Multiple Myeloma

Carfilzomib(Kyprolis), a new drug for myeloma – pro

Carfilzomib(Kyprolis) is a newly approve drug for multiple myeloma. (Onyx Pharmaceuticals) is similar to Velcade.  KYPROLIS is indicated for the treatment of patients with multiple myeloma who have received at least two prior therapies including bortezomib and an immunomodulatory agent and have demonstrated disease progression on or within 60 days of completion of the last therapy. It is a proteasome inhibitor that inhibits the breakdown of proteins

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Multiple Myeloma, Tandem vs Second Transplants and Total Therapy – pro

Lay Summary: I review the current status of tandem versus second transplant and Total Therapy. One needs to differentiate between tandem transplants, a planned sequence of two high dose treatments with HSCT salvage, and a second transplant, an approach of consolidating the first autologous HSCT with another HSCT ONLY if the first one appears partially effective. A tandem autologous transplant, also known as a double autologous transplant, requires

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Single or Tandem Autologous Transplant for Multiple Myeloma, outpatient stem cell transplants – pro

Lay Summary: Single or tandem autologous transplant is standard of care for multiple myeloma. Other types of transplants are discussed under separate rubrics.   Single or tandem autologous transplant is standard of care for multiple myeloma. Autologous stem cell transplantation has emerged as standard therapy for patients with multiple myeloma, primarily as a result of randomized trials performed in France over the past decade. Recent guidelines

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Third transplant for myeloma – pro

A single autologous transplant is considered medically necessary for mulitple myeloma. I was only able to find one fairly dated report of two patients treated with a third autologous transplant. NCCN advises allogeneic transplant on a clinical trial after relapse from an autologous transplant. It says that allogneic transplant includes the non-myeloablative form. Underlying this recommendation is lack of studies that compare this aproach to salvage

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Autologous stem cell transplantation for Amyloidosis – pro

Lay Summary: AuSCT is supported by credible evidence for amylod for patients without organ damage. Treatment for systemic amyloidosis targets the aberrant plasma cell clone to prevent further synthesis and deposition of the amyloid protein. Conventional therapy usually combines oral melphalan with prednisone (MP), shown to yield higher response rates and longer survival than colchicine or prior therapies. Initial results of HDC/AuSCS in uncontrolled

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PET for myeloma – pro

While PET can be useful for evaluation for diagnosis of plasmacytoma and initially that was the only indication lsited by NCCN guidelines, its role for non-secretory myeloma is more controversial. However, NCCN now includes it, which makes it not experimental. In a recent exchange of letters, a correspondent made the claim that such use of PET should have been listed in a review article in the New Engalnd Journal of Medicine. However, the authors

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Revlimid for myeloma treatment – pro

Lenalidomide is an immunomodulatory drug and a structural analogue of thalidomide which has been developed by Celgene. Potential clinical applications investigated for lenalidomide include CNS cancer, inflammation, malignant melanoma, chronic lymphocytic leukaemia, myelodysplastic syndromes, and multiple myeloma (MM). It is FDA approved in combination with dexamethasone for the treatment of relapsed or refractory multiple myeloma patients who have

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IVIG post transplantation – pro

Intravenous gammaglobulin is often administered after bone marrow/ stem cells transplantation to prophylax for infections. Antibiotics and intravenous gamma globulin are often adminstered for at least 100 days after transplant to decrease the risk of bacterial infection immediately following transplant. Although there are no randomized studies of this strategy, it is recommended by the joint guidelines of CDC, the Infectious Disease Society of America,

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AVN944 – pro

Lay Summary: AVN-944 is reviewed. AVN-944 is an inhibitor of inosine monophosphate dehydrogenase (IMPDH), an enzyme that catalyzes the rate-limiting step in guanine nucleotide synthesis, and induces apoptosis in malignant hematopoietic cell lines in vitro. Pre-clinical studies showed that AVN944 is a highly specific inhibitor of IMPDH, suppresses pools of GTP, and in cultured cells has a selective growth inhibition effect on cancer cells vs. normal

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Rituxan for Waldenstrom’s macroglobulinemia – pro

Waldenström's macroglobulinemia (WM) is a CD20 expressing B-cell malignancy represented by the pathological diagnosis of IgM secreting lymphoplasmacytic lymphoma. Since 1999, there have been many reprts and several phase II studies of Rituxan in this disease. Major response rates of 30% have been reported in most studies with standard dose rituximab, i.e. 4 weekly infusions at 375 mg/m2/week. A recent guideline states: "Rituximab is active in the

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