Interdisciplinary approach to multiple myeloma – time to diagnosis and warning signs

Herget, Georg W.; Kälberer, Felix; Ihorst, Gabriele; Graziani, Giulia; Klein, Lukas; Rassner, Michael; Gehler, Christian; Jung, Johannes; Schmal, Hagen; Wäsch, Ralph; Engelhardt, Monika

doi:10.1080/10428194.2020.1849681

Cited by 7 publications

(3 citation statements)

References 31 publications

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“…Previous findings support the observation that pain and sensory loss are very frequent, and that bladder and sphincter dysfunction coincide with more advanced cancers involving spinal metastases [20]. The awareness on the part of physicians and patients is, therefore, crucial to ensure a timely diagnosis and consequent treatment [21].…”

Section: Symptomssupporting

confidence: 65%

Does the Pathologic Fracture Predict Severe Paralysis in Patients with Metastatic Epidural Spinal Cord Compression (MESCC)?—A Retrospective, Single-Center Cohort Analysis

Klein

Herget

Ihorst

et al. 2023

JCM

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Currently, there is uncertainty about the predictive factors for metastatic epidural spinal cord compression (MESCC) and consecutive symptomatology in tumor patients. Prognostic algorithms for identifying patients at risk for paralysis are missing. The influence of the pathologic fracture on the patient’s symptoms is widely discussed in the literature and we hypothesize that pathologic fractures contribute to spinal cord compression and are therefore predictive of severe paralysis. We tested this hypothesis in 136 patients who underwent surgery for spinal metastases. The most common primary cancers were prostate (24.3%, n = 33), breast (11.0%, n = 15), lung (10.3%, n = 14), and cancer of unknown primary (10.3%, n = 14). MESCC primarily affected the thoracic (77.2%, n = 105), followed by the lumbar (13.2%, n = 18) and cervical (9.6%, n = 13) spine. Pathologic fractures occurred in 63.2% (n = 86) of patients, mainly in osteolytic metastases. On the American spinal injury association (ASIA) impairment scale (AIS), 63.2% (n = 86) of patients exhibited AIS grade D and 36.8% (n = 50) AIS grade C-A preoperatively. The presence of a pathologic fracture alone did not predict severe paralysis (AIS C-A, p = 0.583). However, the duration of sensorimotor impairments, patient age, spinal instability neoplastic score (SINS), and the epidural spinal cord compression (ESCC) grade together predicted severe paralysis (p = 0.006) as did the ESCC grade 3 alone (p = 0.028). This is in contrast to previous studies that stated no correlation between the degree of spinal cord compression and the severity of neurologic impairments. Furthermore, the high percentage of pathologic fractures found in this study is above previously reported incidences. The risk factors identified can help to predict the development of paralysis and assist in the improvement of follow-up algorithms and the timing of therapeutic interventions.

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Section: Symptomssupporting

confidence: 65%

Does the Pathologic Fracture Predict Severe Paralysis in Patients with Metastatic Epidural Spinal Cord Compression (MESCC)?—A Retrospective, Single-Center Cohort Analysis

Klein

Herget

Ihorst

et al. 2023

JCM

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“…The low index of suspicion for MM among primary care clinicians results in the patients "initial symptoms" being ignored or missed [13]. This is evident in the prolonged time to diagnosis that appears to cross the socio-economic divide and the recurring sentiment to put effort into shortening time to presentation and diagnosis in MM [47][48][49][50]. Whilst a week to diagnosis is impossible, future prospective studies may assist in deciding on the most reasonable duration to presentation and more importantly, how to achieve a quicker diagnostic algorithm.…”

Section: Plos Onementioning

confidence: 99%

Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa

Chili,

Mackraj,

Rapiti

2023

PLoS ONE

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Objectives To profile the outcome of multiple myeloma (MM) patients treated at a South African tertiary hospital in KwaZulu-Natal (KZN) and to compare MM in HIV-negative patients and MM in people living with HIV (PLWH). Methods A retrospective analysis of patients with MM was conducted over 5 years (2015–2020). Patient demographics, presenting complaints, symptom duration, disease stage, molecular profile, treatment, and survival data were captured. Statistical analysis was conducted using R Statistical software of the R Core Team, 2020, version 3.6.3. Results 135 patients; 79% (n = 106) HIV-negative and 21% (n = 29) PLWH were investigated. 54% (n = 74) females and 57% (n = 76) 51–70-year-olds. The 40-50-year-old patient group had a significantly higher proportion of PLWH (p = 0.032). Pathological fractures were the commonest presenting complaint, 47% (n = 57 and 49% (n = 49) had International Staging System, stage III disease. Fluorescent in-situ hybridization (FISH) MM profiling was completed in 58% (n = 78). Positivity for del 11q22 was found in 23.7% (n = 14) with significantly more HIV-negative patients having the mutation (p = 0.027). Overall, 42.2% (n = 57) achieved 2-year overall survival (OS). There were no significant differences in treatment (p = 0.926) and 2-year survival outcome (p = 0.792) between the two groups. Conclusion The incidence of HIV in newly diagnosed MM patients in KZN was increasing. KZN patient profile differed from other reports by showing female predominance but was similar in advanced-stage presentation and bone fracture predominance. Statistically significant differences between the HIV-negative patients and PLWH were observed in age distribution and mutational landscape. Further studies are required in this area.

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“…Since most myeloma patients suffer from osteolytic lesions, bisphosphonates or denosumab should be administered regularly [91]. Medical care of myeloma patients with skeletal lesions should include close collaboration with radiologists, orthopedists and radiation oncologists [6,45,[91][92][93][94].…”

Section: Supportivesmentioning

confidence: 99%

Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors

Gengenbach

Graziani

Reinhardt

et al. 2021

Cancers

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Treatment of relapsed/refractory multiple myeloma (RRMM) is more complex today due to the availability of novel therapeutic options, mostly applied as combination regimens. immunotherapy options have especially increased substantially, likewise the understanding that patient-, disease- and treatment-related factors should be considered at all stages of the disease. RRMM is based on definitions of the international myeloma working group (IMWG) and includes biochemical progression, such as paraprotein increase, or symptomatic relapse with CRAB criteria (hypercalcemia, renal impairment, anemia, bone lesions). When choosing RRMM-treatment, the biochemical markers for progression and severity of the disease, dynamic of disease relapse, type and number of prior therapy lines, including toxicity and underlying health status, need to be considered, and shared decision making should be pursued. Objectively characterizing health status via geriatric assessment (GA) at each multiple myeloma (MM) treatment decision point has been shown to be a better estimate than via age and comorbidities alone. The well-established national comprehensive cancer network, IMWG, European myeloma network and other national treatment algorithms consider these issues. Ideally, GA-based clinical trials should be supported in the future to choose wisely and efficaciously from available intervention and treatment options in often-older MM adults in order to further improve morbidity and mortality.

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Interdisciplinary approach to multiple myeloma – time to diagnosis and warning signs

Cited by 7 publications

References 31 publications

Does the Pathologic Fracture Predict Severe Paralysis in Patients with Metastatic Epidural Spinal Cord Compression (MESCC)?—A Retrospective, Single-Center Cohort Analysis

Does the Pathologic Fracture Predict Severe Paralysis in Patients with Metastatic Epidural Spinal Cord Compression (MESCC)?—A Retrospective, Single-Center Cohort Analysis

Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa

Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors

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