Feasibility of autologous hematopoietic stem cell transplant in patients aged ≥70 years with multiple myeloma.
Leuk Lymphoma. 2012 Jan;53(1):118-22.
Bashir Q, Shah N, Parmar S, Wei W, Rondon G, Weber DM, Wang M, Orlowski RZ, Thomas SK, Shah J, Qureshi SR, Dinh YT, Popat U, Anderlini P, Hosing C, Giralt S, Champlin RE, Qazilbash MH.
The authors present data from 84 patients with multiple myeloma aged 70 years and older who underwent autologous stem cell transplant at MD Anderson Cancer Center between 1999 and 2010.

Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide.
Blood. 2012 Jan 26;119(4):933-9.
Larocca A, Cavallo F, Bringhen S, Di Raimondo F, Falanga A, Evangelista A, Cavalli M, Stanevsky A, Corradini P, Pezzatti S, Patriarca F, Cavo M, Peccatori J, Catalano L, Carella AM, Cafro AM, Siniscalchi A, Crippa C, Petrucci MT, Yehuda DB, Beggiato E, Di Toritto TC, Boccadoro M, Nagler A, Palumbo A.
342 patients with newly diagnosed multiple myeloma were treated with lenalidomide and randomized to either aspirin 100 mg PO daily or enoxaparin 100 mg SC daily. Results:
  - Venous thromboembolism developed in 2.3% of patients in the aspirin group, and 1.2% in the enoxaparin group
  - Pulmonary embolism developed in 1.7% of patients in the aspirin group, and 0% in the enoxaparin group
  - No cases of arterial embolism were observed
The authors concluded that aspirin is sufficient in the prophylaxis of venous thromboembolism for patients receiving lenalidomide.

Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study.
Leukemia. 2012 Jan;26(1):149-57.
Kumar SK, Lee JH, Lahuerta JJ, Morgan G, Richardson PG, Crowley J, Haessler J, Feather J, Hoering A, Moreau P, LeLeu X, Hulin C, Klein SK, Sonneveld P, Siegel D, Bladé J, Goldschmidt H, Jagannath S, Miguel JS, Orlowski R, Palumbo A, Sezer O, Rajkumar SV, Durie BG; International Myeloma Working Group.
This is a review of 286 patients with multiple myeloma resistant to novel agents (bortezomib and lenalidomide or thalidomide). Salvage therapy included stem cell transplantation in nearly 20% of patients. The overall outcome was poor. Results:
  - Only 32% of patients had a partial response or better
  - Median event-free survival: 5 months
  - Median overall survival: 9 months



A comparison of lenalidomide/dexamethasone versus cyclophosphamide/lenalidomide/dexamethasone versus cyclophosphamide/bortezomib/dexamethasone in newly diagnosed multiple myeloma.
Br J Haematol. 2012 Feb;156(3):326-33.
Khan ML, Reeder CB, Kumar SK, Lacy MQ, Reece DE, Dispenzieri A, Gertz MA, Greipp P, Hayman S, Zeldenhurst S, Dingli D, Lust J, Russell S, Laumann KM, Mikhael JR, Leif Bergsagel P, Fonseca R, Vincent Rajkumar S, Keith Stewart A.
This is a retrospective analysis of 3 phase II trials, which involved three different induction chemotherapy regimens:
   - RD (34 patients), repeated every 28 days
            - Revlimid 25 mg on days 1-21
            - Dexamethasone 40 mg on days 1-4, 9-12, 17-20
   - CRD (53 patients), repeated every 28 days
            - Cyclophosphamide 300 mg/m2 on days 1, 8 , 15
            - Revlimid 25 mg on days 1-21
            - Dexamethasone 40 mg on days 1, 8, 15, 22
   - CVD, also called CyBorD (63 patients), repeated every 28 days
            - Cyclophosphamide 300 mg/m2 PO on days 1, 8 , 15, 22
            - Velcade 1.3 mg/m2 IV on days 1, 4, 8, 11
            - Dexamethasone 40 mg on days 1-4, 9-12, 17-20
Only 80 of the 150 patients underwent upfront stem cell transplantation.
   - Rates of near-complete response or better, after 4 cycles of therapy: 41% with CVD, 12% with RD, and 2% with CRD.
   - Rates of VGPR or better, after 4 cycles of therapy: 65% with CVD, 35% with RD, and 30% with CRD
   - Median progression-free survival was similar (2.3-3.2 years, 2.6 years for all 150 patients)
   - 3-year overall survival was similar (79-88%)
   - 4-year overall survival: 80% for all 150 patients

Percutaneous vertebroplasty in multiple myeloma: prospective long-term follow-up in 106 consecutive patients.
Cardiovasc Intervent Radiol. 2012 Feb;35(1):139-45.
Anselmetti GC, Manca A, Montemurro F, Hirsch J, Chiara G, Grignani G, Carnevale Schianca F, Capaldi A, Rota Scalabrini D, Sardo E, Debernardi F, Iussich G, Regge D.


MARCH 2012

Early versus delayed autologous transplantation after immunomodulatory agents-based induction therapy in patients with newly diagnosed multiple myeloma.
Cancer. 2012 Mar 15;118(6):1585-92.
Kumar SK, Lacy MQ, Dispenzieri A, Buadi FK, Hayman SR, Dingli D, Gay F, Sinha S, Leung N, Hogan W, Rajkumar SV, Gertz MA.
This is a retrospective study of 290 patients with newly diagnosed myeloma.
  - 178 patients underwent "early" transplant, i.e., transplant was done within 12 months of diagnosis
  - 112 patients underwent "delayed" transplant
The rate of overall survival at 4 years was similar, 73% in both groups.
In my personal opinion, the results of this study may be biased by the nature of the myeloma population at Mayo Clinic: patients with clinically aggressive myeloma, for example requiring hemodialysis for renal failure, or using a wheelchair because of spinal cord compression, were unlikely to travel to the Mayo Clinic. Maybe this is a selected population of patients with relatively indolent myeloma. In fact, only 16% of patients in the group of delayed transplant had a stage III disease. Therefore, the results of this study should be interpreted with caution, as it does not indicates that transplant can safely be delayed in all patients with multiple myeloma. Even a prospective study done at the Mayo Clinic may not be reflective of the real population of myeloma patients, as patients who travel to the Mayo Clinic are usually healthier and wealthier than in other parts of the world.

Prevalence of monoclonal gammopathy among patients with psoriatic arthritis.
J Rheumatol. 2012 Mar;39(3):564-7.
Eder L, Thavaneswaran A, Pereira D, Sussman G, Gladman DD.
Among 361 patients with psoriatic arthritis, 35 (10%) were found to have MGUS. Therefore, in these patients, MGUS was more common than in the general population. One patient had multiple myeloma.

Low-dose vs. high-dose thalidomide for advanced multiple myeloma: a prospective trial from the Intergroupe Francophone du Myélome.
Eur J Haematol. 2012 Mar;88(3):249-59.
Yakoub-Agha I, Mary JY, Hulin C, Doyen C, Marit G, Benboubker L, Voillat L, Moreau P, Berthou C, Stoppa AM, Maloisel F, Rodon P, Dib M, Pegourie B, Casassus P, Slama B, Damaj G, Zerbib R, Harousseau JL, Mohty M, Facon T; Intergroupe Francophone du Myélome (IFM).
400 patients with relapsed/refractory myeloma were randomized to 100 vs 400 mg/day of thalidomide. The lower dose was better tolerated, and it produced similar outcomes. The 1-year overall survival rate was 69% with 100 mg, and 73% with 400 mg.


Giampaolo Talamo, MD