Multiple Myeloma, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology

Kumar, Shaji; Callander, Natalie S.; Adekola, Kehinde; Anderson, Larry D.; Baljevic, Muhamed; Campagnaro, Erica; Castillo, Jorge J.; Chandler, Jason C.; Costello, Caitlin; Efebera, Yvonne A.; Faiman, Matthew; Garfall, Alfred L.; Godby, Kelly N.; Hillengaß, Jens; Holmberg, Leona; Htut, Myo; Huff, Carol Ann; Kang, Yubin; Hultcrantz, Malin; Larson, Sarah; Liedtke, Michaela; Martin, Thomas G.; Omel, James; Shain, Kenneth H.; Sborov, Douglas W.; Stockerl-Goldstein, Keith; Weber, Donna M.; Keller, Jennifer; Kumar, Rashmi

doi:10.6004/jnccn.2020.0057

Cited by 175 publications

(165 citation statements)

References 189 publications

(295 reference statements)

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“…The NCCN guidelines have added bortezomib-based maintenance therapy as an option for patients with or without ASCT ( 25 ). In PI maintenance therapy, the PCD regimen was the most adopted option, due to its greater efficacy, fewer adverse reactions, lower cost, and convenience to administer.…”

Section: Discussionmentioning

confidence: 99%

Different Patient Subgroup Different Maintenance, Proteasome Inhibitors or Immunomodulators Maintenance for Newly Diagnosed Multiple Myeloma: A 7-Year Single-Center Data in China

et al. 2021

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IntroductionWe analyzed different patient subgroups to determine optimal maintenance therapy in newly diagnosed multiple myeloma (NDMM) patients.MethodsA total of 226 NDMM patients in our center were included in the study. The characteristics, survival, and adverse reactions were compared among patients who received maintenance therapy or not, and patients who received proteasome inhibitors (PIs) or immunomodulators (IMiDs) maintenance. The survival of different maintenance durations of bortezomib-based regimens was also analyzed.ResultsThe maintenance therapy not only upgraded more patient responses (34.3 vs 13.3%, P = 0.006), but also significantly prolonged their progression-free survival (PFS) (median PFS: 41.1 vs 10.5 months, P < 0.001) and overall survival (OS) (median OS: not reached vs 38.6 months, P < 0.001). Compared with IMiDs, the PFS (median PFS: 43.7 vs 38.5 months, P = 0.034) and OS (median OS: not reached vs 78.5 months, P = 0.041) were both enhanced by PIs maintenance. Patients younger than 65 years who received PIs had a significantly prolonged OS (P = 0.032). Patients achieving only a partial response (PR) after induction and consolidation therapy had significantly longer PFS and OS after PIs maintenance compared to IMiDs (P = 0.007, 0.002). High-risk patients (ISS 2–3, DS 2–3, and RISS 2–3) given PIs maintenance benefit from a prolonged PFS (P = 0.002, 0.02, 0.06) and OS (P = 0.059, 0.047, 0.044, respectively) compared with IMiDs therapy. OS was significantly prolonged in patients who received ≥ 12 months of bortezomib-based maintenance therapy compared to those who were treated for < 12 months (P < 0.001), but no difference was observed in OS between patients who received 12 to 24 or ≥ 24 months of bortezomib-based maintenance therapy (P = 0.292).ConclusionPIs maintenance was superior to IMiDs in overall PFS and OS. The beneficial effect was most evident in patients achieving PR after induction and consolidation therapy, and in high-risk patients. Moreover, younger patients also benefited from PIs maintenance with an increased OS. A bortezomib-based maintenance therapy duration of 12 to 24 months after induction and consolidation therapy produced satisfactory OS.

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Section: Discussionmentioning

confidence: 99%

Different Patient Subgroup Different Maintenance, Proteasome Inhibitors or Immunomodulators Maintenance for Newly Diagnosed Multiple Myeloma: A 7-Year Single-Center Data in China

et al. 2021

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“…The diagnosis depends on the presence of clonal plasma cells in the bone marrow or in a biopsy-proven bone or plasmacytoma (2,15). Our patient presented with multiple vertebral compression fractures, anemia and clonal plasma cells in the bone marrow at diagnosis.…”

Section: Discussionmentioning

confidence: 91%

“…Regarding therapy, there has been a breakthrough in the treatment of MM over the past few years, which presently can rely on new therapies involving immunomodulators or proteasome inhibitors. According to the National Comprehensive Cancer Network, patients with MM should be treated including induction therapy with three drug regimens, including bortezomib/lenalidomide/dexamethasone, bortezomib/ doxorubicin/dexamethasone, and bortezomib/cyclophosphamide/ dexamethasone, plus hematopoietic stem cell transplantation (SCT) for patients under the age of 65 years who do not have substantial heart, lung, renal, or liver dysfunction (1,2,15). Although the majority of the population are not good candidates of ASCT in adults, ASCT after primary therapy has been standard of care of MM.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple myeloma (MM) is a neoplastic disorder of B-cell origin caused by clonal proliferation of malignant plasma cells in bone marrow (1). The monoclonal protein, the malignant cells or cytokines secreted by the malignant proliferating myeloma cells lead to end-organ damage, such as bone destruction, pathologic fractures, renal insufficiency, anemia, and hypercalcemia (2). MM accounts for approximately 1% of all neoplastic diseases and the median age at diagnosis is approximately 70 years (3,4).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Multiple Vertebral Compression Fractures in 14-Year-Old Children With Multiple Myeloma

Wang

Zhang

et al. 2021

Front. Oncol.

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Multiple myeloma (MM) is a neoplastic disorder characterized by clonal proliferation of malignant plasma cells derived from B cells in bone marrow. Pediatric MM is rare with only approximately 0.3% of cases diagnosed before the age of 30. In this report, we present a 14 years old boy diagnosed as MM with multiple pathologic vertebral fractures. To our knowledge, our patient is the youngest Chinese case in the literature to present with MM. He was treated with bortezomib, dexamethasone, and cyclophosphamide followed by autologous hematopoietic stem cell transplantation with good clinical response. We hope to aid in the understanding of the pathophysiology and management of this condition.

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“…The major classes include alkylating agents (melphalan andcyclophosphamide), corticosteroids (dexamethasone andprednisone), immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), and proteasome inhibitors (bortezomib, carfilzomib, andixazomib) [ 1 ]. The treatment paradigm in MMis evolving with the introduction of various immunotherapies [ 2 ]. First came the monoclonal antibodies (mAbs), which represented a paradigm shift in treating all MM stages [ 3 , 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

CART-Cell Therapy: Recent Advances and New Evidence in Multiple Myeloma

Martino

Canale

Alati

et al. 2021

Cancers

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Despite the improvement in survival outcomes, multiple myeloma (MM) remains an incurable disease. Chimeric antigen receptor (CAR) T-cell therapy targeting B-cell maturation antigen (BCMA) represents a new strategy for the treatment of relapsed/refractory MM (R/R). In this paper, we describe several recent advances in the field of anti-BCMA CAR T-cell therapy and MM. Currently, available data on anti-BCMA CART-cell therapy has demonstrated efficacy and manageable toxicity in heavily pretreated R/R MM patients. Despite this, the main issues remain to be addressed. First of all, a significant proportion of patients eventually relapse. The potential strategy to prevent relapse includes sequential or combined infusion with CAR T-cells against targets other than BCMA, CAR T-cells with novel dual-targeting vector design, and BCMA expression upregulation. Another dark side of CART therapy is safety. Cytokine release syndrome (CRS) andneurologic toxicity are well-described adverse effects. In the MM trials, most CRS events tended to be grade 1 or 2, with fewer patients experiencing grade 3 or higher. Another critical point is the extended timeline of the manufacturing process. Allo-CARs offers the potential for scalable manufacturing for on-demand treatment with shorter waiting days. Another issue is undoubtedly going to be access to this therapy. Currently, only a few academic centers can perform these procedures. Recognizing these issues, the excellent response with BCMA-targeted CAR T-cell therapy makes it a treatment strategy of great promise.

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Multiple Myeloma, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology

Abstract: Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple myeloma, and newly diagnosed multiple myeloma.

Cited by 175 publications

References 189 publications

Different Patient Subgroup Different Maintenance, Proteasome Inhibitors or Immunomodulators Maintenance for Newly Diagnosed Multiple Myeloma: A 7-Year Single-Center Data in China

Different Patient Subgroup Different Maintenance, Proteasome Inhibitors or Immunomodulators Maintenance for Newly Diagnosed Multiple Myeloma: A 7-Year Single-Center Data in China

Case Report: Multiple Vertebral Compression Fractures in 14-Year-Old Children With Multiple Myeloma

CART-Cell Therapy: Recent Advances and New Evidence in Multiple Myeloma

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