APRIL 2008

Risk of multiple myeloma and monoclonal gammopathy of undetermined significance among white and black male United States veterans with prior autoimmune, infectious, inflammatory, and allergic disorders.
Blood. 2008 Apr 1;111(7):3388-94.
Brown LM, Gridley G, Check D, Landgren O.
This is a retrospective study of more than 4 million male US veterans, exploring the role of prior autoimmune, infectious, inflammatory, and allergic disorders in the etiology of MM and MGUS. The analysis included 4641 patients with MM, and 2046 patients with MGUS. Significantly elevated risks of MM were associated with autoimmune (RR, 1.15), infectious (RR, 1.29), and inflammatory disorders (RR, 1.18).
 - Specific prior autoimmune diseases: polymyositis/dermatomyositis, systemic sclerosis, autoimmune hemolytic anemia, pernicious anemia, and ankylosing spondylitis.
 - Specific prior infectious diseases: pneumonia, hepatitis, meningitis, septicemia, herpes zoster, and poliomyelitis.
 - Specific prior inflammatory diseases: glomerulonephritis, nephrotic syndrome, and osteoarthritis.
Risks for MGUS were of similar magnitude. Authors conclude that various types of immune-mediated conditions might act as triggers for MM/MGUS development.

High-dose melphalan-based autotransplants for multiple myeloma: the Arkansas experience since 1989 in 3077 patients.
Cancer. 2008 Apr 15;112(8):1754-64.
Pineda-Roman M, Barlogie B, Anaissie E, Zangari M, Bolejack V, van Rhee F, Tricot G, Crowley J.

Myelomatous meningitis.
Cancer. 2008 Apr 1;112(7):1562-7.
Chamberlain MC, Glantz M.
This is a  case series of 14 patients with CSF-positive MM. Patients received intra-CSF chemotherapy + RT (to the brain in 5 patients and to the spine in 6 patients). There were 6 partial responses and 8 cases of progressive disease. The median duration of response was short, only 2.5 months (range: 0-6 months). 6 patients died because of progressive neurologic disease. 6-month neurologic disease progression-free survival rate was only 7%.

Bortezomib plus melphalan and prednisone in elderly untreated patients with multiple myeloma: updated time-to-events results and prognostic factors for time to progression.
Haematologica. 2008 Apr;93(4):560-5.
Mateos MV, Hernández JM, Hernández MT, Gutiérrez NC, Palomera L, Fuertes M, Garcia-Sanchez P, Lahuerta JJ, de la Rubia J, Terol MJ, Sureda A, Bargay J, Ribas P, Alegre A, de Arriba F, Oriol A, Carrera D, García-Laraña J, García-Sanz R, Bladé J, Prósper F, Mateo G, Esseltine DL, van de Velde H, San Miguel JF.
This is an updated analysis of a previously reported trial of VMP (bortezomib, melphalan, and prednisone) in elderly patients with newly diagnosed myeloma. After a median follow-up of 26 months:
  - Median time to progression: 27 months with VMP vs 20 months with MP
  - Median overall survival: not reached with VMP vs 26 months with MP
  - 3-year survival: 85% with VMP vs 38% with MP
Since time to progression was not significantly influenced by cytogenetic abnormalities, the authors believed that VMP could overcome the adverse prognostic impact of high-risk cytogenetic abnormalities.

Suppression of abnormal karyotype predicts superior survival in multiple myeloma.
Leukemia. 2008 Apr;22(4):850-5.
Arzoumanian V, Hoering A, Sawyer J, van Rhee F, Bailey C, Gurley J, Shaughnessy JD Jr, Anaissie E, Crowley J, Barlogie B.
Cytogenetic studies were reviewed in 2041 patients with multiple myeloma. Cytogenetic abnormalities were found in one-third of patients at baseline, in 14% after induction therapy, 10% after stem cell transplantation, and 28% at relapse. The presence of cytogenetic abnormalities, either at baseline or at relapse, was associated with poor prognosis, whereas their disappearance after the induction therapy had a favorable impact on prognosis.

Outcome after autologous stem cell transplantation for multiple myeloma in patients with preceding plasma cell disorders.
Br J Haematol. 2008 Apr;141(2):205-11.
Kumar SK, Dingli D, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK, Rajkumar SV, Litzow MR, Gertz MA.
Among 804 myeloma patients undergoing stem cell transplantation, 151 had a preexisting plasma cell disorder, such as MGUS, smoldering myeloma, or a solitary plasmacytoma. The two groups of patients had similar response rates to stem cell transplant. Patients with a prior diagnosis of MGUS had  a longer time to progression (27.5 vs 17.2 months, p= 0.01), and longer overall survival from transplant (80.2 vs 48.3 months, p= 0.03), whereas patients with a prior diagnosis of smoldering myeloma or solitary plasmacytoma had similar time to progression and overall survival to those of patients with de novo myeloma.

Primary extramedullary plasmacytoma: similarities with and differences from multiple myeloma revealed by interphase cytogenetics.
Haematologica. 2008 Apr;93(4):623-6.
Bink K, Haralambieva E, Kremer M, Ott G, Beham-Schmid C, de Leval L, Peh SC, Laeng HR, Jütting U, Hutzler P, Quintanilla-Martinez L, Fend F.
These authors performed FISH in 38 cases of primary extramedullary plasmacytoma. 14 cases (37%) contained IgH breaks. 6 patients had a t(4;14) translocation. Loss of 13q was present in 40%, and chromosomal gains in 82%. The cytogenetics in extramedullary plasmacytomas are similar to those of MM, except for the absence of t(11;14), is different.

Dkk1-induced inhibition of Wnt signaling in osteoblast differentiation is an underlying mechanism of bone loss in multiple myeloma.
Bone. 2008 Apr;42(4):669-80.
Qiang YW, Barlogie B, Rudikoff S, Shaughnessy JD Jr.
This study showed that Dkk1 promotes osteolysis by abrogating osteoblast differentiation mediated by bone morphogenic protein 2 (BMP-2). The autocrine Wnt signaling in osteoblasts is necessary to induce BMP-2-mediated differentiation of the pre-osteoblast cells. Wnt signaling alone does not induce this differentiation.

Vertebroplasty in multiple myeloma: outcomes in a large patient series.
AJNR Am J Neuroradiol. 2008 Apr;29(4):642-8.
McDonald RJ, Trout AT, Gray LA, Dispenzieri A, Thielen KR, Kallmes DF.
This study reviewed clinical outcomes in 67 multiple myeloma patients treated with vertebroplasty. The authors observed a significant improvements in all of the outcome measures after the vertebroplasty:
  - 82% of patients had a significant improvement in subjective rest pain
  - 89% of patients had a significant improvement in subjective activity pain
  - 65% of patients required fewer narcotics after vertebroplasty
  - 70% of patients had improved mobility

Thalidomide for treatment of multiple myeloma: 10 years later.
Blood. 2008 Apr 15;111(8):3968-77.
Palumbo A, Facon T, Sonneveld P, Bladè J, Offidani M, Gay F, Moreau P, Waage A, Spencer A, Ludwig H, Boccadoro M, Harousseau JL.

Alternate day pomalidomide retains anti-myeloma effect with reduced adverse events and evidence of in vivo immunomodulation.
Br J Haematol. 2008 Apr;141(1):41-51.
Streetly MJ, Gyertson K, Daniel Y, Zeldis JB, Kazmi M, Schey SA.
This is a phase 1 study of pomalidomide in 20 patients with relapsed myeloma. The maximum tolerated dose (MTD) was defined as 5 mg every other day. No thrombotic events were observed. In 17 patients, pomalidomide was continued beyond the 4 weeks of the phase 1 study, for a median of 14 months. RR was 60%, with 10% CR. Median PFS was 10.5 months and OS was 33 months.

Anti-CD20 monoclonal antibody therapy in multiple myeloma.
Kapoor P, Greipp PT, Morice WG, Rajkumar SV, Witzig TE, Greipp PR.
Br J Haematol. 2008 Apr;141(2):135-48.

Thromboembolic events with lenalidomide-based therapy for multiple myeloma.
Cancer. 2008 Apr 1;112(7):1522-8.
Menon SP, Rajkumar SV, Lacy M, Falco P, Palumbo A.
This is a report of 125 myeloma patients enrolled in 3 clinical trials involving treatment with lenalidomide. 10 patients (8%) developed DVT, including 4 patients who did not receive prophylaxis. DVT was observed in 6 of 104 patients who received aspirin prophylaxis (6%). No difference in the rate of DVT was observed between patients who received erythropoietin and those who did not, whereas there was a trend for higher rate of DVT in patients treated with high-dose dexamethasone compared with low-dose corticosteroids (either prednisone, or dexamethasone 40 mg/month), but the difference was not statistically significant.


MAY 2008

Eight-year median survival in multiple myeloma after total therapy 2: roles of thalidomide and consolidation chemotherapy in the context of total therapy 1.
Br J Haematol. 2008 May;141(4):433-44.
Zangari M, van Rhee F, Anaissie E, Pineda-Roman M, Haessler J, Crowley J, Barlogie B.
This study reports the rusults of Total Therapy 2, with longer follow-up. Results were better than those achieved with Total Therapy 1, in terms of CR duration, EFS, and OS. Event-free survival was 4.8 years and overall survival was 8.0 years. In patients without cytogenetic abnormalities, improved results were mainly related to post-transplant consolidation therapy, whereas in patients with cytogenetic abnormalities, improved results were mainly related to the use of thalidomide. With longer follow-up, Total Therapy 2 revealed an apparent separation of the survival curves between the two randomized groups (thalidomide vs non-thalidomide), and it did not confirm the previously observed shorter post-relapse survival of the thalidomide group.

Prevalence and significance of vitamin D deficiency in multiple myeloma patients.
Br J Haematol. 2008 May 15.
Badros A, Goloubeva O, Terpos E, Milliron T, Baer MR, Streeten E.

The evolving use of serum free light chain assays in haematology.
Br J Haematol. 2008 May;141(4):413-22.
Pratt G.

Monitoring of minimal residual disease in multiple myeloma after allo-SCT: flow cytometry vs PCR-based techniques.
Bone Marrow Transplant. 2008 May;41(10):913-6.
Lioznov M, Badbaran A, Fehse B, Bacher U, Zander AR, Kröger NM.

Bortezomib, doxorubicin and dexamethasone (PAD) front-line treatment of multiple myeloma: updated results after long-term follow-up.
Br J Haematol. 2008 May;141(4):512-6.
Popat R, Oakervee HE, Hallam S, Curry N, Odeh L, Foot N, Esseltine DL, Drake M, Morris C, Cavenagh JD.
The PAD regimen was given in patients with newly diagnosed myeloma as induction therapy before stem cell transplantation. Results: rate of CR/VGPR was 62% in patients treated with bortezomib 1.3 mg/m2 and 42% in patients treated with 1.0 mg/m2. PFS and OS favoured bortezomib 1.3 mg/m2, but differences did not reach statistical significance.

The impact of race on outcomes of autologous transplantation in patients with multiple myeloma.
Am J Hematol. 2008 May;83(5):355-8.
Verma PS, Howard RS, Weiss BM.
This is a retrospective analysis of 55 Caucasian and 36 African-American patients with myeloma patients who underwent autologous stem cell transplant. Survival was similar.

Genetic aberrations and survival in plasma cell leukemia.
Leukemia. 2008 May;22(5):1044-52.
Tiedemann RE, Gonzalez-Paz N, Kyle RA, Santana-Davila R, Price-Troska T, Van Wier SA, Chng WJ, Ketterling RP, Gertz MA, Henderson K, Greipp PR, Dispenzieri A, Lacy MQ, Rajkumar SV, Bergsagel PL, Stewart AK, Fonseca R.
This study reports the cytogenetic findings of 80 patients with plasma cell leukemia. Patients with primary PCL had a median age at presentation younger than those with secondary plasma cell leukemia (55 vs 65 years). The survival of patients with primary plasma cell leukemia was better than that in secondary plasma cell leukemia (11.1 vs 1.3 months).

Extramedullary relapses after allogeneic non-myeloablative stem cell transplantation in multiple myeloma patients do not negatively affect treatment outcome.
Bone Marrow Transplant. 2008 May;41(9):779-84.
Minnema MC, van de Donk NW, Zweegman S, Hegenbart U, Schonland S, Raymakers R, Zijlmans JM, Kersten MJ, Bos GM, Lokhorst HM.
In this study of 54 patients with myeloma relapsed after mini-allogeneic SCT, the incidence of extramedullary relapse was 20%. Interestingly, response rate, overall survival, and progression-free survival were similar those observed in patients without extramedullary disease.


JUNE 2008

An observational, retrospective analysis of retreatment with bortezomib for multiple myeloma.
Clin Lymphoma Myeloma. 2008 Jun;8(3):140-5.
Conner TM, Doan QD, Walters IB, LeBlanc AL, Beveridge RA.
This is a retrospective review of data from patients with multiple myeloma treated with bortezomib and subsequently retreated with the same agent, with therapy given at least 2 months apart. Median time between bortezomib treatments was 10 months. Response among 82 evaluable patients:
  - Less than PR: 63%
  - PR: 15%
  - VGPR: 6%
  - Progressive disease: 6%
  - Death: 10%

Features and risk factors of peripheral neuropathy during treatment with bortezomib for advanced multiple myeloma.
Clin Lymphoma Myeloma. 2008 Jun;8(3):146-52.
El-Cheikh J, Stoppa AM, Bouabdallah R, de Lavallade H, Coso D, de Collela JM, Auran-Schleinitz T, Gastaut JA, Blaise D, Mohty M.
Among 100 myeloma patients treated with bortezomib for a median of 8 months (range: 0.1-32 months), 38% developed bortezomib-induced peripheral neuropathy. This was grade 3 in 5 patients and grade 4 in 1 patient. Median time to onset of neuropathy was 53 days (range: 11-182 days). Neuropathy improved or completely resolved in 53% of cases, at a median of 3 months (range: 1-8 months). The incidence of bortezomib-induced peripheral neuropathy was significantly higher in patients who received > 4 cycles of bortezomib, and in patients previously treated with thalidomide.

Idiotype vaccination in patients with myeloma reduced circulating myeloma cells (CMC).
Ann Oncol. 2008 Jun;19(6):1172-9.
Abdalla AO, Kokhaei P, Hansson L, Mellstedt H, Osterborg A.
11 patients with multiple myeloma were immunized with the autologous idiotype expressed by circulating myeloma cells. No responses were observed.

Desensitization to thalidomide in a patient with multiple myeloma.
Clin Lymphoma Myeloma. 2008 Jun;8(3):176-8.
Nucera E, Schiavino D, Hohaus S, Leone G, Buonomo A, Lombardo C, Patriarca G.
The authors report the case of a 65-year-old woman with multiple myeloma who developed a maculopapular rash after 2 days of thalidomide therapy, and who was successfully desensitized
. On the fifth day of an oral desensitization protocol, she could tolerate the drug.

Prediction of survival using absolute lymphocyte count for newly diagnosed patients with multiple myeloma: a retrospective study.
Br J Haematol. 2008 Jun;141(6):792-8.
Ege H, Gertz MA, Markovic SN, Lacy MQ, Dispenzieri A, Hayman SR, Kumar SK, Porrata LF.
A retrospective analysis of the absolute lymphocyte count (ALC) was conducted in 537 patients with newly diagnosed multiple myeloma. ALC proved to be an important prognostic factor, even after multivariate analysis. After a median follow-up of 35.1 months, patients with ALC >1,400 had a superior overall survival compared with patients with ALC <1,400 (65 vs 26 months, p <0.01). The results suggested that the immune status plays an important role in the survival of MM.

The presence of DRB1*01 allele in multiple myeloma patients is associated with an indolent disease.
Tissue Antigens. 2008 Jun;71(6):548-51.
Alcoceba M, Marín L, Balanzategui A, Sarasquete ME, Martín-Jiménez P, Chillón MC, Corral R, Pérez-Persona E, Fernández-Calvo FJ, Hernández JM, Bladé J, Lahuerta JJ, González M, San Miguel JF, García-Sanz R.
This study evaluated the HLA-DRB1 phenotypic frequencies in 53 patients with smoldering/indolent myeloma and 128 patients with symptomatic myeloma. Frequency of DRB1*01 was higher in patients with smoldering myeloma than in those with symptomatic myeloma (38% vs 14%, p= 0.001) or healthy individuals (38% vs 22%, p= 0.01). The authors proposed that HLA-DRB1*01 confers a better ability to present myeloma-related antigens to immunocompetent cells, favoring a better immune response against the myeloma.

Effect of pathologic fractures on survival in multiple myeloma patients: a case control study.
J Exp Clin Cancer Res. 2008 Jun 10;27:11.
Sonmez M, Akagun T, Topbas M, Cobanoglu U, Sonmez B, Yilmaz M, Ovali E, Omay SB.

Among 49 patients with MM, pathologic fractures (PFs) were observed in 24 patients (49%) and absent in 25 patients (51%). The risk of death was increased in the patients with PFs compared with patients without PFs. OS was 17.6 months in patients with PFs and 57.3 months in patients without PFs.

Serum concentrations of DKK-1 correlate with the extent of bone disease in patients with multiple myeloma.
Eur J Haematol. 2008 Jun;80(6):490-4.
Kaiser M, Mieth M, Liebisch P, Oberländer R, Rademacher J, Jakob C, Kleeberg L, Fleissner C, Braendle E, Peters M, Stover D, Sezer O, Heider U.
This study compared serum levels of DKK-1 in 184 untreated MM patients to those of 33 MGUS patients. Serum DKK-1 was elevated in MM as compared with MGUS (mean 11,963 pg/mL vs. 1,993 pg/mL. Serum DKK-1 levels correlated with the Durie and Salmon stage. MM patients without lytic lesions in x-rays had significantly lower DKK-1 levels than patients with lytic bone lesions. Serum DKK-1 correlated with the number of bone lesions.

Eliminating the complete response penalty from myeloma response criteria.
Blood. 2008 Jun 15;111(12):5759-60.
Rajkumar SV, Durie BG.

Prognostic value of immunophenotyping in multiple myeloma: a study by the PETHEMA/GEM cooperative study groups on patients uniformly treated with high-dose therapy.
J Clin Oncol. 2008 Jun 1;26(16):2737-44.
Mateo G, Montalbán MA, Vidriales MB, Lahuerta JJ, Mateos MV, Gutiérrez N, Rosiñol L, Montejano L, Bladé J, Martínez R, de la Rubia J, Diaz-Mediavilla J, Sureda A, Ribera JM, Ojanguren JM, de Arriba F, Palomera L, Terol MJ, Orfao A, San Miguel JF; PETHEMA Study Group; GEM Study Group.
This prospective study in 685 patients with newly diagnosed multiple myeloma evaluated the prognostic impact of several antigenic markers, assessed by flow cytometry. Worse prognosis, with shorter PFS and OS, was seen with expression of both CD19 and CD28 and absence of CD117. CD28 expression was associated with t(14;16) and del(17p), and the absence of CD117 was associated with t(4;14) and del(13q). Patients could be stratified into 3 risk categories:
  - Good risk: CD28 negative, CD117+
  - Intermediate risk: either both markers negative or both positive
  - Poor risk: CD28+, CD117 negative
Progression-free survival was 45, 37, and 30 months, respectively.

Instability of immunophenotype in plasma cell myeloma.
Am J Clin Pathol. 2008 Jun;129(6):926-33.
Cao W, Goolsby CL, Nelson BP, Singhal S, Mehta J, Peterson LC.
In this study of flow cytometry in 56 myeloma patients, 23 patients (41%) showed a change in immunophenotype (CD52 in 17 cases,  CD20 in 7 cases, and CD56 in 6 cases). The instability of the immunophenotype in multiple myeloma can have important implications, especially in the detection of residual disease, and when considering the potential application of antigen-directed therapy.

Individualizing treatment of patients with myeloma in the era of novel agents.
J Clin Oncol. 2008 Jun 1;26(16):2761-6.
San-Miguel J, Harousseau JL, Joshua D, Anderson KC.

Impact of pretransplant therapy in patients with newly diagnosed myeloma undergoing autologous SCT.
Bone Marrow Transplant. 2008 Jun;41(12):1013-9.
Kumar SK, Dingli D, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Rajkumar SV, Litzow MR, Gertz MA.
This study assesses the effect of initial therapy on the outcome of 472 patients with multiple myeloma undergoing autologous SCT within 12 months of diagnosis. The induction therapy consisted of: VAD, Dexamethasone, Dexamethasone + Thalidomide, and Dexamethasone + Lenalidomide. There was no difference in the response rates to the autologous SCT. The median time to progression after the SCT was 21-27 months and median overall survival was 62-70 months. The authors conclude that in patients undergoing early autologous SCT, the type of induction therapy has no long-term impact on the outcome of the transplant.

Maintenance treatment in multiple myeloma.
Ann Oncol. 2008 Jun;19 Suppl 4:iv54-5.
Harousseau JL.


Thalidomide maintenance following high-dose melphalan with autologous stem cell support in myeloma.
Clin Lymphoma Myeloma. 2008 Jun;8(3):153-8.
Chang JE, Juckett MB, Callander NS, Kahl BS, Gangnon RE, Mitchell TL, Longo WL.
31 patients with myeloma were treated with autologous stem cell transplant and then thalidomide 50 mg PO qhs, escalated to a maximum dose of 200 mg per day.
  - Treatment was poorly tolerated, mainly because of peripheral neuropathy.
  - Maintenance at the dose of 200 mg was not feasible (goal achieved in 55% of patients). The median tolerated dose was 100 mg.
  - No DVT was observed.
  - CR + VGPR: 65% at 1 year and 42% at 2 years.
  - Median OS: > 60 months. Median PFS: 20.8 months.

The addition of liposomal doxorubicin to bortezomib, thalidomide and dexamethasone significantly improves clinical outcome of advanced multiple myeloma.
Br J Haematol. 2008 Jun;141(6):814-9.
Ciolli S, Leoni F, Casini C, Breschi C, Santini V, Bosi A.
This study compared VTD (28 patients) with VTD + Doxil (42 patients) in advanced MM.
  - Velcade 1.0 mg/m2 IV on days 1, 4, 8, 11 in a 28-d cycle
  - Thalidomide 100 mg PO qhs
  - Dexamethasone 24 mg PO on the day of, and the day after Velcade
  - Doxil 50 mg/m2 (30 mg/m2 for patients older than 75 years) IV on day 4, 1 hour after bortezomib infusion
VTD + Doxil produced better results, in terms of overall response rate (81% vs 50%), time to progression (19 vs 11 months), and progression-free survival (15 vs 8 months).

Bortezomib, doxorubicin and dexamethasone in advanced multiple myeloma.
Ann Oncol. 2008 Jun;19(6):1160-5.
Palumbo A, Gay F, Bringhen S, Falcone A, Pescosta N, Callea V, Caravita T, Morabito F, Magarotto V, Ruggeri M, Avonto I, Musto P, Cascavilla N, Bruno B, Boccadoro M.
In this study, 64 patients with relapsed/refractory myeloma were treated with PAD for a median of four cycles.
  - Bortezomib 1.3 mg/m2 IV days 1, 4, 8, 11
  - Doxorubicin 20 mg/m2 IV days 1, 4 or pegylated liposomal doxorubicin 30 mg/m2 IV day 1
  - Dexamethasone 40 mg PO days 1-4
Cycles were repeated every 28 days. 43 patients (67%) achieved at least a PR, including 16 (25%) with at least a VGPR. At 1 year, EFS was 34% and OS 66%. Grade 3-4 toxic effects included thrombocytopenia (48%), neutropenia (36%), infections (15%), anemia (13%), gastrointestinal disturbances (11%), peripheral neuropathy (10%), and CHF (2 patients).

Effect of lenalidomide therapy on mobilization of peripheral blood stem cells in previously untreated multiple myeloma patients.
Leukemia. 2008 Jun;22(6):1280-1.
Mazumder A, Kaufman J, Niesvizky R, Lonial S, Vesole D, Jagannath S.
These authors observed low stem cell yield after lenalidomide induction therapy. With G-CSF 10 mcg/Kg for 4 days, 12 of 28 patients (43%) failed to collect a sufficient number of CD34+ cells/Kg for even one transplant. 3 patients also failed collection after plerixafor. The authors conclude that patients with prior exposure to lenalidomide should undergo mobilization chemotherapy with cyclophosphamide.

Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma.
Leukemia. 2008 Jun;22(6):1282-4.
Paripati H, Stewart AK, Cabou S, Dueck A, Zepeda VJ, Pirooz N, Ehlenbeck C, Reeder C, Slack J, Leis JF, Boesiger J, Torloni AS, Fonseca R, Bergsagel PL.
In this report, 9 of 20 patients (45%) previously treated with lenalidomide failed stem cell collection.

Review of peripheral neuropathy in plasma cell disorders.
Silberman J, Lonial S.
Hematol Oncol. 2008 Jun;26(2):55-65.

Reduced-intensity conditioning allogeneic SCT as salvage treatment for relapsed multiple myeloma.
Bone Marrow Transplant. 2008 Jun;41(11):953-60.
de Lavallade H, El-Cheikh J, Faucher C, Fürst S, Stoppa AM, Coso D, Bouabdallah R, Chabannon C, Gastaut JA, Blaise D, Mohty M.
This is a retrospective analysis of 32 patients with relapsed myeloma, treated with RIC allogeneic SCT. PFS at 3 years was 46%.
Conditioning regimens:
  - FBA: Fludarabine 30 mg/m2 x 5 days + Busulfan 4 mg/Kg PO x 2 days + ATG 2.5 mg/Kg x 1 day
  - FT: Fludarabine 30 mg/m2 x 3 days + low-dose TBI (2 Gy)

Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains.
Kidney Int. 2008 Jun;73(11):1282-8.
Leung N, Gertz MA, Zeldenrust SR, Rajkumar SV, Dispenzieri A, Fervenza FC, Kumar S, Lacy MQ, Lust JA, Greipp PR, Witzig TE, Hayman SR, Russell SJ, Kyle RA, Winters JL.
This is a study of 40 patients with MM and renal failure who underwent plasma exchange. In most patients, renal insufficiency resolved when the serum free light chains decreased by at least 50%. The median time to response was about 2 months.



Giampaolo Talamo, M.D.