The role of vertebral augmentation in multiple myeloma: International Myeloma Working Group Consensus Statement

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There are approximately 20 000 new patients diagnosed with myeloma in the United States each year.1 With the availability of better treatments and resultant improved survival, there are currently close to 100 000 patients living with myeloma in the United States. Similar incidence and prevalence rates exist throughout Europe.2 Of these patients, the spine is affected by osteolytic and/or osteopenic bone disease in 70%.3 Myeloma is the commonest primary cancer affecting the spine. Painful vertebral compression fractures (VCFs) affect approximately 30% of myeloma patients. As myeloma patients live longer, it is especially relevant to provide the best available treatment for pain and reduce disabilities that can result from VCFs.4 The focus of […]

Confirmation of the utility of the International Staging System and identification of a unique pattern of disease in Brazilian patients with multiple myeloma

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Multiple myeloma (MM) is one of the most frequent hematologic malignancies, and its incidence varies worldwide. Except for occasional case series or correlative biological studies, little is known about the incidence and clinical features of MM in Latin America. In Brazil, national estimates for the incidence of MM are currently unavailable. Sixteen Brazilian institutions provided information on patients diagnosed with MM between 1998 and 2004. The investigators included all patients whose charts were available. All patients were undergoing care at these institutions. The diagnosis was based on the new criteria,1 and/or standard clinical, laboratory and radiographical features, as well as on bone marrow findings compatible with MM. Since the majority […]

Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group

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We analyzed the presenting features and survival in 1689 patients with multiple myeloma aged younger than 50 years compared with 8860 patients 50 years of age and older. Of the total 10 549 patients, 7765 received conventional therapy and 2784 received high-dose therapy. Young patients were more frequently male, had more favorable features such as low International Staging System (ISS) and Durie-Salmon stage as well as less frequently adverse prognostic factors including high C-reactive protein (CRP), low hemoglobin, increased serum creatinine, and poor performance status. Survival was significantly longer in young patients (median, 5.2 years vs 3.7 years; P < .001) both after conventional (median, 4.5 years vs 3.3 years; […]

Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma

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The incidence of venous thromboembolism (VTE) is more than 1 per thousand annually in the general population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive thalidomide or lenalidomide, especially in combination with dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular-weight heparin (LMWH), warfarin or aspirin, have been investigated in small, uncontrolled clinical studies. This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model. Individual risk factors for thrombosis associated with thalidomide/lenalidomide-based therapy include age, history of VTE, central venous catheter, comorbidities (infections, diabetes, cardiac disease), immobilization, surgery and inherited thrombophilia. Myeloma-related […]

Use of bisphosphonates in multiple myeloma: IMWG response to Mayo Clinic consensus statement.

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The International Myeloma Working Group (IMWG), which comprises 85 investigators  specializing in the area of multiple myeloma, has reviewed and considered the recent Mayo Clinic consensus statement for the use of bisphosphonates (BPs) in multiple myeloma. Although the IMWG is in general agreement with the Mayo consensus statement, several important issues have been raised and are discussed subsequently. These comments are in response to the recommendations of  the Mayo group, which is normally part of the IMWG. Author: Durie BG Mayo Clin Proc. 2007 Apr;82(4):516-7; author reply 517-8. Click here to view Article  

International uniform response criteria for multiple myeloma

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New uniform response  criteria are required to adequately assess clinical outcomes in myeloma. The European Group for Blood and Bone Marrow Transplant/International Bone Marrow Transplant Registry criteria have been expanded, clari?ed and updated to provide a new comprehensive evalua- tion system. Categories for stringent complete response and very good partial response are added. The serum free light- chain assay is included to allow evaluation of patients with oligo-secretory disease. Inconsistencies in prior criteria are clari?ed making con?rmation of response and disease progres- sion easier to perform. Emphasis is placed upon time to event and duration of response as critical end points. The require- ments necessary to use overall survival duration […]

International Staging System for Multiple Myeloma

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Purpose There is a need for a simple, reliable staging system for multiple myeloma that can be applied internationally for patient classification and stratification. Patients and Methods Clinical  and  laboratory  data  were  gathered  on  10,750  previously  untreated  symptomatic myeloma patients from 17 institutions, including sites in North America, Europe, and Asia. Potential prognostic factors were evaluated by univariate and multivariate techniques. Three modeling approaches were then explored to develop a staging system including two nontree and one tree survival assessment methodologies. Results Serum beta2-microglobulin (SB2M), serum albumin, platelet count, serum creatinine, and age emerged as powerful predictors of survival and were then used in the tree analysis approach. A combination […]

Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation

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These consensus guidelines have been compiled with input from the Scientific Advisors of the International Myeloma Foundation. Their production involved several steps including: A 3-day Scientific Advisors meeting, during which each specific area was presented and discussed (May 2002). Review of key literature, especially randomized study results, but also Medline, Internet, Cochrane database searches, and prior guidelines (Br J Haematol 115: 522-540, 2001). Feedback from patients participating in the International Myeloma Foundation, patient These guidelines encompass both the published literature and expert opinions. Recommendations based upon expert opinions are identified as such. The intent is for the guidelines to be international in scope, plus provide recommendations for both clinical practice […]