How to Manage Neutropenia in Multiple Myeloma

Palumbo, Antônio; Bladé, J; Boccadoro, Mario; Palladino, Carmela; Davies, Faith E.; Dimopoulos, Meletios Α.; Dmoszyńska, Anna; Einsele, Hermann; Moreau, Philippe; Sezer, Orhan; Spencer, Andrew; Sonneveld, Pieter; Miguel, Jesús F. San

doi:10.1016/j.clml.2011.11.001

Cited by 44 publications

(44 citation statements)

References 39 publications

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“…In case of persisting severe neutropenia despite G-CSF, therapy should be delayed until ANC recovery (> 1000 cells/mL) and then restarted with appropriate dose reductions. 71 …”

Section: Neutropeniamentioning

confidence: 99%

“…The risk of severe neutropenia (grade 3-4) during treatment is related to patient characteristics, baseline absolute neutrophil count (ANC), disease stage and type of chemotherapy administered (3-drug regimens including lenalidomide plus alkylators or doxorubicin are at high risk). 71 Granulocyte-colony stimulating factor (G-CSF) can be used to manage severe neutropenia, both as primary prophylaxis or reactive treatment, thus allowing patients to stay on therapy for a longer period. Patients receiving high-risk therapies (expected grade 3-4 neutropenia rate > 50%) and those receiving intermediate-or low-risk regimens (expected grade 3-4 neutropenia rate < 50%) with additional risk factors, should be given G-CSF as primary prophylaxis.…”

Section: Neutropeniamentioning

confidence: 99%

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Management of older adults with multiple myeloma

Palumbo¹,

Mina²

2013

Blood Reviews

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Two-thirds of patients with multiple myeloma are aged 65 years or more and the prevalence of multiple myeloma in elderly patients is expected to rise in the next future. Patients older than 65 years are usually considered ineligible for transplantation. The introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, combined with conventional chemotherapy, has radically changed the treatment paradigm of elderly patients and improved outcome. A sequential approach, consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy, induces a profound cytoreduction and delays relapse, thus improving survival. Novel agents associated with reduced-intensity autologous transplant showed to be safe and effective in fit elderly patients. Patients older than 75 years or vulnerable ones are more susceptible to adverse events that negatively affect treatment adherence and outcome. In this setting, less toxic regimens and appropriate dose reductions should be adopted. Here we provide an overview of novel agent-based treatment strategies for elderly patients with multiple myeloma.

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“…In case of persisting severe neutropenia despite G-CSF, therapy should be delayed until ANC recovery (> 1000 cells/mL) and then restarted with appropriate dose reductions. 71 …”

Section: Neutropeniamentioning

confidence: 99%

Section: Neutropeniamentioning

confidence: 99%

Management of older adults with multiple myeloma

Palumbo¹,

Mina²

2013

Blood Reviews

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“…Although prophylactic G-CSF use has been suggested previously [26], it has not become part of clinical practice in multiple myeloma, likely because current guidelines and other publications have focused on initially trying to control neutropenia through lenalidomide exposure reduction [5,24]. However, along with the results of the present study, new evidence suggests that control of neutropenia through G-CSF use, rather than through lenalidomide dose reduction, may deserve more attention.…”

Section: Discussionmentioning

confidence: 74%

“…Relapsed and refractory myeloma represents a more advanced stage of disease, a factor commonly identified as a predictor of chemotherapy-induced neutropenia and FN in cancer patients [23]. Other known risk factors-such as older age, poorer performance status, comorbidities, and abnormal laboratory values-were not significantly associated with grade 3/4 neutropenia in our model, but this could be explained by relatively low patient numbers, and should not exclude consideration of these factors by physicians during neutropenia risk assessments [23,24].…”

Section: Discussionmentioning

confidence: 87%

An international, multicenter, prospective, observational study of neutropenia in patients being treated with lenalidomide + dexamethasone for relapsed or relapsed/refractory multiple myeloma (RR‐MM)

et al. 2016

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Neutropenia is a well‐known dose‐limiting toxicity associated with lenalidomide plus dexamethasone treatment in patients with multiple myeloma; however, little is known about its management and associated outcomes in the real world setting. The present prospective, multicenter, observational study evaluated the incidence, management, and outcomes of grade 3/4 neutropenia in patients with relapsed or relapsed/refractory multiple myeloma who initiated treatment with lenalidomide plus dexamethasone. Of 198 patients, 62 (31%, 95% CI: 25, 38) experienced grade 3/4 neutropenia, and half of these patients experienced 3 or more events during the 12‐month observational period. Grade 3/4 neutropenia occurred throughout lenalidomide treatment, with a median time to first event of 8.8 weeks (Q1, Q3: 5.9, 17.3). In a multivariate analysis, diagnosis of relapsed and refractory disease was associated with grade 3/4 neutropenia. Lenalidomide exposure reduction, use of G‐CSF, unplanned hospitalization, and outpatient clinic visits were more common in patients who experienced grade 3/4 neutropenia than in those who did not. In conclusion, grade 3/4 neutropenia is a common toxicity and patients are at continued risk throughout treatment with lenalidomide and dexamethasone. Further efforts should be made to improve the recommendations for neutropenia management in this population. Am. J. Hematol. 91:806–811, 2016. © 2016 Wiley Periodicals, Inc.

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“…Nevertheless, there are cases of plasma cell myeloma with biclonal IgD and IgM reported showing disease aggressiveness and chemoresistant (Chen et al 2013). In our case, although the patient was started on chemotherapy regime but eventually died due to neutropenic sepsis which is a main concern especially when using thalidomide for the treatment of frail patients (Palumbo et al 2012).…”

Section: Discussionmentioning

confidence: 99%

A Rare Occurrence of Plasma Cell Myeloma with Biclonal Gammopathy

Aziz¹

2017

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ABSTRAK Myeloma sel plasma telah diketahui menyebabkan pengeluaran immunoglobulin (Ig) ABSTRACTPlasma cell myeloma is known to cause expansion of a single clone of immunoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal M proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different 104

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How to Manage Neutropenia in Multiple Myeloma

Cited by 44 publications

References 39 publications

Management of older adults with multiple myeloma

Management of older adults with multiple myeloma

An international, multicenter, prospective, observational study of neutropenia in patients being treated with lenalidomide + dexamethasone for relapsed or relapsed/refractory multiple myeloma (RR‐MM)

A Rare Occurrence of Plasma Cell Myeloma with Biclonal Gammopathy

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