A Phase II trial of autologous stem cell transplantation followed by mini-allogeneic stem cell transplantation for the treatment of multiple myeloma: an analysis of Eastern Cooperative Oncology Group ECOG E4A98 and E1A97.
Biol Blood Marrow Transplant. 2009 Jan;15(1):83-91.
Vesole DH, Zhang L, Flomenberg N, Greipp PR, Lazarus HM; ECOG Myeloma and BMT Committees.

In this study, 32 MM patients received melphalan 200 mg/m2 with autologous HSCT, followed by a mini-allogeneic SCT from matched sibling donor, using fludarabine 30 mg/m2 daily x 5 + cyclophosphamide 1 g/m2 daily x 2. 23 patients (72%) completed both SCT. After a median follow up of 4.6 years, the median PFS was 3.6 years, and the 2-year OS was 78%. Response rate was 78%, including 30% CR. This approach failed to be curative, because a plateau in PFS or OS was not observed, even in patients achieving CR.

Acyclovir to prevent reactivation of varicella zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy.
Cancer. 2009 Jan 1;115(1):229-32.
Vickrey E, Allen S, Mehta J, Singhal S.
In this retrospective study, 125 myeloma patients treated with bortezomib received routine acyclovir prophylaxis at the dose of 400 mg daily (alternatives, used in <20% of patients, were acyclovir 200 mg, valacyclovir 250 or 500 mg, and famciclovir 500 mg). After a median duration of bortezomib therapy of 16 weeks (range, 1-164 weeks), no episodes of herpes zoster were observed.

MMSET deregulation affects cell cycle progression and adhesion regulons in t(4;14) myeloma plasma cells.
Haematologica. 2009 Jan;94(1):78-86.
Brito JL, Walker B, Jenner M, Dickens NJ, Brown NJ, Ross FM, Avramidou A, Irving JA, Gonzalez D, Davies FE, Morgan GJ.
Using several biological assays, these authors found that MMSET regulates the expression of genes involved in:
 - Cell cycle progression (CCND2, CCNG1, BRCA1, AURKA and CHEK1)
 - Apoptosis (CASP1, CASP4 and FOXO3A)
 - Cell adhesion (ADAM9 and DSG2)

Identification of primary MAFB target genes in multiple myeloma.
Exp Hematol. 2009 Jan;37(1):78-86.
van Stralen E, van de Wetering M, Agnelli L, Neri A, Clevers HC, Bast BJ.

This study attempts to identify MAFB target genes in MM. Authors identified 14 upregulated genes, and evaluated their downstream consequences in the combined MAFB/C-MAF pathway.



Contaminating tumour cells in autologous PBSC grafts do not influence survival or relapse following transplant for multiple myeloma or B-cell non-Hodgkin's lymphoma.
Bone Marrow Transplant. 2009 Feb;43(3):223-8.
Ho J, Yang L, Banihashemi B, Martin L, Halpenny M, Atkins H, Sabloff M, McDiarmid SA, Huebsch LB, Bence-Bruckler I, Giulivi A, Allan DS.
158 patients with either NHL or MM undergoing autologous SCT were assessed for clonal IgH CDR3 gene rearrangements using PCR. No improvement in overall survival (OS) or PFS for MM or NHL was observed in patients with PCR-negative PBSC grafts compared with PCR-positive patients. Since MM patients with contaminating tumour cells in their PBSC  grafts did not have worsened OS or PFS, purging strategies may not be necessary in MM.

Relationship between monoclonal gammopathy of undetermined significance and radiation exposure in Nagasaki atomic bomb survivors.
Blood. 2009 Feb 19;113(8):1639-50.
Iwanaga M, Tagawa M, Tsukasaki K, Matsuo T, Yokota K, Miyazaki Y, Fukushima T, Hata T, Imaizumi Y, Imanishi D, Taguchi J, Momita S, Kamihira S, Tomonaga M.
These authors investigated the possible relationship between radiation exposure and MGUS prevalence in Nagasaki atomic bomb survivors between 1988 and 2004. 1082 cases of MGUS were identified from 52,525 study participants. MGUS prevalence correlated with dose of radiation, and the correlation was observed in persons exposed at age 20 years or younger, but not in those exposed at age 20 years or older. Although people exposed at younger age had a significantly high risk of MGUS when exposed to a high radiation dose, no clear association was found between radiation exposure and progression of MGUS to multiple myeloma.

Skin involvement in immunoglobulin E multiple myeloma.
J Clin Oncol. 2009 Feb 1;27(4):637-8.
Wozney JL, Ahmed F, Bayerl MG, Ehmann WC, Talamo G.


MARCH 2009

Second auto-SCT is safe and effective salvage therapy for relapsed multiple myeloma.
Bone Marrow Transplant. 2009 Mar;43(5):417-22.
Olin RL, Vogl DT, Porter DL, Luger SM, Schuster SJ, Tsai DE, Siegel DL, Cook RJ, Mangan PA, Cunningham K, Stadtmauer EA.
This is a study of 41 MM patients who received a salvage auto-SCT, with a median time between transplants of 37 months (range 3-91). The overall response rate was 55%. After a median follow-up of 15 months, the median PFS was 8.5 months and the median OS was 20.7 months.

A case of severe aplastic anemia secondary to treatment with lenalidomide for multiple myeloma.
Eur J Haematol. 2009 Mar;82(3):231-4.
Dasanu CA, Alexandrescu DT.
This is a case report of a 64-year-old male patient who developed progressive pancytopenia three weeks after starting lenalidomide for relapsed MM. A bone marrow biopsy confirmed the diagnosis of severe aplastic anemia. After lenalidomide discontinuation, normal hematopoiesis gradually recovered.

'Light-chain escape-multiple myeloma'-an escape phenomenon from plateau phase: report of the largest patient series using LC-monitoring.
J Cancer Res Clin Oncol. 2009 Mar;135(3):477-84.
Kühnemund A, Liebisch P, Bauchmüller K, zur Hausen A, Veelken H, Wäsch R, Engelhardt M.



Giampaolo Talamo, MD