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Plasma Cell Neoplasms, A Therapeutic Approach

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Plasma Cell Neoplasms

Abstract

Plasma cell neoplasms represent a spectrum of diseases progressing from monoclonal gammopathy of undetermined significance (MGUS) to asymptomatic multiple myeloma (MM) to symptomatic MM. Significant advances in the management of MM continue to help increase survival and quality of life for patients. Prior to initiating treatment, diagnosis confirmation and risk stratification are crucial, particularly with transplant eligibility as that can direct initial treatment choices. Major drug classes for treating MM have included alkylating agents, anthracyclines, and corticosteroids for years, but immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) have changed the landscape improving responses and outcomes for patients.

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References

  1. Castelli R, Gualtierotti R, Orofino N, Losurdo A, Gandolfi S, Cugno M. Current and emerging treatment options for patients with relapsed myeloma. Clin Med Insights. 2013;7:209–19.

    Article  Google Scholar 

  2. Watanabe R, Tokuhira M, Kizaki M. Current approaches for the treatment of multiple myeloma. Int J Hematol. 2013;97(3):333–44.

    Article  CAS  PubMed  Google Scholar 

  3. Rajkumar SV. IV. Initial treatment of multiple myeloma. Hematol Oncol. 2013;31(Suppl 1):33–7.

    Article  PubMed  Google Scholar 

  4. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003;121(5):749–57.

    Article  Google Scholar 

  5. Pingali SR, Haddad RY, Saad A. Current concepts of clinical management of multiple myeloma. Dis Mon. 2012;58(4):195–207.

    Article  PubMed  Google Scholar 

  6. Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E, et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Clin Oncol (R Coll Radiol). 2004;16(6):405–13.

    Article  Google Scholar 

  7. Dispenzieri A, Gertz MA, Buadi F. What do I need to know about immunoglobulin light chain (AL) amyloidosis? Blood Rev. 2012;26(4):137–54.

    Article  PubMed  Google Scholar 

  8. Chaulagain CP, Comenzo RL. New insights and modern treatment of AL amyloidosis. Curr Hematol Malig Rep. 2013;8(4):291–8.

    Article  PubMed  Google Scholar 

  9. Dispenzieri A. POEMS syndrome: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol. 2014;89(2):213–23.

    Article  Google Scholar 

  10. Mikhael J, Dingli D, Roy V, Reeder C, Buadi F, Hayman S, Dispenzieri A, Fonseca R, Sher T, Kyle RA, Lin Y, Russell SJ, Kumar S, Bergsagel PL, Zeldenrust SR, Leung N, Drake MT, Kapoor P, Ansell SM, Witzig TE, Lust JA, Dalton RJ, Gertz MA, Stewart AK, Rajkumar SV, Chanan-Khan A, Lacy MQ, et al. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013. Mayo Clin Proc. 2013;88(4):360–76.

    Article  PubMed  Google Scholar 

  11. San-Miguel JF, Paiva B, Gutierrez NC. New tools for diagnosis and monitoring of multiple myeloma. Am Soc Clin Oncol Educ Book. 2013;33:313–8.

    Google Scholar 

  12. Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, et al. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia. 2010;24(6):1121–7.

    Article  CAS  PubMed  Google Scholar 

  13. Rajkumar SV, Kyle RA. Treatment of multiple myeloma and related disorders. Cambridge: Cambridge University Press; 2009.

    Google Scholar 

  14. Chng WJ, Dispenzieri A, Chim C-S, Fonseca R, Goldschmidt H, Lentzsch S, Munshi N, Palumbo A, Miguel JS, Sonneveld P, Cavo M, Usmani S, Durie BG, Avet-Loiseau H, et al. IMWG consensus on risk stratification in multiple myeloma. Leukemia. 2014;28(2):269–7.

    Google Scholar 

  15. Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975;36(3):842–54.

    Article  CAS  PubMed  Google Scholar 

  16. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Blade J, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23(15):3412–20.

    Article  PubMed  Google Scholar 

  17. Chesi M, Bergsagel PL. Molecular pathogenesis of multiple myeloma: basic and clinical updates. Int J Hematol. 2013;97(3):313–23.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Feyler S, Selby P, Cook G. Regulating the regulators in cancer-immunosuppression in multiple myeloma (MM). Blood Rev. 2013;27(3):155–164.

    Article  CAS  PubMed  Google Scholar 

  19. Dimopoulos MA, Beksac M, Benboubker L, Roddie H, Allietta N, Broer E, et al. Phase 2 study of bortezomib–dexamethasone alone or with added cyclophosphamide or lenalidomide for sub-optimal response as second-line treatment for patients with multiple myeloma. Haematologica. 2013;98(8):1264–72.

    Google Scholar 

  20. Harousseau JL, Attal M, Avet-Loiseau H, Marit G, Caillot D, Mohty M, et al. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol. 2010;28(30):4621–9.

    Article  CAS  PubMed  Google Scholar 

  21. Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME, et al. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010;11(1):29–37.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Cavo M, Tacchetti P, Patriarca F, Petrucci MT, Pantani L, Galli M, et al. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet. 2010;376(9758):2075–85.

    Article  CAS  PubMed  Google Scholar 

  23. Lonial S, Anderson KC. Association of response endpoints with survival outcomes in multiple myeloma. Leukemia. 2014;28(2):258–68.

    Google Scholar 

  24. Beksac M, Haznedar R, Firatli-Tuglular T, Ozdogu H, Aydogdu I, Konuk N, et al. Addition of thalidomide to oral melphalan/prednisone in patients with multiple myeloma not eligible for transplantation: results of a randomized trial from the Turkish Myeloma Study Group. Eur J Haematol. 2011;86(1):16–22.

    Article  CAS  PubMed  Google Scholar 

  25. Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B, et al. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet. 2007;370(9594):1209–18.

    Article  CAS  PubMed  Google Scholar 

  26. Hulin C, Facon T, Rodon P, Pegourie B, Benboubker L, Doyen C, et al. Efficacy of melphalan and prednisone plus thalidomide in patients older than 75 years with newly diagnosed multiple myeloma: IFM 01/01 trial. J Clin Oncol. 2009;27(22):3664–70.

    Article  CAS  PubMed  Google Scholar 

  27. Palumbo A, Bringhen S, Caravita T, Merla E, Capparella V, Callea V, et al. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet. 2006;367(9513):825–31.

    Article  CAS  PubMed  Google Scholar 

  28. Waage A, Gimsing P, Fayers P, Abildgaard N, Ahlberg L, Björkstrand B, et al. Melphalan and prednisone plus thalidomide or placebo in elderly patients with multiple myeloma. Blood. 2010;116(9):1405–12.

    Article  CAS  PubMed  Google Scholar 

  29. Wijermans P, Schaafsma M, Termorshuizen F, Ammerlaan R, Wittebol S, Sinnige H, et al. Phase III study of the value of thalidomide added to melphalan plus prednisone in elderly patients with newly diagnosed multiple myeloma: the HOVON 49 study. J Clin Oncol. 2010;28(19):3160–6.

    Article  CAS  PubMed  Google Scholar 

  30. San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M, et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008;359(9):906–17.

    Article  CAS  PubMed  Google Scholar 

  31. Mateos M, Oriol A, Martínez-López J, Gutiérrez N, Teruel A, de Paz R, et al. Bortezomib, melphalan, and prednisone versus bortezomib, thalidomide, and prednisone as induction therapy followed by maintenance treatment with bortezomib and thalidomide versus bortezomib and prednisone in elderly patients with untreated multiple myeloma: a randomised trial. Lancet Oncol. 2010;11(10):934–41.

    Article  CAS  PubMed  Google Scholar 

  32. Palumbo A, Hajek R, Delforge M, Kropff M, Petrucci MT, Catalano J, et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med. 2012;366(19):1759–69.

    Article  CAS  PubMed  Google Scholar 

  33. Ludwig H, Durie BG, McCarthy P, Palumbo A, San Miguel J, Barlogie B, et al. IMWG consensus on maintenance therapy in multiple myeloma. Blood. 2012;119(13):3003–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Attal M, Harousseau J, Leyvraz S, Doyen C, Hulin C, Benboubker L, et al. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood. 2006;108(10):3289–94.

    Article  CAS  PubMed  Google Scholar 

  35. Stewart AK, Trudel S, Bahlis NJ, White D, Sabry W, Belch A, et al. A randomized phase III trial of thalidomide and prednisone as maintenance therapy following autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) with a quality of life assessment: NCIC CTG MY. 10 Trial. Blood. 2013;121(9):1517–23.

    Google Scholar 

  36. Morgan GJ, Gregory WM, Davies FE, Bell SE, Szubert AJ, Brown JM, et al. The role of maintenance thalidomide therapy in multiple myeloma: MRC myeloma IX results and meta-analysis. Blood. 2012;119(1):7–15.

    Article  CAS  PubMed  Google Scholar 

  37. McCarthy P, Owzar K, Anderson K, Hofmeister C, Hurd D, Hassoun H. Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous hematopoietic stem cell transplantation (AHSCT) for multiple myeloma: CALGB 100104. Blood. 2010;116(21).

    Google Scholar 

  38. Attal M, Marit G, Caillot D, Facon T, Hulin C, et al. Maintenance treatment with lenalidomide after transplantation for myeloma: final analysis of the IFM 2005–02. Blood. Washington, DC: American Society of Hematology; 2010.

    Google Scholar 

  39. Palumbo A, Bringhen S, Rossi D, Cavalli M, Larocca A, Ria R, et al. Bortezomib–melphalan–prednisone–thalidomide followed by maintenance with bortezomib–thalidomide compared with bortezomib–melphalan–prednisone for initial treatment of multiple myeloma: a randomized controlled trial. J Clin Oncol. 2010;28(34):5101–9.

    Article  CAS  PubMed  Google Scholar 

  40. Mateos M, Richardson PG, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, et al. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol. 2010;28(13):2259–66.

    Article  CAS  PubMed  Google Scholar 

  41. Morris C, Lacobelli S, Brand R, Bjorkstrand B, Drake M, Niederwieser D, et al. Benefit and timing of second transplantations in multiple myeloma: clinical findings and methodological limitations in a European Group for Blood and Marrow Transplantation registry study. J Clin Onco. 2004;22(9):1674–81.

    Article  CAS  Google Scholar 

  42. Richardson PG, Schlossman RL, Weller E, Hideshima T, Mitsiades C, Davies F, et al. Immunomodulatory drug CC-5013 overcomes drug resistance and is well tolerated in patients with relapsed multiple myeloma. Blood. 2002;100(9):3063–7.

    Article  CAS  PubMed  Google Scholar 

  43. Schey S, Ramasamy K. Pomalidomide therapy for myeloma. Expert Opin Investig Drugs. 2011;20(5):691–700.

    Article  CAS  PubMed  Google Scholar 

  44. Mark TM, Coleman M, Niesvizky R. Preclinical and clinical results with pomalidomide in the treatment of relapsed/refractory multiple myeloma. Leuk Res. 2014;38(5):517–24.

    Article  CAS  PubMed  Google Scholar 

  45. Richardson PG, Sonneveld P, Schuster M, Irwin D, Stadtmauer E, Facon T, et al. Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trial. Blood. 2007;110(10):3557–60.

    Article  CAS  PubMed  Google Scholar 

  46. Siegel DS, Martin T, Wang M, Vij R, Jakubowiak AJ, Lonial S, et al. A phase 2 study of single-agent carfilzomib (PX-171-003-A1) in patients with relapsed and refractory multiple myeloma. Blood. 2012;120(14):2817–25.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Richardson P, Schlossman R, Alsina M, Weber D, Coutre S, Gasparetto C, Mukhopadhyay S, Ondovik MS, Khan M, Paley CS, Lonial S, et al. PANORAMA 2: panobinostat in combination with bortezomib and dexamethasone in patients with relapsed and bortezomib-refractory myeloma. Blood. 2013;122(14):2331–7.

    Article  CAS  PubMed  Google Scholar 

  48. Lonial S, Vij R, Harousseau J, Facon T, Moreau P, Mazumder A, et al. Elotuzumab in combination with lenalidomide and low-dose dexamethasone in relapsed or refractory multiple myeloma. J Clin Oncol. 2012;30(16):1953–9.

    Article  CAS  PubMed  Google Scholar 

  49. Ocio EM, Richardson PG, Rajkumar SV, Palumbo A, Mateos MV, Orlowski R, Kumar S, Usmani S, Roodman D, Niesvizky R, Einsele H, Anderson KC, Dimopoulos MA, Avet-Loiseau H, Mellqvist UH, Turesson I, Merlini G, Schots R, McCarthy P, Bergsagel L, Chim CS, Lahuerta JJ, Shah J, Reiman A, Mikhael J, Zweegman S, Lonial S, Comenzo R, Chng WJ, Moreau P, Sonneveld P, Ludwig H, Durie BG, San Miguel JF, et al. New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the international myeloma working group (imwG). Leukemia. 2014;28(3):525–42.

    Google Scholar 

  50. Lentzsch S, O’Sullivan A, Kennedy RC, Abbas M, Dai L, Pregja SL, et al. Combination of bendamustine, lenalidomide, and dexamethasone (BLD) in patients with relapsed or refractory multiple myeloma is feasible and highly effective: results of phase 1/2 open-label, dose escalation study. Blood. 2012;119(20):4608–13.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Anderson KC, Alsina M, Bensinger W, Biermann JS, Cohen AD, Devine S, et al. NCCN guidelines multiple myeloma version 2.2014. J Natl Compr Cancer Netw. 2014:2/1/2014.

    Google Scholar 

  52. Durie B, Harousseau J, Miguel J, Blade J, Barlogie B, Anderson K, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006;20(9):1467–73.

    Article  CAS  PubMed  Google Scholar 

  53. Ludwig H, Miguel J, Dimopoulos M, Palumbo A, Sanz RG, Powles R, et al. International Myeloma Working Group recommendations for global myeloma care. Leukemia. 2014;28(5):981–92.

    Google Scholar 

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Correspondence to Sagar S. Patel MD .

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McClune, B., Patel, S. (2016). Plasma Cell Neoplasms, A Therapeutic Approach. In: Linden, M., McKenna, R. (eds) Plasma Cell Neoplasms. Springer, Cham. https://doi.org/10.1007/978-3-319-10918-3_7

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  • DOI: https://doi.org/10.1007/978-3-319-10918-3_7

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