New proteasome inhibitors in the treatment of multiple myeloma

Abstract

The treatment of patients with relapsed and/or refractory multiple myeloma has improved considerably in the last 15 years, after the introduction of proteasome inhibitors and immunomodulatory drugs. The first clinical trials with new proteasome inhibitors have produced exciting results, particularly those comparing triplet regimens with standard doublet regimens, with a gain in progression-free survival accompanied by an acceptable safety profile and either similar or better health-related quality of life. New proteasome inhibitors hold the potential to fill unmet needs in multiple myeloma management regarding improvement of clinical outcomes, including delayed progression of disease in high-risk patients. This review summarizes the main pharmacological properties and clinical outcomes of these agents, and discusses their potential to change the whole multiple myeloma therapeutic landscape.

Standardization of sampling and sample preparation for analysis of human monocyte subsets in peripheral blood

“…The beneficial effect against myeloma was detected two decades ago, and both thalidomide and its analogues, lenalidomide and pomalidomide, are currently used in myeloma treatment [369][370][371][372]. These drugs have antiangiogenic, immunomodulatory, anti-inflammatory, and antiproliferative effects [371,372], and they are typically used in combination with steroids or proteasome inhibitors in myeloma treatment [373].…”

Potential diagnostic value of circulating miRNA for multiple myeloma: A meta-analysis

“…The onset of MM is a gradual evolutionary process, from the initial monoclonal gammopathy of undetermined significance (MGUS) to smoldering MM, intramedullary MM, and finally to non-bone marrow MM / plasma cell leukemia (PCL) [6] , [7] . Despite the advent of multiple targeted new drugs such as immunomodulatory drugs (IMiDs) [8] and proteasome inhibitors (PI) [9] , which have greatly improved the quality of life of patients with MM, some patients have been affected by cytogenetic abnormalities and changes in the bone marrow microenvironment, and malignant transformation of plasma cells has occurred, causing MGUS to progress to MM [10] . As the traditional gold standard for diagnosing MM, bone marrow biopsy may not be accepted by all patients, because of its invasive injury that causes pain for patients, and the condition may have reached an advanced stage.…”

Use of an Extremely Biodiverse Probiotic and a Supplement Based on Microbial Chondroitin Sulfate is Associated with a Significant Decrease of Serum Free Kappa Light Chains as well as a Trend Toward Normalization of Kappa/Lambda Ratio and of Plasma Cell Bone Marrow Infiltration in a Case of Multiple Myeloma

“…Multiple myeloma is considered an incurable hematologic neoplasia often requiring multiple sequential therapeutic regimens that have to be constantly tailored to the changing patient's conditions (Rajkumar et al, 2016). The standard of care for patients over 65 years and/or patients with serious concurrent chronic diseases is represented by chemotherapy with prednisone and melphalan or, more recently, with proteasome inhibitors (Hungria et al, 2019). An obstacle to chemotherapy of multiple myeloma is represented by renal insufficiency, a condition that is common in these patients and can often limit the choice of therapy (Mikhael et al, 2018).…”