The Safety and Efficacy of Radiation Therapy with Concurrent Dexamethasone, Cyclophosphamide, Etoposide, and Cisplatin-Based Systemic Therapy for Multiple Myeloma

Nehlsen, Anthony D.; Sindhu, Kunal K.; Moshier, Erin; Richter, Joshua; Richard, Shambavi; Chari, Ajai; Sanchez, Larysa; Parekh, Samir; Cho, Hearn Jay; Jagannath, Sundar; Dharmarajan, Kavita V.

doi:10.1016/j.clml.2021.09.015

Cited by 5 publications

(2 citation statements)

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“…This raises the question of whether RT leads to a further increase in toxicities, which has been discussed in the literature with unclear results [17][18][19][20]. Evidence is sparse, with some analyses lacking control groups [20] or only investigating typical radiotherapy-associated toxicities without consideration of potential aggravation of (hematological) toxicities due to systemic therapy [19].…”

Section: Discussionmentioning

confidence: 99%

“…This is of pivotal importance, as RT is considered an integral part of treatment strategies for MM even in cases of critical shortage of resources, e.g., during the COVID-19 pandemic [15,16]. Previous retrospective analyses point towards a safe combination of RT and ST, but patient numbers are often limited or evaluations were conducted prior to the introduction of modern therapeutic agents [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Oertel,

Schlusemann,

Shumilov

et al. 2023

Cancers

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Radiotherapy (RT) is an established treatment modality in the management of patients with multiple myeloma (MM), aiming at analgesia and stabilization of osteolytic lesions. As a multifocal disease, the combined use of RT, systemic chemotherapy, and targeted therapy (ST) is pivotal to achieve better disease control. However, adding RT to ST may lead to increased toxicity. The aim of this study was to evaluate the tolerability of ST given concurrently with RT. Overall, 82 patients treated at our hematological center with a median follow-up of 60 months from initial diagnosis and 46.5 months from the start of RT were evaluated retrospectively. Toxicities were recorded from 30 days before RT up to 90 days after RT. 54 patients (65.9%) developed at least one non-hematological toxicity, with 50 patients (61.0%) showing low-grade (grade I or II) and 14 patients (17.1%) revealing high-grade (grade III and IV) toxicities. Hematological toxicities were documented in 50 patients (61.0%) before RT, 60 patients (73.2%) during RT, and 67 patients (81.7%) following RT. After RT, patients who had received ST during RT showed a significant increase in high-grade hematological toxicities (p = 0.018). In summary, RT can be safely implemented into modern treatment regimens for MM, but stringent monitoring of potential toxicities even after completion of RT has to be ensured.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Oertel,

Schlusemann,

Shumilov

et al. 2023

Cancers

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Cisplatin in cancer treatment

Romani

2022

Biochemical Pharmacology

127

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Remineralization Rate of Lytic Lesions of the Spine in Multiple Myeloma Patients Undergoing Radiation Therapy

Zijlstra,

te Velde,

Striano

et al. 2024

Global Spine Journal

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Study Design Retrospective cohort study. Objective In general, Multiple Myeloma (MM) patients are treated with systemic therapy including chemotherapy. Radiation therapy can have an important supportive role in the palliative management of MM-related osteolytic lesions. Our study aims to investigate the degree of radiation-induced remineralization in MM patients to gain a better understanding of its potential impact on bone mineral density and, consequently, fracture prevention. Our primary outcome measure was percent change in bone mineral density measured in Hounsfield Units (Δ% HU) between pre- and post-radiation measurements, compared to non-targeted vertebrae. Methods We included 119 patients with MM who underwent radiotherapy of the spine between January 2010 and June 2021 and who had a CT scan of the spine at baseline and between 3-24 months after radiation. A linear mixed effect model tested any differences in remineralization rate per month (βdifference) between targeted and non-targeted vertebrae. Results Analyses of CT scans yielded 565 unique vertebrae (366 targeted and 199 non-targeted vertebrae). In both targeted and non-targeted vertebrae, there was an increase in bone density per month (βoverall = .04; P = .002) with the largest effect being between 9-18 months post-radiation. Radiation did not cause a greater increase in bone density per month compared to non-targeted vertebrae (βdifference = .67; P = .118). Conclusion Our results demonstrate that following radiation, bone density increased over time for both targeted and non-targeted vertebrae. However, no conclusive evidence was found that targeted vertebrae have a higher remineralization rate than non-targeted vertebrae in patients with MM.

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The Safety and Efficacy of Radiation Therapy with Concurrent Dexamethasone, Cyclophosphamide, Etoposide, and Cisplatin-Based Systemic Therapy for Multiple Myeloma

Cited by 5 publications

References 25 publications

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era

Cisplatin in cancer treatment

Remineralization Rate of Lytic Lesions of the Spine in Multiple Myeloma Patients Undergoing Radiation Therapy

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