multiple myeloma: applying emerging evidence in practice
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Multiple MyelomaApplying Emerging Evidence in Practice
Jeffrey A. Zonder, MDProfessor of OncologyWayne State University
DisclosuresDr. Zonder discloses the following commercial relationships:Array Biopharma (consultant)Bristol-Myers Squibb (consultant)Celgene (consultant; grants/research support)Janssen (consultant)Pharmacyclics (Data Safety Monitoring board)Prothena (consultant)Seattle Genetics (consultant)Takeda (consultant)
Nursing Learning ObjectivesDescribe clinical challenges associated with the contemporary management of multiple myelomaEvaluate patient- and tumor-related factors that inform evidence-based treatment planningRecognize the clinical application of novel therapies in the treatment of newly diagnosed and relapsed/refractory multiple myelomaAssess side-effect profile of novel therapies for multiple myeloma
Start at the BeginningMultiple Myeloma Arises From MGUSMGUS = monoclonal gammopathy of undetermined significance.
Incidence of Monoclonal Gammopathy of Undetermined Significance Varies according to sex: M > W Varies according to age: Olmsted County50-59 y: 2.2% 70-79 y: 5.9%80-89 y: 8.7%Varies according to ethnicity
3.8%8.4%
5.8%Kyle et al, 2006; Dispenzieri et al, 2010; Cohen et al, 1998; Landgren et al, 2007.
MMMGUSMM = multiple myeloma. Landgren et al, 2009. Uncertain Significance
MGUSStepwise Transformation Process
MM
t(IgH)del13KRASNRASNFkBactdel17pmycLandgren et al, 2009.
Risk Factors for Progression of MGUS
FLC = free light chain.Rajkumar et al, 2005.
Serum Free Light Chain Ratio as Independent Risk Factor for Progressionin MGUS Baseline serum samples obtained within 30 days of diagnosis were available in 1148 of 1384 MGUS patients seen at the Mayo Clinic from 1960 to 1994Malignant progression occurred in 87 (7.6%) patients at a median follow-up of 15 years An abnormal free light chain (FLC) ratio (k/l ratio 1.65) was detected in 379 (33%) patients. The risk of progression in patients with an abnormal FLC ratio was significantly higher compared to patients with a normal ratio (P