Recent Abstract from Mayo Clinic -- Not regarding imetelstat
Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients.
Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV.
Divisions of Hematology, Mayo Clinic, Rochester, MN, USA.
Therapy for multiple myeloma (MM) has dramatically changed in the past decade with introduction of new drugs, but it is not clear if the improvements have been sustained. We studied 1038 patients diagnosed between 2001 and 2010, grouping patients into two five-year periods by diagnosis, 2001-2005 and 2006-2010. The median estimated follow up for the cohort was 5.9 years with 47% alive at last follow up. The median overall survival (OS) for the entire cohort was 5.2 years; 4.6 years for patients in the 2001-2005 group compared with 6.1 years for the 2006-2010 cohort (P=0.002). The improvement was primarily seen among patients over 65 years; the 6-year OS improving from 31% to 56% P
Smoldering multiple myeloma requiring treatment: time for a new definition?
Dispenzieri A, Stewart AK, Chanan-Khan A, Rajkumar SV, Kyle RA, Fonseca R, Kapoor P, Bergsagel PL, McCurdy A, Gertz MA, Lacy MQ, Lust JA, Russell SJ, Zeldenrust SR, Reeder C, Roy V, Buadi F, Dingli D, Hayman SR, Leung N, Lin Y, Mikhael J, Kumar SK.
Mayo Clinic, Rochester, MN, United States;
Smoldering multiple myeloma (SMM) bridges the gap between monoclonal gammopathy of undetermined significance (MGUS) - a mostly pre-malignant disorder - and active multiple myeloma (MM). Until recently, no interventional study in patients with SMM showed improved overall survival with therapy as compared to observation. A report from the PETHEMA-GEM group described both fewer myeloma related events and better overall survival among patients with high-risk SMM patients who were treated with lenalidomide and dexamethasone. This unique study has prompted us to review current knowledge about SMM, and address the following questions: 1) are there patients currently defined as SMM, who should be treated routinely? 2) should the definitions of SMM and MM be reconsidered? 3) has the time come when not treating is more dangerous than treating; and 4) could unintended medical harm result from overzealous intervention? Our conclusion is that those patients with the highest risk SMM--extreme bone marrow plasmacytosis, extremely abnormal serum immunoglobulin free light chain ratio, and multiple bone lesions detected only by modern imaging -- be reclassified as active MM, such that they can receive MM appropriate therapy and the paradigm of careful observation for patients with SMM can be preserved.
This Mayo Clinic abstract deals with disease classification...
Myeloma: classification and risk assessment.
Fonseca R, Monge J.
Division of Hematology and Oncology, Mayo Clinic in Arizona, Scottsdale, AZ.. Electronic address: email@example.com.
Multiple myeloma (MM) is a heterogeneous disease for which several new treatments are available. Much has been learned about its biology over the past 15 years. We now understand that there are various subtypes of the disease, each one associated with different outcomes and clinical pathological features. While a detailed classification of the disease into at least seven or eight major subtypes is possible, a practical clinical approach classifies the disease into high-risk and not-high-risk MM. This classification has allowed for tailored approaches to therapy and treatment planning. Furthermore, the discussion of outcomes with patients should include risk stratification, as the prospects for survival are quite different depending on whether the patient has high-risk MM or not. The tools for measuring risk subcategory are widely available and now routinely employed in the clinic. The continued search for genetic abnormalities that underlie the biology of MM may allow for even better precision therapy in the future.