APRIL 2002

Thalidomide as salvage therapy for VAD-refractory multiple myeloma prior to autologous PBSCT.
Bone Marrow Transplant. 2002 Apr;29(7):577-80.
Ahmad I, Islam T, Chanan-Khan A, Hahn T, Wentling D, Becker JL, McCarthy PL Jr, Alam AR.

Myeloma of the central nervous system: association with high-risk chromosomal abnormalities, plasmablastic morphology and extramedullary manifestations.
Br J Haematol. 2002 Apr;117(1):103-8.
Fassas AB, Muwalla F, Berryman T, Benramdane R, Joseph L, Anaissie E, Sethi R, Desikan R, Siegel D, Badros A, Toor A, Zangari M, Morris C, Angtuaco E, Mathew S, Wilson C, Hough A, Harik S, Barlogie B, Tricot G.
Involvement of the CNS by MM is extremely rare. This study reports the characteristics of 18 such patients. Incidence was approximately 1%. There was an association with adverse biological features (unfavourable cytogenetic abnormalities, high tumour mass, plasmablastic morphology, additional extramedullary manifestations, and presence of circulating plasma cells). The outcome of these patients was very poor despite the use of aggressive treatment, including autologous stem cell transplant.

Fluoro-deoxyglucose positron emission tomography imaging for the detection of occult disease in multiple myeloma.
Br J Haematol. 2002 Apr;117(1):133-5.
Orchard K, Barrington S, Buscombe J, Hilson A, Prentice HG, Mehta A.

Multiple myeloma cured by conventional chemotherapy: a report and a review.
Leuk Lymphoma. 2002 Apr;43(4):907-10.
Notaro R, De Renzo A, De Rosa G, Karadimitris A, Rotoli B.
This is a case report of a 28-year-old man who received cyclophosphamide every 3-4 weeks for about 3 years, and he remained in persistent complete remission for 23 years without further treatment. The authors review 5 other cases of myeloma cured by conventional chemotherapy reported in the medical literature.


MAY 2002

Myeloma and the t(11;14)(q13;q32); evidence for a biologically defined unique subset of patients.
Blood. 2002 May 15;99(10):3735-41.
Fonseca R, Blood EA, Oken MM, Kyle RA, Dewald GW, Bailey RJ, Van Wier SA, Henderson KJ, Hoyer JD, Harrington D, Kay NE, Van Ness B, Greipp PR.
These authors determine the clinical and biologic significance of the t(11;14) translocation using FISH in 336 MM patients. 53 (16%) patients were positive for t(11;14)(q13;q32). These patients were:
 - were more likely to have a serum M protein of <1 g/dL (28% vs 15%)
 - had a lower plasma cell labeling index
 - were less likely to be hyperdiploid by DNA content analysis (14% vs 62%)
 - had a better survival and response to treatment (but this did not reach statistical significance)

Effects of long-term intravenous ibandronate therapy on skeletal-related events, survival, and bone resorption markers in patients with advanced multiple myeloma.
J Clin Oncol. 2002 May 1;20(9):2353-9.
Menssen HD, Sakalová A, Fontana A, Herrmann Z, Boewer C, Facon T, Lichinitser MR, Singer CR, Euller-Ziegler L, Wetterwald M, Fiere D, Hrubisko M, Thiel E, Delmas PD.
Ibandronate is a third-generation amino-bisphosphonate. This is a double-blind, randomized, placebo-controlled study that assesses the efficacy of ibandronate in preventing skeletal-related events (SREs) in patients with advanced myeloma. Patients were randomly assigned to receive either ibandronate 2 mg or placebo IV monthly for 12-24 months. The occurrence of SRE per patient year and the time to first SRE were not significantly different between the groups, and the authors concluded that ibandronate 2 mg IV monthly neither reduced bone morbidity nor prolonged survival in patients with multiple myeloma.

Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma.
J Clin Oncol. 2002 May 1;20(9):2382-7.
Dudeney S, Lieberman IH, Reinhardt MK, Hussein M.
This study evaluates the efficacy of 55 consecutive kyphoplasty procedures in 18 myeloma patients with osteolytic vertebral compression fractures. Kyphoplasty restored, on average, 34% of height lost at the time of fracture. It led to a significant clinical improvement of bony pain and physical function. The authors found no major complications related directly to use of this technique.  Asymptomatic cement leakage occurred at 2 levels (4%).

Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients.
Blood. 2002 May 1;99(9):3163-8.
Berenson JR, Crowley JJ, Grogan TM, Zangmeister J, Briggs AD, Mills GM, Barlogie B, Salmon SE.
This study showed that single agent prednisone 50 mg PO on alternate days is an effective maintenance regimen in multiple myeloma. The authors compared prednisone 10 mg vs 50 mg PO every other day as maintenance therapy after VAD-based induction chemotherapy in 125 patients with newly diagnosed myeloma. Prednisone maintenance was continued until until disease progression. After a median follow-up of 53 months, patients who received prednisone 50 mg qod has superior outcomes compared to the patients treated with prednisone 10 mg qod: from the time of maintenance, the progression-free survival was 14 vs 5 months (p= 0.003), and the overall survival was 37 vs 26 months (p= 0.05). Toxicities were similar in the two groups.

Liposomal daunorubicin (DaunoXome) plus dexamethasone for patients with multiple myeloma. A phase II International Oncology Study Group study.
Cancer. 2002 May 15;94(10):2645-52.
Mohrbacher AF, Gregory SA, Gabriel DA, Rusk JM, Giles FJ.
This is a phase II study of liposomal daunorubicin 100 mg/m2 IV every 3 weeks for max 6 cycles in patients with myeloma, either newly diagnosed (4 patients) or with relapsing/refractory disease (37 patients). Results: partial response 17%, stable disease 63%. Median survival 7.6 months. Main toxicity was myelosuppression.


JUNE 2002

Isotype class switching and the pathogenesis of multiple myeloma.
Hematol Oncol. 2002 Jun;20(2):75-85.
Fenton JA, Pratt G, Rawstron AC, Morgan GJ.

Different patterns of relapse after autologous peripheral blood stem cell transplantation in multiple myeloma: clinical results of 280 cases from the Spanish Registry.
Haematologica. 2002 Jun;87(6):609-14.
Alegre A, Granda A, Martínez-Chamorro C, Díaz-Mediavilla J, Martínez R, García-Laraña J, Lahuerta JJ, Sureda A, Bladé J, de la Rubia J, Fernández-Rañada JM, San Miguel J; Spanish Registry of Transplants in Multiple Myelomas; Spanish Group of Hemopoietic Transplant (GETH); PETHEMA.
This retrospective study evaluated the clinical patterns of relapses after autologous transplant in 280 myeloma patients. The patterns of relapse were heterogeneous:
  - Increase of serum/urine paraprotein and various symptoms, mainly new bone lesions (66%)
  - Slow increase of serum/urine paraprotein in asymptomatic patients (18%)
  - Extramedullary disease and minimal or no increase of paraprotein (14%)
  - Secondary plasma cell leukemia (2%)
After relapse, median overall survival was only 14 months.

Role of Helicobacter pylori infection in the incidence and clinical course of monoclonal gammopathy of undetermined significance.
Am J Gastroenterol. 2002 Jun;97(6):1371-4.
Malik AA, Ganti AK, Potti A, Levitt R, Hanley JF.
57 patients with MGUS 57 underwent evaluation for H. pylori infection and 39 of them (68%) were found to have the infection. Interestingly, the eradication of H. pylori with combination therapy led to the disappearance of the MGUS in 11 of these 39 patients (28%).



Giampaolo Talamo, MD