Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Moreau, Philippe; Miguel, Jesús F. San; Ludwig, Heinz; Schouten, Harry C.; Mohty, Mohamad; Dimopoulos, Meletios Α.; Dreyling, Martin

doi:10.1093/annonc/mdt297

Cited by 337 publications

(355 citation statements)

References 31 publications

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“…It typically affects the elderly population, with the median age at diagnosis being 70 years. 1,2 Cardiovascular disease is one of the most frequent comorbidities in MM patients, 3 being the main cause of death in western countries. 4 Since the global population is aging, the prevalence of both MM and cardiovascular disease is expected to increase in the near future.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular adverse events in modern myeloma therapy – Incidence and risks. A review from the European Myeloma Network (EMN) and Italian Society of Arterial Hypertension (SIIA)

et al. 2018

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Cardiovascular disease in patients with multiple myeloma may derive from factors unrelated to the disease (age, diabetes, dyslipidemia, obesity, prior cardiovascular diseases), related to the disease (cardiac AL-amyloidosis, hyperviscosity, high-output failure, arteriovenous shunting, anemia, renal dysfunction) and/or related to anti-myeloma treatment (anthracyclines, corticosteroids, alkylating agents, immunomodulatory drugs, proteasome inhibitors). Good knowledge of cardiovascular events, effective dose reductions, prevention and management of early and late cardiovascular side effects of chemotherapeutic agents are essential in current clinical practice. Myeloma experts are obliged to carefully balance the efficacy and toxicity of drugs for each individual patient. This review summarizes current data and novel insights into cardiovascular adverse events of today’s anti-myeloma treatment, focusing on carfilzomib, as a starting point for developing consensus recommendations on preventing and managing cardiovascular side effects in patients with multiple myeloma.

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Section: Introductionmentioning

confidence: 99%

Cardiovascular adverse events in modern myeloma therapy – Incidence and risks. A review from the European Myeloma Network (EMN) and Italian Society of Arterial Hypertension (SIIA)

et al. 2018

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“…Multiple myeloma (MM) is a malignant clonal plasma cell dyscrasia which accounts for 1% of all new-onset tumors and 10% of hematological malignancies [1]. Although treatment for MM has improved greatly in the last decade, the disease is not yet curable due to recurrent relapse and drug resistance.…”

Section: Introductionmentioning

confidence: 99%

Epinephrine Stimulates Cell Proliferation and Induces Chemoresistance in Myeloma Cells through the β-Adrenoreceptor in vitro

Yu¹,

Zhuang²

2017

Acta Haematol

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Objectives: To explore the effect of the β-adrenoreceptor signaling pathway on myeloma cells. Methods: The myeloma U266 cell line was treated with epinephrine and propranolol. Cell proliferation was analyzed by MTS assay. Apoptosis was detected by flow cytometry. The β-receptor subtype and the key enzyme of epinephrine were identified by reverse transcription polymerase chain reaction (RT-PCR). Results: Epinephrine (5-50 μM) promoted U266 cell growth in a dose-dependent manner and neutralized the inhibition effect of bortezomib (25 and 50 ng/mL) in vitro. Cell proliferation was inhibited by a β-receptor antagonist, propranolol, at a concentration of 50-200 μM. The proportions of early and late apoptotic cells were enhanced after treatment with propranolol. The expression of caspase 3/7, 8, and 9 was elevated in propranolol-treated myeloma cells. Both β₁- and β₂-adrenoceptor mRNAs were expressed in the U266 cell line. Key enzymes dopamine hydroxylase and tyrosinehydroxylase were identified in myeloma cells. Conclusions: Our results reveal that epinephrine stimulates myeloma cell growth in vitro while the β-blocker propranolol has an antiproliferative effect, indicating that stress hormones may trigger the progression of myeloma.

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“…The day diagnosis of MM was confirmed, induction chemotherapy with VCD was initiated according to standard protocol with bortezomib 1.3 mg/m 2 subcutaneously on days 1, 4, 8 and 11, cyclophosphamide 500 mg/m 2 intravenously on days 1 and 8 and dexamethasone orally 40 mg per day on days 1+2, 4+5, 8+9 and 11+12 12. For anuric acute renal failure, postdilution haemodialysis was performed during the first cycle VCD three times per week.…”

Section: Treatmentmentioning

confidence: 99%

From carcinoma through lymphoma to myeloma: a gastric mass diagnostic rollercoaster ride

Schmid

Kopfstein²

2018

BMJ Case Reports

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We describe a dramatic clinical presentation of extramedullary multiple myeloma (MM) in an elderly patient with known monoclonal gammopathy of unknown significance (MGUS). Gastrointestinal symptoms and a gastric mass on imaging studies suggested an advanced solid gastric malignancy. Pathological workup of gastric biopsies first suspected a lymphoma, a second opinion finally confirmed an extramedullary MM. Treatment with bortezomib, cyclophosphamide and dexamethasone induced rapid relief of symptoms and normalisation of renal function as well as serum MM markers. Our case highlights the diagnostic difficulties when MM presents with signs and symptoms of respective end-organ involvement rather than typical 'CRAB' criteria. It underlines the importance of actively considering MM in a patient with MGUS, regardless of the clinical presentation of a specific medical problem. Our report also impressively illustrates the rapid response of MM and its gastric extramedullary manifestation to guideline-adherent chemotherapy.

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Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 337 publications

References 31 publications

Cardiovascular adverse events in modern myeloma therapy – Incidence and risks. A review from the European Myeloma Network (EMN) and Italian Society of Arterial Hypertension (SIIA)

Cardiovascular adverse events in modern myeloma therapy – Incidence and risks. A review from the European Myeloma Network (EMN) and Italian Society of Arterial Hypertension (SIIA)

Epinephrine Stimulates Cell Proliferation and Induces Chemoresistance in Myeloma Cells through the β-Adrenoreceptor in vitro

From carcinoma through lymphoma to myeloma: a gastric mass diagnostic rollercoaster ride

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