Chemotherapy of myeloma: Drug combinations versus single agents, an overview, and comments on acute leukemia in myeloma

Bergsagel, Daniel E.

doi:10.1002/hon.2900060216

Cited by 37 publications

(11 citation statements)

References 15 publications

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“…This strategy was aimed at avoiding unnecessary side effects and cumulative exposure of alkylating drugs, which were found to be associated with myelodysplastic syndrome and acute leukemia. [43][44][45][46] Patients with DSS I disease, who also meet the criteria for smoldering or asymptomatic myeloma, could be managed expectantly. Median progression-free survival (PFS) in asymptomatic DSS I patients, observed without any therapy, ranged from 12 months to .48 months.…”

Section: Results Of Interventional Therapeutic Trialsmentioning

confidence: 99%

Smoldering multiple myeloma requiring treatment: time for a new definition?

Dispenzieri

Stewart

Chanan‐Khan

et al. 2013

Blood

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Smoldering multiple myeloma (SMM) bridges the gap between monoclonal gammopathy of undetermined significance (a mostly premalignant disorder) and active multiple myeloma (MM). Until recently, no interventional study in patients with SMM showed improved overall survival (OS) with therapy as compared with observation. A report from the PETHEMA-GEM (Programa Español de Tratamientos en Hematologica) group described both fewer myeloma-related events and better OS among patients with high-risk SMM who were treated with lenalidomide and dexamethasone. This unique study prompted us to review current knowledge about SMM and address the following questions: (1) Are there patients currently defined as SMM who should be treated routinely? (2) Should the definitions of SMM and MM be reconsidered? (3) Has the time come when not treating is more dangerous than treating? (4) Could unintended medical harm result from overzealous intervention? Our conclusion is that those patients with the highest-risk SMM (extreme bone marrow plasmacytosis, extremely abnormal serum immunoglobulin free light chain ratio, and multiple bone lesions detected only by modern imaging) should be reclassified as active MM so that they can receive MM-appropriate therapy and the paradigm of careful observation for patients with SMM can be preserved.

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Section: Results Of Interventional Therapeutic Trialsmentioning

confidence: 99%

Smoldering multiple myeloma requiring treatment: time for a new definition?

Dispenzieri

Stewart

Chanan‐Khan

et al. 2013

Blood

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“…This report describes the development of AML in a patient after long-term alkylator therapy for MM. The occurrence of AML following alkylating therapy is well documented [l-31 and the presence of chromosome deletions -5 and -7, as seen in the current case, may distinguish this condition from de novo AML [10,11]. The cytogenetic markers described do not, however, exclude evolution of acute leukemia from a stem cell common to the plasma cell and myeloid cells.…”

Section: Discussionmentioning

confidence: 62%

Acute leukemia evolving from multiple myeloma and co‐expressing myeloid and plasma cell antigens

Stewart¹,

Freedman²,

Garvey³

1990

American J Hematol

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This report describes the development of acute myeloblastic leukemia in a patient after long-term alkylator therapy for multiple myeloma. Despite chromosome deletions -5, -7, the patient lacked the histochemistry and clinical findings characteristic of therapy-induced leukemia. In double-labeled surface marker studies by flow cytometry, the leukemic blast cells co-expressed myeloid and plasma cell surface markers. The findings may support the hypothesis of a single stem cell abnormality's being responsible for both the malignant plasma cells and the myeloid leukemic cells.

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“…Since standard treatment cannot eradicate the malig nant clone and has shown so far only palliative effects, new maintenance strategies have been investigated. In respon ding patients, chemotherapy prolonged until relapse did not improve survival and increased the risk of chemoresistance and the potential leukemogenesis of alkylating agents [9,10]. Better results have been obtained with re combinant interferon a-2b (IFN): patients responding to the induction chemotherapy showed a longer response du ration and survival in comparison to the untreated control group [11].…”

Section: Introductionmentioning

confidence: 86%

Interferon plus Glucocorticoids as Intensified Maintenance Therapy Prolongs Tumor Control in Relapsed Myeloma

Palumbo¹,

Boccadoro²,

Garino³

et al. 1993

Acta Haematol

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Interferon-α-2b (IFN) has been demonstrated to prolong remission duration and survival in responding multiple myeloma (MM) patients. The aim of this study was to intensify maintenance therapy adding glucocorticoids (GLU) to the standard IFN therapy. Twenty-eight relapsed MMs with stable disease or response after conventional chemotherapy received IFN + GLU. The treatment included 3 megaunits of IFN 3 times a week continuously until relapse, plus 4 days pulsed high-dose dexamethasone (40 mg/day for 4 days every 28 days for 6 consecutive months every 12 months) in patients < 70 years, or oral prednisone (PDN, 50 mg 3 times a week) in patients > 70 years, both until relapse. Conventional chemotherapy induced a response in 12/28 MMs. For all patients the actuarial median progression-free survival from relapse was 24 months and the survival from relapse 42 months with no difference between responding and nonresponding patients. The first duration of tumor control, i.e. the interval from diagnosis to first relapse, was shorter than the period between first and second relapse in 11/28 patients (40%). Toxicity was mild and oral PDN significantly increased the subjective tolerability of IFN. These findings indicate that IFN + GLU after induction chemotherapy may prolong the duration of tumor control in relapsed MM.

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Chemotherapy of myeloma: Drug combinations versus single agents, an overview, and comments on acute leukemia in myeloma

Cited by 37 publications

References 15 publications

Smoldering multiple myeloma requiring treatment: time for a new definition?

Smoldering multiple myeloma requiring treatment: time for a new definition?

Acute leukemia evolving from multiple myeloma and co‐expressing myeloid and plasma cell antigens

Interferon plus Glucocorticoids as Intensified Maintenance Therapy Prolongs Tumor Control in Relapsed Myeloma

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