell transplantation (AHCT) with either lenalidomide or bortezomib for multiple myeloma (MM) have separately been shown to improve progression-free survival (PFS), but have never been directly compared. We performed a retrospective study to investigate progression-free and overall survival outcomes and toxicities of lenalidomide maintenance therapy compared with bortezomib maintenance in MM patients post-AHCT. This study included 156 patients who received post-AHCT lenalidomide or bortezomib maintenance therapy for MM. The primary outcome was PFS. Ninety-two patients received lenalidomide maintenance and 64 received bortezomib maintenance post-AHCT. By multivariable analysis, maintenance therapy choice and cytogenetics risk did not impact PFS or OS. Staging by International Staging System and pre-maintenance disease response were the greatest predictors for PFS. Treatment-related toxicities were as anticipated with 5.4% of patients receiving maintenance lenalidomide experiencing secondary primary malignancies (SPMs) compared with 3% for bortezomib. These findings suggest there were no differences in PFS or OS between lenalidomide and bortezomib maintenance therapy options for post-transplantation MM patients. These data should be validated in a larger, prospective cohort to determine if maintenance choice should be guided by side effect profile and patient anticipated tolerance rather than by disease biology alone.

show abstract

Section: Discussionsupporting

confidence: 93%

Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma

Huang

Phillips

Byrne

et al. 2018

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…Ongoing monitoring of myeloma during and after therapy for SPMs is paramount to intervene in the case of disease progression. The results of the current study provide observational evidence for the International Myeloma Working Group consensus recommendations, which emphasized the risk of myeloma‐related death after diagnosis of an SPM …”

Section: Discussionmentioning

confidence: 53%

“…The results of the current study provide observational evidence for the International Myeloma Working Group consensus recommendations, which emphasized the risk of myeloma-related death after diagnosis of an SPM. 8 In the current study, we noted that lung cancer, which was associated with the highest disease-specific mortality, demonstrated a unique pattern of outcomes. Although OS after a diagnosis of lung cancer ultimately did not differ between patients with myeloma and controls, and lung cancer-related mortality predominated, the CSS and CIF of cancer-related death were in fact significantly better among patients with myeloma, even after adjustment for stage of disease.…”

Section: Discussionmentioning

confidence: 59%

“…1,[5][6][7] Longer survival results in a more common clinical scenario of secondary primary malignancies (SPMs) among survivors of myeloma, an issue of increasing importance recognized by the International Myeloma Working Group. 8 Previous characterizations of SPMs in patients with myeloma estimate that the cumulative incidence of an SPM is approximately 3% to 5%. 9,10 Because of the ongoing risk of myeloma progression and exposure to high-dose therapy and autologous stem cell transplantation, as well as long-term maintenance therapy with immunomodulatory drugs, patients who experience SPMs may be at a disadvantage with regard to treatment options or subsequent outcomes of the second cancer.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study

Barth

Castillo

Olszewski

2018

Cancer

View full text Add to dashboard Cite

Background Therapeutic advances have extended survival for patients with myeloma, who may develop secondary cancers. Methods Using the population‐based Surveillance, Epidemiology, and End Results registry (2004‐2015), the authors examined the characteristics, overall and cause‐specific survival, and cumulative incidence function of cancer‐related death among patients with myeloma with secondary cancers of the breast, prostate, lung, colon/rectum, or bladder or melanoma. Each patient was matched based on age, sex, race, and year of diagnosis to 50 controls from a general population who were diagnosed with the index cancer. Results Patients with myeloma with breast, prostate, or lung cancer were more commonly diagnosed at an early stage, whereas the stage distribution did not differ significantly among patients with melanoma, colorectal cancer, or bladder cancer. For all studied cancers except those of the lung, overall mortality was significantly higher among patients with myeloma compared with controls (hazard ratios, 1.84‐2.81). However, the cumulative incidence function of cancer‐related death did not differ (subhazard ratios, 0.84‐0.99) and was surpassed by myeloma‐related deaths (23% to 35% at 5 years). In patients with lung cancer, cancer‐related mortality was uniquely lower among patients with myeloma (subhazard ratio, 0.59; 95% confidence interval, 0.52‐0.68), even after adjustment for stage of disease. There was no significant difference noted with regard to noncancer deaths for any studied solid tumor. Use of surgery (evaluated in patients with nonmetastatic tumors, and in addition matched by disease stage) did not differ between cases and controls, except for fewer prostatectomies being noted among patients with myeloma (odds ratio, 0.56; 95% confidence interval, 0.42‐0.74). Conclusions The results of the current study support curative treatment approaches to secondary cancers among patients with myeloma while highlighting the need for ongoing active myeloma management.

show abstract

“…Although this rate is higher than normal, it is uncertain whether it is related to lenalidomide or the original nature of myeloma [10,13]. …”

Section: Discussionmentioning

confidence: 99%

Realistic Lenalidomide Dose Adjustment Strategy for Transplant-Ineligible Elderly Patients with Relapsed/Refractory Multiple Myeloma: Japanese Real-World Experience

et al. 2017

View full text Add to dashboard Cite

Lenalidomide is an immunomodulatory drug administered orally in the treatment of multiple myeloma. Some elderly patients require a reduced lenalidomide dose because of comorbidities and/or adverse events. This study investigated the actual dose of lenalidomide in elderly patients, finding that most received reduced (5-10 mg) doses. The most common reasons for dose reduction were renal dysfunction (54% of patients), fatigue (grade ≥3; 20%), hematologic disorder (grade ≥3; 14%), and rash (grade ≥3; 9%). Their median time to progression was 11.8 months and their median overall survival was 39.2 months. The overall response rate was 73%, including 17% with a complete response, 19% with a very good partial response, and 37% with a partial response. These results showed that, contrary to western countries, most patients were treated with a reduced dose of lenalidomide in Japan. However, it is suggested that continued treatment with a tolerable dose may yield favorable outcomes.

show abstract

Second primary malignancies in multiple myeloma: an overview and IMWG consensus

Cited by 116 publications

References 86 publications

Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma

Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma

Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study

Realistic Lenalidomide Dose Adjustment Strategy for Transplant-Ineligible Elderly Patients with Relapsed/Refractory Multiple Myeloma: Japanese Real-World Experience

Contact Info

Product

Resources

About