European Myeloma Network Guidelines for the Management of Multiple Myeloma-related Complications

Terpos, Evangelos; Kleber, Martina; Engelhardt, Monika; Zweegman, Sonja; Kastritis, Efstathios; Donk, Niels W.C.J. van de; Bruno, Benedetto; Sezer, Orhan; Broijl, Annemiek; Bringhen, Sara; Beksaç, Meral; Larocca, Alessandra; Hájek, Roman; Musto, Pellegrino; Johnsen, Hans Erik; Morabito, Fortunato; Ludwig, Heinz; Cavo, Michèle; Einsele, Hermann; Sonneveld, Pieter; Palumbo, Antônio

doi:10.3324/haematol.2014.117176

Cited by 318 publications

(294 citation statements)

References 92 publications

(115 reference statements)

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“…Also, more data are needed in for the role of drugs such ixazomib in patients with RF and CrCl < 30 ml/min [21][22][23][24]. For lenalidomide there are several reports indicating a potential role in patients with RF [6,[25][26][27] although the results as primary therapy in patients with severe RF [28] or patients requiring dialysis are not ample [25,29,30]. Pomalidomide may be given without dose modifications in patients with severe RI, but still more data are needed and no data exist in newly diagnosed patients [31,32].…”

Section: Discussionmentioning

confidence: 99%

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Bortezomib‐based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis

et al. 2016

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Renal failure (RF) is a common and severe complication of symptomatic myeloma, associated with significant morbidity and mortality. Such patients are commonly excluded from clinical trials. Bortezomib/dexamethasone (VD)-based regimens are the backbone of the treatment of newly diagnosed MM patients who present with severe RF even those requiring dialysis. We analyzed the outcomes of 83 consecutive bortezomib-treated patients with severe RF (eGFR < 30 ml/min/1.73 m 2 ), of which 31 (37%) required dialysis. By IMWG renal response criteria, 54 (65%) patients achieved at least MRrenal, including CRrenal in 35% and PRrenal in 12%. Triplet combinations (i.e., VD plus a third agent) versus VD alone were associated with higher rates of renal responses (72 vs. 50%; P 5 0.06). Fifteen of the 31 (48%) patients became dialysis independent within a median of 217 days (range 11-724). Triplets were associated with a higher probability of dialysis discontinuation (57 vs. 35%). Serum free light chain (sFLC) level 11,550 mg/L was associated with lower rates of major renal response, longer time to major renal response, lower probability, and longer time to dialysis discontinuation. Rapid myeloma response (PR within the first month) was also associated with higher rates of renal response. Patients who became dialysis-independent had longer survival than those remaining on dialysis. In conclusion, VD-based triplets are associated with a significant probability of renal response and dialysis discontinuation, improving the survival of patients who became dialysis independent. Rapid disease response is important for renal recovery and sFLCs are predictive of the probability and of the time required for renal response.

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Section: Discussionmentioning

confidence: 99%

“…Bortezomib/dexamethasone (VD) based regimens have been proposed as the backbone of the treatment of newly diagnosed MM patients who present with severe RF, based on the data from several series of patients with moderate or more severe RF [1,[4][5][6]. Regarding patients on dialysis the data are less abundant.…”

Section: Introductionmentioning

confidence: 99%

Bortezomib‐based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis

et al. 2016

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“…A next step includes prospective randomized clinical studies to design therapeutic approaches with the help of a GA algorithm. 2,14,20,41,42 We conclude that both IMWG score and R-MCI are useful instruments in older myeloma patients for identifying those with geriatric risks. The publication of our validation analysis should attract the attention of cancer experts and help in the care of MM patients, the latter being an aim that all of us are enthusiastically persisting in daily.…”

Section: P=00054mentioning

confidence: 99%

“…Our thoroughly performed validation of the IMWG score and others, including the R-MCI, was performed within a structured prospective GA and by an experienced group who has been doing these assessments for years. 2,7,10,20,21 Moreover, we applied all current state-ofthe-art statistics with our renowned statistical team with the important aim to validate easy to assess risk scores that function to improve MM care. 40 Currently, the IMWG score consists of: 1. age (3 age groups), 2.…”

Section: P=00054mentioning

confidence: 99%

“…19 Herein, we prospectively and carefully assessed the IMWG score's impact on clinical outcome, and are the first who have thoroughly validated the IMWG baseline GA in a well-characterized external cohort. Since our prior analyses demonstrated that multivariate risk factors in MM patients include impaired renal function, lung function and Karnofsky performance status (KPS), 2,7,8,10,20 and that with a revised Myeloma Comorbidity Index (R-MCI), the inclusion of frailty, age and cytogenetics improves its prediction of fit, intermediate-fit and frail patients, 21 we included the R-MCI, CCI, HCT-CI and KF Index in this analysis. Our intention was validation, as diligently performed herein, and not the improvement of the IMWG score.…”

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confidence: 99%

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