Multiple Myeloma Review Article 2016

Multiple myeloma review article 2016 - multiple myeloma is a malignant sickness characterized by the proliferation of clonal plasma cells in the bone marrow and normally observed by way of the secretion of monoclonal immunoglobulins which can be detectable in serum or urine. The multiplied information of microenvironmental interactions among malignant plasma cells and the area of interest of the bone marrow and its position in prone disease progression and the purchase of resistance to therapy has helped develop new therapeutic capsules to be used in mixture with cytostatic therapy. together with autologous stem cell transplantation and advances in supportive care, the use of new tablets which include proteasome inhibitors and immunomodulatory tablets has multiplied response charges and widespread survival in latest years. current clinical research focuses on the balance between remedy efficacy and exceptional of existence, the ultimate sequencing of treatment options, the query of lengthy-term remission and capability remedy through multimodal treatment, the preventive remedy of excessive-danger ardent myeloma and the role of maintenance. the approaching results of ongoing medical trials, along with a number of promising new treatments, growth the hope for continuous enhancements within the prognosis of myeloma patients in the destiny.

Multiple Myeloma Review Article 2016

Progress in MM treatment and patient survival has reinforced the need for better tools to predict and control the efficacy of treatment. The current criteria for the definition of complete response are based on low-sensitivity techniques (immunofixation and morphology); Therefore, more sensitive methods for evaluating the response depth (minimal residual disease), both within the BM (immunophenotyping of multiparametric flow cytometry and molecular methods such as polymerase chain reaction specific oligonucleotídica allele and next generation sequencing) emission tomography with computed tomography [PET/CT]), for optimal control to avoid undertreatment and overtreatment. There is clear evidence that the better the quality of the response, the greater the survival and, most likely, the concepts of immunophenotypic and molecular remission, as well as the referral determined by PET/CT will soon be widely applied as new criteria of response. Consequently, the present review of Paiva, Van Dongen and ORFAO represents a unique opportunity to understand the pros and cons of each technique.

Multiple myeloma review article 2016 - In this series of reviews, 3 experts from the French myeloma group analyze treatment options for newly diagnosed MM patients. As mentioned earlier, the outcome of patients with MM has improved significantly over the past decade. This was due in the first place to the introduction of a high-dose therapy followed by autologous stem cell transplantation and, in particular, the use of novel agents such as proteasome inhibitors (bortezomib [Btz]) and immunomodulatory agents (thalidomide [Thal] and lenalidomide [Len]).

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In patients with transplanted MM, the new standard includes 4 to 6 induction cycles based on bortezomib with 3 drugs (Btz/Thal/dexamethasone [dex] or Btz/Len/dex or Btz/cyclophosphamide/dex) Inducing 80% 90% of responses, including up to 30% full answers, followed by autologous stem cell transplantation. Recent data have shown that consolidation and maintenance (especially with Len) can significantly prolong survival without progression, but optimal timing and duration of treatment are still under investigation. Allogeneic stem cell transplantation remains experimental due to transplant mortality (10%-15%) and persistence of relapses. In elderly patients, new standards are melphalan/prednisone/Btz or Len/Dex, but melphalan/prednisone/Thal is also frequently used. The value of maintenance in elderly patients is also under investigation.

Multiple myeloma review article 2016 - Although the survival of myeloma patients has doubled at least and a small fraction can even be cured operationally, most patients eventually relapse and treatment at this stage can be particularly complex. The final review article of this series provides a complementary view of the leaders in the United States and Europe. At the time of relapse, the use of alternative drugs to which they are given in advance is the current practice. There are currently many new options for the treatment of MM weapons, including recently approved drugs (such as second and third generation proteasome inhibitors, Carfilzomib and Ixazomib and Agent Immunomodulatory pomalidomide), as well as other emerging agents with new mechanisms of action (e.g. monoclonal antibodies, histone deacetylase inhibitors, and kinesin protein inhibitors) that are under active research. The ultimate goal must be to find a balance between efficacy, toxicity and cost and, at the end of the road, the dream of achieving the cure for this disease.

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