Maintenance Therapy With Immunomodulatory Drugs in Multiple Myeloma: A Meta-Analysis and Systematic Review

Abstract

Thalidomide- or lenalidomide-based maintenance therapy improves PFS but not OS in MM and increases risks of grade 3-4 adverse events, including thromboembolism, peripheral neuropathy, neutropenia, and infection.

A systematic review of health‐related quality of life in longitudinal studies of myeloma patients

“…Maintenance therapy was found to improve progression-free survival and overall survival in MM patients, 65 but was associated with increased risk of grade 3-4 adverse events. 66 Based on this systematic review, data on HRQoL during maintenance treatment are sparse and inconclusive and HRQoL measurement should be a part of future protocols including maintenance therapy.…”

Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis andPneumocystis cariniipneumonia

“…So how does myeloma present? Its clinical presentation covers a wide spectrum of diseases and includes a normocytic, normochromic anaemia in 75% of cases, bone pain in 60% of cases at diagnosis, most commonly affecting the back and chest, with the extremities less frequently involved, fatigue and weight loss 4. In 1/5th of cases, renal failure may be the presenting manifestation, as in our reported case, with light chain nephropathy and hypercalcaemia the main causes.…”

“…The plasma cells proliferate in the bone marrow and often result in extensive skeletal destruction with osteolytic lesions, osteopenia and/or pathological fractures. The median age at presentation is 66 years, with 10% of patients <50 years and 2% <40 years 4. Myeloma presents with non-specific symptoms, thus leading to a delay in diagnosis, ultimately resulting in early morbidity and mortality.…”

“…According to the literature, 97% of patients with multiple myeloma will have a monoclonal (M) protein produced and secreted by the malignant plasma cells, which can be detected by protein electrophoresis of the serum and/or of an aliquot of urine from a 24 hour collection. The malignant plasma cells can produce immunoglobulin heavy chains plus light chains, light chains alone, or neither combined with immunofixation of the serum and urine 4. Urinalysis for myeloma cast nephropathy is typically negative for protein.…”

A case of lenalidomide-dependent myelodysplastic syndrome

“…Myelosuppression was recognized with increased frequency as a significant adverse event in the phase 2 trial of lenalidomide for myeloma 4 and confirmed in subsequent metaanalysis. 5 Toxicity was especially frequent at higher doses in the setting of renal failure. 6 However, unlike alkylating chemotherapy, lenalidomide does not damage DNA, but rather acts through other mechanisms, including by changing protein levels by causing targeted degradation of transcription factors IKZF1 and IKZF3 by direct interaction [7][8][9] or through an oxidationdependent mechanism.…”