Cardiovascular adverse events in modern myeloma therapy – Incidence and risks. A review from the European Myeloma Network (EMN) and Italian Society of Arterial Hypertension (SIIA)

Bringhen, Sara; Milan, Alberto; Ferri, Claudio; Wäsch, Ralph; Larocca, Alessandra; Salvini, Marco; Terpos, Evangelos; Goldschmidt, Hartmut; Cavo, Michèle; Petrucci, Maria Teresa; Ludwig, Heinz; Auner, Holger W.; Caers, Jo; Gramatzki, Martin; Boccadoro, Mario; Einsele, Hermann; Sonneveld, Pieter; Engelhardt, Monika

doi:10.3324/haematol.2018.191288

Cited by 77 publications

(79 citation statements)

References 58 publications

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“…Furthermore, patients with MM are typically older adults with several age-related comorbidities that have a significant impact on disease outcomes [20]. The multifactorial burden of cardiovascular disease is also substantial and may be aggravated by preexisting conditions, disease complications and drug toxicities [21]. In addition, individuals with MM are at an increased risk for venous thromboembolism (VTE) that may vary according to patient-, diseaseor treatment-related characteristics [22].…”

Section: Vulnerability Of Patients With Multiple Myelomamentioning

confidence: 99%

Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

et al. 2020

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Patients with multiple myeloma (MM) seem to be at increased risk for more severe COVID-19 infection and associated complications due to their immunocompromised state, the older age and comorbidities. The European Myeloma Network has provided an expert consensus statement in order to guide therapeutic decisions in the era of the COVID-19 pandemic. Patient education for personal hygiene and social distancing measures, along with treatment individualization, telemedicine and continuous surveillance for early diagnosis of COVID-19 are essential. In countries or local communities where COVID-19 infection is widely spread, MM patients should have a PCR test of nasopharyngeal swab for SARS-CoV-2 before hospital admission, starting a new treatment line, cell apheresis or ASCT in order to avoid ward or community spread and infections. Oral agent-based regimens should be considered, especially for the elderly and frail patients with standard risk disease, whereas de-intensified regimens for dexamethasone, bortezomib, carfilzomib and daratumumab should be used based on patient risk and response. Treatment initiation should not be postponed for patients with end organ damage, myeloma emergencies and aggressive relapses. Autologous (and especially allogeneic) transplantation should be delayed and extended induction should be administered, especially in standard risk patients and those with adequate MM response to induction. Watchful waiting should be considered for standard risk relapsed patients with low tumor burden, and slow biochemical relapses. The conduction of clinical trials should continue with appropriate adaptations to the current circumstances. Patients with MM and symptomatic COVID-19 disease should interrupt anti-myeloma treatment until recovery. For patients with positive PCR test for SARS-CoV-2, but with no symptoms for COVID-19, a 14-day quarantine should be considered if myeloma-related events allow the delay of treatment. The need for surveillance for drug interactions due to polypharmacy is highlighted. The participation in international COVID-19 cancer registries is greatly encouraged.

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Section: Vulnerability Of Patients With Multiple Myelomamentioning

confidence: 99%

Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

et al. 2020

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“…Therefore, the development of a rapid and effective methodology for evaluating the efficacy of several therapeutic agents based on the patient-individualized profile would be of utmost significance [ 32 , 33 , 34 , 35 , 36 ]. In the same context, and beyond finding a specific sensitive target, the application of a suitable preclinical model would prevent ineffective therapy of resistant MM cells and unwanted toxicities [ 37 , 38 , 39 ].…”

Section: The Need For Personalized Preclinical Bm Modelsmentioning

confidence: 99%

Ex Vivo Models Simulating the Bone Marrow Environment and Predicting Response to Therapy in Multiple Myeloma

Papadimitriou

Kostopoulos

Tsopanidou

et al. 2020

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Multiple myeloma (MM) remains incurable despite the abundance of novel drugs. As it has been previously shown, preclinical 2D models fail to predict disease progression due to their inability to simulate the microenvironment of the bone marrow. In this review, we focus on 3D models and present all currently available ex vivo MM models that fulfil certain criteria, such as development of complex 3D environments using patients’ cells and ability to test different drugs in order to assess personalized MM treatment efficacy of various regimens and combinations. We selected models representing the top-notch ex vivo platforms and evaluated them in terms of cost, time-span, and feasibility of the method. Finally, we propose where such a model can be more informative in a patient’s treatment timeline. Overall, advanced 3D preclinical models are very promising as they may eventually offer the opportunity to precisely select the optimal personalized treatment for each MM patient.

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“…Protocols of targeted therapeutics should consider incorporating specific monitoring and management guidelines for specific toxicities for risk mitigation based on the most recent and up to date integrated safety analysis of the particular drug that will be used [[69], [70], [71]]. The higher mortality rate for early toxicity in patients ≥80 years emphasizes the need for a careful frailty assessment and more effective risk-mitigation measures for elderly.…”

Section: Future Directions and Outstanding Questionsmentioning

confidence: 99%

Contemporary patient-tailored treatment strategies against high risk and relapsed or refractory multiple myeloma

et al. 2019

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Recurrence of disease due to chemotherapy drug resistance remains a major obstacle to a more successful survival outcome of multiple myeloma (MM). Overcoming drug resistance and salvaging patients with relapsed and/or refractory (R/R) MM is an urgent and unmet medical need. Several new personalized treatment strategies have been developed against molecular targets to overcome this drug resistance. There are several targeted therapeutics with anti-MM activity in clinical pipeline, including inhibitors of anti-apoptotic proteins, monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, fusion proteins, and various cell therapy platforms. For example, B-cell maturation antigen (BCMA)-specific CAR-T cell platforms showed promising activity in heavily pretreated R/R MM patients. Therefore, there is renewed hope for high-risk as well as R/R MM patients in the era of personalized medicine.

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Cardiovascular adverse events in modern myeloma therapy – Incidence and risks. A review from the European Myeloma Network (EMN) and Italian Society of Arterial Hypertension (SIIA)

Cited by 77 publications

References 58 publications

Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

Ex Vivo Models Simulating the Bone Marrow Environment and Predicting Response to Therapy in Multiple Myeloma

Contemporary patient-tailored treatment strategies against high risk and relapsed or refractory multiple myeloma

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