State-of-the-Art Management of Complications of Myeloma and Its Treatment

Hartley-Brown, Monique; Sullivan, Daniel M.; Baz, Rachid

doi:10.1155/2010/343089

Cited by 4 publications

(7 citation statements)

References 66 publications

(66 reference statements)

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“…The proliferation of malignant plasma cell clones in patients with multiple myeloma (MM) results in organ dysfunction and bone damage 1 . Despite being rare among cancersrepresenting $1.1% of cases in Europe in 2018 2 -the crude incidence of MM in 2018 in Austria, Belgium, Greece, and Italy per 100,000 people was 6.4, 8.9, 7.3, and 10.2, respectively 2 .…”

Section: Introductionmentioning

confidence: 99%

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A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

Terpos

Jamotte

Christodoulopoulou

et al. 2019

Journal of Medical Economics

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Aim: The approved indication for denosumab (120 mg) was expanded in 2018 to include skeletalrelated event (SRE) prevention in patients with multiple myeloma (MM). Therefore, a cost-effectiveness analysis was conducted comparing denosumab with zoledronic acid (ZA) for SRE prevention in patients with MM from the national healthcare system perspective in a representative sample of European countries: Austria, Belgium, Greece, and Italy. Methods: The XGEVA global economic model for patients with MM was used to calculate incremental cost-effectiveness ratios (ICERs) for denosumab vs ZA over a lifetime horizon. Clinical inputs were derived from the denosumab vs ZA randomized, phase 3 study ("20090482") in patients newly-diagnosed with MM, and comprised real-world adjusted SRE rates, serious adverse event (SAE) rates, treatment duration, dose intensity, progression-free survival (PFS), and overall survival (OS). Economic inputs comprised country-specific denosumab and ZA acquisition and administration costs, SRE and SAE management costs, and discount rates. Health utility decrements associated with MM disease progression, SRE and SAE occurrence, and route of administration were included. Results: Estimated ICERs (cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA in Austria, Belgium, Greece, and Italy were e26,294, e17,737, e6,982, and e27,228, respectively. Using 1-3 times gross domestic product (GDP) per capita per QALY as willingness to pay thresholds, denosumab was 69-94%, 84-96%, 79-96%, and 50-92% likely to be cost-effective vs ZA, respectively. Limitations: Economic inputs were derived from various sources, and time to event inputs were extrapolated from 20090482 study data. Conclusions: Denosumab is cost-effective vs ZA for SRE prevention in patients with MM in Austria, Belgium, Greece, and Italy, based on often-adopted World Health Organization thresholds. This conclusion is robust to changes in model parameters and assumptions. Cost-effectiveness estimates varied across the four countries, reflecting differences in healthcare costs and national economic evaluation guidelines.

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Section: Introductionmentioning

confidence: 99%

“…Lytic bone lesions are a common feature of MM and are associated with substantial morbidity and mortality 1,3 ; most patients ($80-90%) develop lytic bone lesions during the disease course 4 . Lytic bone lesions cause pain and reduce the structural integrity of bone, thereby increasing the risk of skeletal-related events (SREs) 3,5 .…”

Section: Introductionmentioning

confidence: 99%

A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

Terpos

Jamotte

Christodoulopoulou

et al. 2019

Journal of Medical Economics

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Section: Secondary Immunodeficiencies In Lymphoproliferative Malignanmentioning

confidence: 99%

“…To reduce treatment burden, and the subsequent risk of infections, on fragile elderly patients, doses of steroids and chemotherapy should be reduced rather than using short, intensive treatment periods. Prevention of DVT and neuropathy can also reduce the occurrence of infections in MM patients 35,54. For infection prophylaxis in MM patients, UK guidelines currently recommend the following (all grade C recommendations, level IV evidence): vaccination against influenza, S pneumoniae, and H influenzae, but efficacy is not guaranteed; prophylactic immunoglobulin is not routinely recommended but may be useful in a small subset of patients with severe, recurrent bacterial infections and hypogammaglobulinemia; prophylactic aciclovir is recommended for patients receiving bortezomib therapy, following ASCT, or in patients with recurrent herpetic infections 55,56.…”

mentioning

confidence: 99%

Secondary immunodeficiency in lymphoproliferative malignancies

Friman

Winqvist

Blimark

et al. 2016

Hematological Oncology

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Secondary immunodeficiencies occur as a consequence of various diseases, including hematological malignancies, and the use of pharmacological therapies, such as immunosuppressive, anti-inflammatory, and biological drugs. Infections are the main cause of morbidity and mortality in multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) patients. Recent advances in treatment have prolonged the duration of remission and the time between relapse phases in MM and CLL patients. However, managing multiple relapses and the use of salvage therapies can lead to cumulative immunosuppression and a higher risk of infections. The pathogenesis of immune deficiency secondary to lymphoproliferative malignancy is multifactorial including disease- and treatment-related factors. Supportive treatment, including early vaccination, anti-infective prophylaxis, and replacement immunoglobulin, plays a key role in preventing infections in MM and CLL. This article provides an overview of the basic immunology necessary to understand the pathogenesis of secondary immunodeficiency and the infectious complications in MM and CLL. We also discuss the evidence supporting the role of prophylactic replacement immunoglobulin treatment in patients with antibody failure secondary to MM and CLL and the indications for its use. Copyright © 2016 John Wiley & Sons, Ltd.

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A 52-year-old male with multiple myeloma presented to our emergency department due to abrupt swelling of the right side of his scrotum.

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mentioning

confidence: 99%

Scrotal abscess extending into the inguinal canal: A rare complication of multipl myeloma

Özkan

Altınoluk²,

Resim³

et al. 2011

Turk J Hematol

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Infectious complications play a major role in the course of multiple myeloma and often lead to death [1,2]. We report a rare case of multiple myeloma with a scrotal abscess extending into the inguinal region 1 month after completing the first cycle of chemotherapy.A 52-year-old male with multiple myeloma presented to our emergency department due to abrupt swelling of the right side of his scrotum. Genitourinary examination showed a mass on the right side of the scrotum. The area was mildly erythematous and the mass extended into the right groin. Scrotal skin necrosis and decubitus ulcers were not noted. Complete blood count results were as follows: white blood cell count: 15.4×10 9 /L (with 93% segmented neutrophils); Hb: 11 g/dL; Hct: 33.4 %. Biochemical blood test results were normal.Scrotal ultrasonography showed a large fluid collection involving the right scrotal sac that extended into the right inguinal canal. In order to observe the extent of the collection the patient underwent computed tomography (CT), which showed a 13×6×7-

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State-of-the-Art Management of Complications of Myeloma and Its Treatment

Cited by 4 publications

References 66 publications

A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy

Secondary immunodeficiency in lymphoproliferative malignancies

Scrotal abscess extending into the inguinal canal: A rare complication of multipl myeloma

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