Early versus deferred treatment for early stage multiple myeloma

He, Yulong; Wheatley, Keith; Glasmacher, Axel; Ross, H. F.; Djulbegoviĉ, Benjamin

doi:10.1002/14651858.cd004023

Cited by 29 publications

(19 citation statements)

References 22 publications

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“…Prognostic models for predicting asymptomatic MM progression, 8,12,15 including the model described in the current study, would allow the identification of low-risk patients who harbor a very indolent disease similar to MGUS and high-risk patients who might benefit from close follow-up and who may be optimal candidates for experimental therapies aimed at delaying the progression of MM. [35][36][37][38][39][40][41] …”

Section: Discussionmentioning

confidence: 99%

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Rossi

Fangazio

Paoli

et al. 2010

Cancer

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BACKGROUND: Although serum beta-2 microglobulin (B2M) represents a key variable for symptomatic multiple myeloma (MM) prognostication, its role in predicting the risk of progression of asymptomatic MM to symptomatic disease has not been explored. METHODS: This study was bases on a consecutive series of 148 patients with asymptomatic MM and explored the cumulative probability of progression to symptomatic MM as the primary endpoint. RESULTS: In univariate analysis, a serum B2M level >2.5 mg/L was associated with an increased probability of disease progression (5-year risk, 64.5%; P < .001) along with serum monoclonal component (sMC) (P < .001), urinary monoclonal component (uMC) (P < .001), and bone marrow plasma cells (BMPCs) (P < .001). In multivariate analysis, serum B2M was selected as an independent predictor of progression (hazard ratio, 3.30; P ¼.002). Serum B2M was combined with sMC, uMC, and BMPC to create a risk-stratification model based on 4 groups with different risk of progression: very low (5-year risk, 0%), low-intermediate (5-year risk, 19.6%), high-intermediate (5-year risk, 60.7%), and high (5-year risk, 80.7%). The model that included serum B2M along with sMC, uMC, and BMPC was able to predict disease progression better than the model that was based on sMC, uMC, and BMPC without serum B2M (C statistics, 0.760 vs 0.726). CONCLUSIONS: The current results indicated that 1) serum B2M is an independent predictor of asymptomatic MM progression, and 2) serum B2M adds prognostic information when combined with the most widely used prognosticators of asymptomatic MM progression.

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Section: Discussionmentioning

confidence: 99%

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Rossi

Fangazio

Paoli

et al. 2010

Cancer

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“…2 The annual progression rate of AM into 'symptomatic' or 'active' MM is approximately 10% during the first 5 years. 1 This favorable clinical outcome and the occurrence of relevant side effects of chemotherapies suggest the use of simple observation in these patients, 3 whereas conventional chemotherapy [4][5][6] and even the use of new drugs, such as thalidomide, 7,8 generally are not recommended until end-organ damage develops.…”

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confidence: 99%

A multicenter, randomized clinical trial comparing zoledronic acid versus observation in patients with asymptomatic myeloma

Musto

Petrucci

Bringhen

et al. 2008

Cancer

166

106

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BACKGROUND.Bisphosphonates (BPs) are effective in the prevention and treatment of skeletal‐related events (SREs) in patients with symptomatic myeloma who are receiving chemotherapy. Recent data also suggest a possible antineoplastic activity of BPs. Few studies published to date have explored the role of BPs in patients with untreated, asymptomatic myeloma (AM). No data are available on the efficacy of zoledronic acid in these patients.METHODS.The authors conducted a prospective, multicenter, open‐label, phase 3, randomized trial comparing the administration of zoledronic acid versus simple observation in patients with AM. One‐hundred sixty‐three patients were enrolled and randomized (1:1) to receive zoledronic acid (n = 81 patients) or not to receive zoledronic acid (n = 82 patients) for 1 year at a dose of 4 mg monthly as a single, 15‐minute, intravenous infusion.RESULTS.After a median follow‐up of 64.7 person‐months, 44.4% of patients in the zoledronic acid group and 45.1% of the control group progressed to ‘symptomatic’ myeloma requiring chemotherapy (P = .9307). The median time to progression was 67 months and 59 months for the treatment and control groups, respectively (P = .8312). At progression, SREs were significantly lower in the zoledronic acid‐treated group (55.5%) than in the control group (78.3%; P = .041), whereas anemia, renal failure, and extramedullary disease were not statistically different. More frequent adverse events observed in the zoledronic acid‐treated group were asymptomatic hypocalcemia and fever. One patient developed reversible osteonecrosis of the jaw. No renal failure caused by zoledronic acid was reported.CONCLUSIONS.The monthly use of zoledronic acid for 1 year in patients with AM reduced the development of SREs at progression but did not influence the natural history of the disease. Cancer 2008. © 2008 American Cancer Society.

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“…Those with asymptomatic or smoldering myeloma should be monitored closely without therapy [2], or treated in a clinical trial. When treatment is indicated, the decision about the choice of induction therapy is largely based on transplant eligibility.…”

Section: General Approach To Initial Therapymentioning

confidence: 99%

Current Approaches to the Initial Treatment of Symptomatic Multiple Myeloma

Jasielec

Jakubowiak

2013

Int. J. Hematol. Oncol.

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SUMMARY The treatment of newly diagnosed multiple myeloma has dramatically changed since the emergence of proteasome inhibitors and immunomodulatory drugs. Front-line combination regimens incorporating novel drugs such as thalidomide, bortezomib and lenalidomide, have significantly improved response rates and are the standard of care for induction regimens. Although the timing and role of autologous stem cell transplant are now being questioned, it remains an important part of the treatment paradigm in eligible patients. In addition, the concept of extended sequential therapy has recently emerged, including consolidation and/or maintenance in both the post-transplant setting and in nontransplant candidates. In this article we focus on management strategies in newly diagnosed multiple myeloma, including choice of induction regimens in transplant-eligible and -ineligible patients, as well as the role of autologous stem cell transplant, consolidation therapy and maintenance therapy.

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Early versus deferred treatment for early stage multiple myeloma

Cited by 29 publications

References 22 publications

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

Beta‐2‐microglobulin is an independent predictor of progression in asymptomatic multiple myeloma

A multicenter, randomized clinical trial comparing zoledronic acid versus observation in patients with asymptomatic myeloma

Current Approaches to the Initial Treatment of Symptomatic Multiple Myeloma

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