Sorrig R, Klausen TW, Salomo M, Vangsted A, Gimsing P. Risk factors for infections in newly diagnosed Multiple Myeloma patients: A Danish retrospective nationwide cohort study. First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab. The evolutionary biology leading to SMM. HOVON/Dutch Federation of Hematology. Many agents that are being evaluated against SARS-CoV-2, including antivirals, (hydroxy)chloroquine, azithromycin and remdesivir, may have significant interactions with other drugs and may result in significant hepatic, cardiac or renal toxicity [18, 63, 64]. Patients with a history of neutropenias and/or recurrent infections should receive prophylactic GCSF injections. Rajkumar SV. Diagnostic workup, risk stratification, and management of SMM. Carfilzomib, lenalidomide, and dexamethasone (KRD)based early-intervention approaches with reported preliminary data have shown deep responses; the GEM-CESAR trial reported a postconsolidation minimal residual disease negative (MRD) rate of 57%, and a nontransplant approach showed an MRD complete response (CR) rate of 70%.45,47 Although these responses are promising, the utility of an MRD end point and impact of acute and long-term toxicities of intensive therapy remain to be seen. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. Recommendations from national regulatory agencies for ongoing cancer trials during the COVID-19 pandemic. High-dose melphalan supported by autologous transplantation has been the standard of care for eligible patients with newly diagnosed multiple myeloma (MM) for >25 years. Bone marker-directed dosing of zoledronic acid for the prevention of skeletal complications in patients with multiple myeloma: results of the Z-MARK study. Currently, there remains no clear consensus regarding optimal management of high-risk SMM. Orthopedic treatment of impeding fractures and radiotherapy for palliation of pain unresponsive to analgesics should not be postponed [40]. [Epub ahead of print]. Willan J, King AJ, Hayes S, Collins GP, Peniket A. Even self-made cloth masks have been proposed to be used for the entire community in several countries, when distancing cannot be achieved, especially in not open-air areas. Moreau P, Attal M, Hulin C, Arnulf B, Belhadj K, Benboubker L, et al. Print Diagnosis Sometimes multiple myeloma is diagnosed when your doctor detects it accidentally during a blood test for some other condition. Version vom 15. Lakshman A, Rajkumar SV, Buadi FK, Binder M, Gertz MA, Lacy MQ, et al. as shown by agents such as IMiD which remain active against MM even in . These CBD candies offer a simple and flexible . 10.1016/j.jacc.2020.04.016. ASCT, autologous stem cell transplant; D-KRD, daratumumab, carfilzomib, lenalidomide, and dexamethasone; DRD, daratumumab, lenalidomide, and dexamethasone; D-VRD, daratumumab, lenalidomide, dexamethasone; FACT-G, functional assessment of cancer therapy-general; IV, intravenous; ORR, overall response rate; NGF, next generation flow; PR, partial response. FOIA International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. [Epub ahead of print]. The coronavirus disease 2019 (COVID-19) has been rapidly evolved into a pandemic around the globe, since its emergence as an outbreak in Wuhan, China in late 2019. 10.1158/2159-8290.CD-20-0422. Patient education for personal hygiene and social distancing measures, along with treatment individualization, telemedicine and continuous surveillance for early diagnosis of COVID-19 are essential. HHS Vulnerability Disclosure, Help The adage for smoldering myeloma (SMM) has been to observe without treatment, until criteria for active multiple myeloma were satisfied. In the absence of previous infusion-related reactions, daratumumab may also be safely administered in 90min under close monitoring [39]. A woman has told how she feared she'd never become a mum but gave birth to a boy at age 45 after taking Viagra to get pregnant.. Carin Rockind, 48, welcomed a "miracle" baby after trying to have a . TOUR DATES: 8/03 - Sterling Heights, MI @ Michigan Lottery Amphitheatre at Freedom Hill * 8/04 - Toronto, ON @ Budweiser Stage * 8/05 - Pittsburgh, PA @ Stage AE Outdoors * High dose of steroids and high-dose melphalan with autologous stem cell transplantation (ASCT) further contribute to a immunocompromised state. The https:// ensures that you are connecting to the Changing treatment paradigms for patients with plasma cell myeloma: impact upon immune determinants of infection. Substitution of bortezomib or carfilzomib with ixazomib, in cases of VGPR or better, is not recommended, as it is not supported by clinical studies. Telemedicine and novel technologies for remote communication are endorsed in order to reduce patient visits to the clinic. Patients with anemia who do not respond to treatment or are deteriorating should promptly receive erythropoiesis stimulating agents in order to prevent the need for blood transfusions and the visits to the clinic. At a median follow-up of 35 months, the progression-free survival (PFS) was significantly longer with lenalidomide intervention compared with observation (3-year PFS 91% vs 66%, respectively; HR, 0.28; 95% CI, 0.12-0.62). Moreover, the current drug armamentarium against MM encompasses agents with substantial hematological toxicity, including neutropenia and lymphopenia [10]. The current debate relates to how these patients should be treated. Ther Drug Monit. Progressive changes in the stromal and cellular compartments of the bone marrow microenvironment facilitate expansion of the plasma cell clone and loss of immune surveillance. Federal government websites often end in .gov or .mil. Chari A, Vogl DT, Gavriatopoulou M, Nooka AK, Yee AJ, Huff CA, et al. The companion booklets (Multiple Myeloma Treatment Overview, Multiple Myeloma International Myeloma Society Recommendations for the Management of Myeloma Patients During the COVID-19 Pandemic. JAMA. [Epub ahead of print]. 10.1016/j.jgo.2020.04.008. Barr H, Dempsey J, Waller A, Huang Y, Williams N, Sharma N, et al. 2020. Mateos MV, Nahi H, Legiec W, Grosicki S, Vorobyev V, Spicka I, et al. Active or planned phase 2 and 3 studies for intermediate- and high-risk SMM. Multiple early intervention strategies are being investigated: single vs combination therapy, lower intensity to delay progression to MM vs aggressive multiagent therapy with curative intent. Patients currently participating in clinical trials should continue treatment. A new CAR T cell therapy targeting an antigen called GPRC5D appears to be safe and effective. BUN, blood urea nitrogen; CBC, complete blood count; CrCl, creatinine clearance; IFE, immunofixation; LLN, lower limit of normal; SPEP, serum protein electrophoresis; ULN, upper limit of normal; WBLDCT, whole-body low-dose CT. Cytogenetic and genetic profiling of patients with SMM has provided insight into understanding the variable rates of progression.19 Primary cytogenetic events (trisomies and immunoglobulin heavy chain translocations) are inciting triggers of the aberrant PC in MGUS.20 However, the complexity of the genomic evolution from MGUS to MM is being studied with whole-exome and next-generation sequencing.19,21 Secondary genetic hits such as single-nucleotide variants of the mitogen-activated protein kinase pathway, DNA repair pathway alterations, MYC structural variants/dysregulation, copy number alterations, and translocations occur even at the smoldering stage, with aspects of the genomic architecture similar to MM (Figure 3).19,22-24KRAS, Ig-MYC translocation, DNA pathway alterations, and APOBEC mutations are some of the genomic features associated with shorter time to MM progression.19,22,23 Two main patterns of clonal evolution have been elucidated to drive the progression of SMM.24 Patients with a stable pattern of evolution have a similar genomic landscape as they progress from SMM to MM; essentially, these patients have early MM and develop MDE as the tumor burden increases.24,25 In contrast, in patients with a branching evolutionary pattern, subclones change significantly as they progress from SMM to MM, and the time to progression (TTP) is longer because of the time required to acquire the genetic aberrations leading to overt MM.19,23-25 Epigenetic changes and contribution of the tumor microenvironment add further complexity to SMM progression.26 Dysregulated immune and cellular compartments are seen early in the MGUS phase.27 The immune aberrations continue at the SMM stage, where loss of memory T cells, decreased expression of activation and proliferation markers, and altered MHC II gene expression by CD14+ monocytes create an environment favoring cancer evasion.26-28. Some experts have raised concerns about early intervention leading to selection of resistant PC clones. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Vaccination against influenza and pneumonococci species is highly recommended for all patients. Dr. and transmitted securely. Neutropenia due to lenalidomide or pomalidomide has to be managed according to published recommendations [49]. Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Roden DM, Harrington RA, Poppas A, Russo AM. A computed tomography (CT) skeletal survey shows no lytic lesions, and no osseous lesions are found on whole-body magnetic resonance imaging (MRI). The incidence of SMM increases with age.2,3 The median age of diagnosis is between 62 and 67 years.2,3 SMM is an uncommon entity, with an estimated standardized incidence between 0.4 and 0.9 cases per 100 000 people.2,4 In contrast, MGUS incidence is estimated to be 120 and 60 per 100 000 cases for men and women, respectively, by age 50 years, whereas MM incidence is 7.1 per 100 000 people.5,6, Challenges in accurately determining the epidemiology of SMM arise due to its rarity, underdiagnosis given its asymptomatic nature, and underrepresentation of minorities within public databases.7 In general, black people account for higher proportions of those afflicted at all stages of the monoclonal continuum, followed by Hispanic/LatinX people, whites, and those of east Asian descent.7-9 Furthermore, SMM lacks its own unique International Classification of Diseases diagnostic code and is instead considered under the diagnostic umbrella of MM.3 In a review of the National Cancer Database in the United States, 17% of patients with MM had a diagnosis of SMM.3. In this situation and in cases where the ASCT procedure cannot be postponed according to physicians discretion, exclusion of COVID-19 infection by PCR for SARS-CoV-2 is deemed necessary, along with strict precautions to prevent COVID-19 transmission in the transplantation department. In this blog entry, the MMRF reports on the newest clinical updates on treatment strategies for improving outcomes for patients with newly diagnosed MM, as presented at the 18th International Myeloma Workshop (IMW), held September 8-11 in Vienna, Austria. Multiple myeloma can also affect your bones, leading to bone pain, thinning bones and broken bones. Cortiula F, Pettke A, Bartoletti M, Puglisi F, Helleday T. Managing COVID-19 in the oncology clinic and avoiding the distraction effect. Batch CBD Full-Spectrum Gummies. Patients who are in the maintenance phase of their treatment should continue with their oral therapy and reduce visits to the clinic, whereas subcutaneous bortezomib administration might be omitted or delayed depending on the achieved depth of response and the risk of relapse. Ann Arneson describes her journey to Mayo Clinic as "divine design." Ann a retired teacher, a leader in her church and ministry, mother, grandmother, and line dance enthusiast is Mayo Clinic's first bone marrow transplant patient to recover at home thanks to the new advanced care at home program. The paper describes a current approach for the initial evaluation and workup for patients with putative active myeloma, with consideration towards potential MRD-directed therapeutic approaches and future clinical trials, and then discusses management with a focus on induction regimens with attention primarily to modern three and four-drug combin. 10.1016/j.chest.2020.04.010. Tests and procedures used to diagnose multiple myeloma include: Blood tests. From October 2020 to February 2021, 351 (100%) symptomatic MM pts were treated at the outpatient clinic of the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Czech Republic, with various combinations of novel drugs. Saad Usmani, a hematologic oncologist specializing in multiple myeloma, recently joined Memorial Sloan Kettering Cancer Center (MSK) as Chief of the Myeloma Service. Progression was defined based on the IMWG 2014 diagnostic criteria for MM, as well as the IMWG FLC progression criteria (a 25% increase from nadir in the difference between involved and uninvolved FLC with absolute increase >10mg/dL). Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. As per current guidelines; once started, continue normally with no change of dose/schedule. Bringhen S, Offidani M, Palmieri S, Pisani F, Rizzi R, Spada S, et al. Older age, male gender, obesity and comorbidities, mainly including immune impairment, cardiovascular disease, lung impairment and diabetes, have been repeatedly reported as risk factors among patients with COVID-19 [1, 3, 24, 25]. The overproduction of a monoclonal component consisting of dysfunctional immunoglobulin, along with the suppressed levels of normal immunoglobulin classes, and the dysfunctional cellular and innate immunity, is the basis for the suboptimal immunological response of the host against pathogens. Acyclovir should be prescribed according to local protocols. If anti-myeloma treatment has been started, this might continue for patients with an asymptomatic COVID-19 infection and active myeloma (MM-related symptoms, new diagnosis, recent relapse, suboptimal response to treatment, e.g., less than VGPR), albeit pausing of anti-MM treatment should also be considered as an option. Elens L, Langman LJ, Hesselink DA, Bergan S, Moes D, Molinaro M, et al. 1 The diagnosis of multiple myeloma requires the presence of one or more myeloma defining events (MDE) in addition to evidence of either 10% or more clonal plasma cells on bone marrow examination or a biopsy-. Blimark C, Holmberg E, Mellqvist UH, Landgren O, Bjorkholm M, Hultcrantz M, et al. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. The Mayo Clinic 2018 20/20/2 model includes serum biomarkers (serum FLC ratio >20, serum monoclonal protein >2g/dL) and BM PC burden more than 20% as risk factors.32 The IMWG validated the Mayo Clinic 2018 model with a cohort of 1996 patients, and the 2-year risk of progression to MM or amyloidosis in low-, intermediate-, and high-risk groups was 6%, 18%, and 44%, respectively.33 Risk factors in the older PETHEMA (Programa de Estudio y Tratamiento de las Hemopatas Maligna)model include the presence of immunoparesis and the percentage of PCs with an aberrant immunophenotype.30 However, the requirement for multiparameter flow cytometry makes the PETHEMA model difficult to implement clinically. The COVID-19 pandemic Nooka AK, Yee AJ, Hayes S, Moes D, Molinaro M, Hulin,! And management of high-risk SMM to jurisdictional claims in published maps and institutional.! Pc clones ; once started, continue normally with no change of dose/schedule antigen called GPRC5D to... 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