Timing treatment for smoldering myeloma: is earlier better?

Hernández, José-Ángel; Martínez‐López, Joaquín; Lahuerta, Juan-José

doi:10.1080/17474086.2019.1599281

Cited by 4 publications

(3 citation statements)

References 58 publications

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“…Although it should be confirmed in larger series, our results suggest that Ratio-PA could be helpful in the clinical management of SMM patients. Excluding ultra-highrisk SMM patients (risk of progression >80% in the first two years) who should be diagnosed as symptomatic MM [38,39], the optimal time to treat SMM patients remains controversial [40][41][42]. In our series, Ratio-PA high identified 29.8% of SMM patients with 35.3% 10y-PFS who could have benefited from an early treatment, [43] since safer and more effective therapies are now available.…”

Section: Discussionmentioning

confidence: 91%

Proliferation to Apoptosis Tumor Cell Ratio as a Biomarker to Improve Clinical Management of Pre-Malignant and Symptomatic Plasma Cell Neoplasms

Vasco-Mogorrón

Campillo

Periago

et al. 2021

IJMS

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Proliferation and apoptosis of neoplastic cells are prognostic biomarkers in plasma cell neoplasms (PCNs). The prognostic capacity of proliferation to apoptosis ratio (Ratio-PA) in the era of immunomodulatory treatments is re-evaluated in 316 gammopathy of undetermined significance (MGUS), 57 smoldering multiple myeloma (SMM), and 266 multiple myeloma (MM) patients. Ratio-PA of 0.77 ± 0.12, 1.94 ± 0.52, and 11.2 ± 0.7 (p < 0.0001) were observed in MGUS, SMM, and MM patients. Ten-year overall survival (10y-OS) rates for patients with low/high Ratio-PA were 93.5%/77.3% p < 0.0001) for MGUS, 82.5%/64.7% (p < 0.05) for SMM, and 62.3%/47.0% (p < 0.05) for MM. For patients with low, intermediate, and high risk, 10y-OS for low/high Ratio-PA were 95.5%/72.9% (p < 0.0001), 74.2%/50.4% (p < 0.0001), and 35.3%/20.0% (p = 0.836), respectively. Ratio-PA was an independent prognostic factor for OS (HR = 2.119, p < 0.0001, Harrell-C-statistic = 0.7440 ± 0.0194) when co-analyzed with sex, age, and standard risk. In patients with Ratio-PAhigh, only first-line therapy with VRd/VTd, but not PAD/VCD, coupled with ASCT was associated with high 10y-OS (82.7%). Tumor cell Ratio-PA estimated at diagnosis offers a prognostic biomarker that complements standard risk stratification and helps to guide the clinical management of pre-malignant and symptomatic PCNs. Every effort should be made to provide first-line therapies including VTd or VRd associated with ASCT to patients with Ratio-PAhigh at higher risk of progression and death.

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Section: Discussionmentioning

confidence: 91%

Proliferation to Apoptosis Tumor Cell Ratio as a Biomarker to Improve Clinical Management of Pre-Malignant and Symptomatic Plasma Cell Neoplasms

Vasco-Mogorrón

Campillo

Periago

et al. 2021

IJMS

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“…Therefore, recovery of renal function depends on early initiation of chemotherapeutic agents and other supportive measures to reduce ongoing damage from free light chains. In a recent paper [33], the prevalence of renal impairment in a large group of patients with smoldering myeloma (n = 1135) was 20%, at presentation; however, renal function in a large proportion of the patients (54%) improved after antimyeloma induction therapy.…”

Section: Oncology-related Reasonsmentioning

confidence: 97%

Acute Kidney Injury in Oncology Patients

Wang

Diao

et al. 2020

J. Cancer

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With rapid progress in cancer diagnosis and treatment in the last two decades, outcomes in oncological patients have improved significantly. However, the incidence of acute kidney injury (AKI) in this population has also increased significantly. AKI complicates many aspects of patients' care and adversely affects their prognoses; thus, accurately diagnosing the risk factors for AKI ensures appropriate management. AKI may be caused by pre-renal, intrinsic renal, and post-renal reasons, as well as for combined reasons. This review summarizes the potential etiologies of AKI according to the three classifications. For each underlying cause of AKI, the cancer itself and/or cancer treatment may contribute to a patient developing AKI. Therefore, we present disease-and treatment-related factors for each cause category, with special focus on immune checkpoint inhibitors, which are being used increasingly more often. It is important for nephrology services to be knowledgeable to provide the best level of care.

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“…In 2014, the International Myeloma Working Group (IMWG) published updated MM diagnostic criteria classifying some previously defined SMM patients as active MM, for which they receive myeloma treatment. Need for SMM treatment has been the topic of hot debates in the myeloma field, and more evidence is amassing for treating SMM [29][30][31][32]. From this perspective, if there is a suspicion that plasma cell neoplasm may be causing renal impairment, complete or more aggressive workups to establish the diagnosis of MM or MGRS should be performed, as these conditions will require treatment initiation to potentially prevent end organ damage and provide more favorable outcomes.…”

Section: Korean Cancer Associationmentioning

confidence: 99%

Association between Kidney Function, Proteinuria and the Risk of Multiple Myeloma: A Population-Based Retrospective Cohort Study in South Korea

Choi¹,

Ahn²,

Shin³

et al. 2022

Cancer Res Treat

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While renal impairment is one of the first clinical manifestations of multiple myeloma (MM), declined renal function may conversely be a risk factor for cancers including MM. In this study, we investigated the relationship between chronic kidney disease and MM at a population level. Materials and MethodsA total of 9,809,376 adults who participated in a nationwide health screening program and had no MM, cancer or end-stage renal disease at baseline were investigated for incidence of MM.The impact of estimated glomerular filtration rate (eGFR) and random urine dipstick proteinuria, and interactive associations of the two factors on the MM incidence were evaluated. ResultsThe general incidence of MM was 4.8 per 100,000 person-years (mean follow-up of 8.3 years).Participants with eGFR <60 mL/min/1.73m 2 (5.8% of participants) had higher MM incidence than those with eGFR 60 mL/min/1.73m 2 (adjusted hazard ratio [aHR] = 1.29, 95% confidence interval [CI]: 1.17−1.43). When eGFR was graded into five levels, there was a significant inverse dose-response relationship between eGFR level and MM incidence at the lower eGFR levels (reference: eGFR 60−89 mL/min/1.73m 2 ). A dose-response relationship was also found with degree of dipstick proteinuria and incidence of MM. ConclusionAdults with decreased renal function indicated either by decreased eGFR or presence of proteinuria are at a higher risk of developing MM compared to those without, and there is a dose-response relationship between the severity of renal impairment and MM incidence.

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Timing treatment for smoldering myeloma: is earlier better?

Cited by 4 publications

References 58 publications

Proliferation to Apoptosis Tumor Cell Ratio as a Biomarker to Improve Clinical Management of Pre-Malignant and Symptomatic Plasma Cell Neoplasms

Proliferation to Apoptosis Tumor Cell Ratio as a Biomarker to Improve Clinical Management of Pre-Malignant and Symptomatic Plasma Cell Neoplasms

Acute Kidney Injury in Oncology Patients

Association between Kidney Function, Proteinuria and the Risk of Multiple Myeloma: A Population-Based Retrospective Cohort Study in South Korea

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