Management of Newly Diagnosed Symptomatic Multiple Myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines

Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clinic Proceedings (Impact Factor: 5.81). 12/2009; 84(12):1095-110. DOI: 10.4065/mcp.2009.0603
Source: PubMed

ABSTRACT Multiple myeloma is a malignant plasma cell neoplasm that affects more than 20,000 people each year and is the second most common hematologic malignancy. It is part of a spectrum of monoclonal plasma cell disorders, many of which do not require active therapy. During the past decade, considerable progress has been made in our understanding of the disease process and factors that influence outcome, along with development of new drugs that are highly effective in controlling the disease and prolonging survival without compromising quality of life. Identification of well-defined and reproducible prognostic factors and introduction of new therapies with unique modes of action and impact on disease outcome have for the first time opened up the opportunity to develop risk-adapted strategies for managing this disease. Although these risk-adapted strategies have not been prospectively validated, enough evidence can be gathered from existing randomized trials, subgroup analyses, and retrospective studies to develop a working framework. This set of recommendations represents such an effort-the development of a set of consensus guidelines by a group of experts to manage patients with newly diagnosed disease based on an interpretation of the best available evidence.

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Available from: Shaji K Kumar, Dec 12, 2014
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    • "Przykładowo, najbardziej złożona wydaje się omawiana powyżej klasyfikacja mSMART, którą opracowano na podstawie analizy wartości prognostycznej anomalii chromosomowych oraz wybranych negatywnie rokujących czynników biochemicznych, morfologicznych lub molekularnych [18]. Pierwotnie model przewidywał dwie kategorie rokownicze: grupę standardowego ryzyka (około 75% chorych) oraz grupę wysokiego ryzyka (25% chorych) [31] [32]. Ostatnio klasyfikacja ta została poszerzona o trzecią kategorię ryzyka pośredniego, obejmującą przede wszystkim pacjentów z t(4;14). "
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    ABSTRACT: A remarkable progress, which has been made during the last two decades in the multiple myeloma (MM) treatment, is mainly associated with the introduction to MM therapy three new drugs - thalidomide, lenalidomide and bortezomib. Global improvement of prognosis in MM, confirmed by numerous clinical trials and epidemiological studies, is mainly a consequence of very favorable results obtained in patients in the standard-risk group. However, in patients affected by prognostically unfavorable chromosomal aberrations, who constitute approximately 25% of all MM patients, only a slight improvement in the prognosis has become possible. Interestingly, the effectiveness of various new drugs for patients in the high-risk group appears to be different. The results of clinical trials indicate that currently bortezomib seems to be the most effective drug for patients with unfavorable cytogenetic abnormalities, especially patients with translocation t(4;14). In the present article the published data on the efficacy of bortezomib in first-line therapy in patients with unfavorable cytogenetic abnormalities are reviewed. The principles of risk stratification and individualization of therapy in MM are also discussed.
    Acta haematologica Polonica 07/2014; DOI:10.1016/j.achaem.2014.06.002
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    • "In patients with multiple myeloma (MM), clonal expansion of terminally differentiated plasma cells (B cells) in the bone marrow results in the excessive production of monoclonal protein, which leads to anemia, renal failure, and immunodeficiency [1] [2]. The increased population of plasma cells also profoundly disrupts the homeostasis within the bone marrow microenvironment . "
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    ABSTRACT: The large majority of patients with multiple myeloma develop bone lesions and typically receive bisphosphonates to maintain bone health and prevent/delay skeletal-related events. Recent clinical data show that the newer-generation bisphosphonate, zoledronic acid, may confer a survival benefit when combined with antimyeloma therapy. However, clinical data describing the combination of zoledronic acid with newer antimyeloma regimens are limited. This retrospective study analyzed efficacy and safety outcomes in patients with multiple myeloma receiving first- and second-line treatment with bortezomib, lenalidomide, or thalidomide, with or without zoledronic acid. Records data from 94 patients with Durie-Salmon stage 3A/B multiple myeloma were collated. Most patients (~80%) had bone lesions at study entry. Almost all patients received zoledronic acid at some time during their treatment. Adding zoledronic acid was associated with a numerical, but statistically nonsignificant, benefit in the 1-year progression-free survival rate in both the first- and second-line setting. A similar benefit was observed on the 2-year skeletal-related event rate. Notably, combining zoledronic acid with newer antimyeloma agents was feasible, tolerable, and did not affect the duration of antimyeloma treatment. Three cases of osteonecrosis of the jaw were reported; there were no reports of acute renal failure. This retrospective analysis suggests that extended treatment with zoledronic acid in combination with bortezomib, lenalidomide, or thalidomide is safe and tolerable in patients receiving these therapies as first- or second-line treatment. The addition of zoledronic acid may improve both myeloma and skeletal-related outcomes.
    International Journal of Clinical and Experimental Medicine 01/2013; 6(1):30-8. · 1.42 Impact Factor
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    • "Patients with 17p13 deletions often have more aggressive and extramedullary disease (such as plasmacytomas), center nervous system involvement, and hypercalcemia [6] [27]. This abnormality is associated with a shorter survival irrespective of the treatment modality, including the novel bortezomib and IMiDs-based therapies [5] [6] [14] [27] (Table 1). "
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    ABSTRACT: While no specific genetic markers are required in the diagnosis of multiple myeloma (MM), multiple genetic abnormalities and gene signatures are used in disease prognostication and risk stratification. This is particularly important for the adequate identification of the high-risk MM group, which does not benefit from any of the current therapies, and novel approaches need to be proposed. Fluorescence in situ hybridization (FISH) has been employed for establishing risk-based stratification and still remains the most used genetic technique in the clinical routine. The incorporation of gene expression profiling (GEP) in the study of MM has shown to be a very powerful test in the patient stratification, but its incorporation in clinical routine depends on some technical and logistic resolutions. Thus, FISH still remains the gold standard test for detecting genomic abnormalities and outcome discrimination in MM.
    09/2011; 2011:798089. DOI:10.4061/2011/798089
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