Multiple myeloma with extramedullary disease: impact of autologous stem cell transplantation on outcome.
Bone Marrow Transplant. 2017 Oct;52(10):1473-1475.
Kumar L, Gogi R, Patel AK, Mookerjee A, Sahoo RK, Malik PS, Sharma A, Thulkar S, Kumar R, Biswas A, Sharma OD, Gupta R.
This is a retrospective study of 44 myeloma patients with extramedullary disease who underwent an autologous stem cell transplant. After a median follow-up of 7.5 years, 13 patients (30%) were alive, and 9 of them were in CR. As expected, patients with extramedullary disease had lower PFS and OS compared with the rest of myeloma patients. The study did not provide cytogenetic data. The most important predictor for PFS and OS was the achievement of CR after the stem cell transplant. 

Effectiveness of IHD with Adsorptive PMMA Membrane in Myeloma Cast Nephropathy: A Cohort Study.
Am J Nephrol. 2017 Oct 10;46(5):355-363.
Sens F, Chaintreuil D, Jolivot A, Guebre-Egziabher F, Robinson P, Karlin L, Bridoux F, Juillard L.

Monoclonal IgG in MGUS and multiple myeloma targets infectious pathogens.
JCI Insight. 2017 Oct 5;2(19).
Bosseboeuf A, Feron D, Tallet A, Rossi C, Charlier C, Garderet L, Caillot D, Moreau P, Cardó-Vila M, Pasqualini R, Arap W, Nelson AD, Wilson BS, Perreault H, Piver E, Weigel P, Girodon F, Harb J, Bigot-Corbel E, Hermouet S.
Contrary to traditional thought, these authors showed that the monoclonal antibodies secreted by MGUS and myeloma cells can target infectious pathogens: the antigen specificity of purified monoclonal paraprotein of 244 patients was found to be directed against one known pathogen in 23% of cases: EBV (16%), HSV-1 (3%), VZV (2%), CMV (1%), and HCV (1%). The authors believe that MGUS and myeloma could be the result of a dysregulated immune response to an infection.

Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open-label, randomised, phase 3 trial.
Lancet Oncol. 2017 Oct;18(10):1327-1337.
Dimopoulos MA, Goldschmidt H, Niesvizky R, Joshua D, Chng WJ, Oriol A, Orlowski RZ, Ludwig H, Facon T, Hajek R, Weisel K, Hungria V, Minuk L, Feng S, Zahlten-Kumeli A, Kimball AS, Moreau P.

The ENDEAVOR trial is a phase III study comparing bortezomib and carfilzomib in patients with relapsed/refractory multiple myeloma. Patients received 1-3 previous lines of chemotherapy. Bortezomib was given at 1.3 mg/m2 SC/IV on days 1, 4, 8, 11 every 21 days, and carfilzomib at 56 mg/m2 IV on days 1 on days 1,2, 8,9, 15,16 every 28 days (20 mg/m2 on the first two doses). Both groups received dexamethasone. 929 patients were randomized, 465 to the bortezomib group and 464 to the carfilzomib group. Median overall survival: 40 months with bortezomib vs 47.6 months with carfilzomib. The authors note that, at the time of publication, carfilzomib was the only agent in multiple myeloma that demonstrated an improved overall survival in the relapsed setting.







Giampaolo Talamo, MD