Novel Insights in Myeloma

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (10 November 2023) | Viewed by 11041

Special Issue Editor


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Guest Editor
Instituto de Investigación Biomédica de Salamanca (IBSAL), Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, University Hospital of Salamanca, 37007 Salamanca, Spain
Interests: myeloma; asymptomatic myeloma; minimal residual disease; early treatment; novel drugs
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Special Issue Information

Dear Colleagues,

Multiple myeloma represents the second most common hematologic malignancy, and although it remains an incurable disease for most patients, great progress is being made towards finding a cure. This progress is based on basic, translational, and clinical research for better understanding the myeloma biology as well as the development of novel therapeutic approaches targeting the malignant cell and its surrounding microenvironment. Early detection of the disease and early intervention is an example. Other efforts are also being made to establish a more individualized therapeutic approach based on patient and disease-based factors: there are clinical trials focused on fit, intermediated, or frail patients, as well as others evaluating more intensive approaches for patients with high-risk features. The response to treatment continues to be an important predictor for outcomes and investigations into new techniques available in peripheral blood, such as mass spectrometry, are crucial for its evaluation. This Special Issue reflects all these recent advances in research and treatment, focusing on a more individualized approach based on frailty, risk, and response.

This Special Issue aims to focus on an individualized approach for the management of patients with multiple myeloma based on its early detection and intervention, its frailty, risk status, and response.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: Early detection and intervention, frailty-adapted therapy, the management of patients with high-risk features, and how to optimize the techniques for the evaluation of the response to treatment.

I/We look forward to receiving your contributions.

Prof. Dr. María Victoria Mateos
Guest Editor

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Keywords

  • treatment response
  • asymptomatic disease
  • high-risk myeloma
  • frailty-adapted therapy
  • multiple myeloma

Published Papers (5 papers)

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Research

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8 pages, 1402 KiB  
Communication
The Singular Epidemiology of Plasmacytoma and Multiple Myeloma in French Guiana
by Laure Manuella Imounga, Kinan Drak Alsibai, Juliette Plenet, Qiannan Wang, Beatrice Virjophe-Cenciu, Pierre Couppie, Nadia Sabbah, Antoine Adenis and Mathieu Nacher
Cancers 2024, 16(1), 178; https://doi.org/10.3390/cancers16010178 - 29 Dec 2023
Viewed by 511
Abstract
Background: The objective was to review a decade of plasmacytoma (PC) and multiple myeloma (MM) data from French Guiana, and to study its spatial and temporal trends. Methods: This was a retrospective study of MM and PC between January 2005 and December 2014 [...] Read more.
Background: The objective was to review a decade of plasmacytoma (PC) and multiple myeloma (MM) data from French Guiana, and to study its spatial and temporal trends. Methods: This was a retrospective study of MM and PC between January 2005 and December 2014 using cancer registry data, including age-standardized incidence and mortality rates. Results: There were 110 cases of PC and MM (62 women and 48 men), representing the eighth most frequent malignancy in French Guiana. PC and MM were much more common in females. In men, 79% of cases occurred at ≥55 years, and in women, 90% of cases occurred at ≥50 years. The median age at diagnosis was 60 years for men and 66 years for women, while it was 72 years for men and 75 years for women in mainland France. The incidence rate standardized to the world population was 5.9 patients of PC and MM per 100,000 men/year and 7.8 per 100,000 women/year. Conclusions: In our territory, the incidence of PC and MM was higher and patients were diagnosed at a substantially younger age than in mainland France. Women had a greater incidence than men, and there was an increasing temporal trend of incidence among women. African ancestry and the frequency of obesity, notably among women, could have contributed to this observation. Full article
(This article belongs to the Special Issue Novel Insights in Myeloma)
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10 pages, 228 KiB  
Article
What Affects Treatment Underuse in Multiple Myeloma in the United States: A Qualitative Study
by Rose Cytryn, Nina Bickell, Radhi Yagnik, Sundar Jagannath and Jenny J. Lin
Cancers 2023, 15(8), 2369; https://doi.org/10.3390/cancers15082369 - 19 Apr 2023
Viewed by 901
Abstract
Background: Multiple myeloma (MM) is the second most common hematologic malignancy. African Americans are more likely than Whites to be diagnosed with and die of MM, but they experience the same survival times in clinical trials, suggesting that differences in survival may be [...] Read more.
Background: Multiple myeloma (MM) is the second most common hematologic malignancy. African Americans are more likely than Whites to be diagnosed with and die of MM, but they experience the same survival times in clinical trials, suggesting that differences in survival may be attributed to differences in receipt of treatment or differences in access to new treatments. We undertook this study to identify the reasons and needs underlying disparities in treatment among patients diagnosed with MM. Methods: We conducted in-depth interviews in 2019–2020 with patients diagnosed with MM between 2010 and 2014 who were identified as eligible for transplant and maintenance therapy and having experienced delays in or underuse of treatment for MM. Underuse was defined as the lack of a particular treatment that the patient was eligible to receive, not being transplanted if eligible, and/or not receiving maintenance therapy. Underuse included patients’ decision to delay harvest or autologous stem cell transplant (ASCT) for the time being and return to the decision in the future. All interviews were audio-recorded and transcribed verbatim. Four investigators independently coded transcripts through inductive analysis to assess reasons for treatment decisions. Results: Of the 29 patients interviewed, 68% experienced treatment underuse: 21% self-identified as African American, 5% as Hispanic, 10% as mixed race, 57% as White, and 16% as Asian. There were no racial differences in reasons for underuse or delay. Themes relating to treatment underuse included: perceived pros and cons of treatment, including potential harm or lack thereof in delaying treatment; physician recommendations; and personal agency. Conclusion: Patients’ decision making, delays, and underuse of MM treatment are influenced by social, personal, medical, and contextual factors. Patients consider their relationship with their physician to be one of the most significant driving forces in their decisions and treatment plans. Full article
(This article belongs to the Special Issue Novel Insights in Myeloma)
15 pages, 2200 KiB  
Article
Novel Agents as Main Drivers for Continued Improvement in Survival in Multiple Myeloma
by Borja Puertas, Verónica González-Calle, Eduardo Sobejano-Fuertes, Fernando Escalante, José A. Queizán, Abelardo Bárez, Jorge Labrador, José María Alonso-Alonso, Alfonso García de Coca, Alberto Cantalapiedra, Teresa Villaescusa, Carlos Aguilar-Franco, Elena Alejo-Alonso, Beatriz Rey-Bua, Lucía López-Corral, Ramón García-Sanz, Noemi Puig, Norma C. Gutiérrez and María-Victoria Mateos
Cancers 2023, 15(5), 1558; https://doi.org/10.3390/cancers15051558 - 02 Mar 2023
Cited by 5 | Viewed by 3655
Abstract
(1) Background: New therapeutic strategies have improved the prognosis of multiple myeloma (MM), changing the accepted view of this disease from being incurable to treatable. (2) Methods: We studied 1001 patients with MM between 1980 and 2020, grouping patients into ten-year periods by [...] Read more.
(1) Background: New therapeutic strategies have improved the prognosis of multiple myeloma (MM), changing the accepted view of this disease from being incurable to treatable. (2) Methods: We studied 1001 patients with MM between 1980 and 2020, grouping patients into ten-year periods by diagnosis 1980–1990, 1991–2000, 2001–2010 and 2011–2020. (3) Results: After 65.1 months of follow-up, the median OS of the cohort was 60.3 months, and OS increased significantly over time: 22.4 months in 1980–1990, 37.4 months in 1991–2000, 61.8 months in 2001–2010 and 103.6 months in 2011–2020 (p < 0.001). Using novel agents in the front-line setting for myeloma patients yielded a significantly better OS than in those treated with conventional therapies, especially when combinations of at least two novel agents were used. The median OS of patients treated with the combination of at least two novel agents in induction was significantly prolonged compared to those treated with a single novel agent or conventional therapy in induction: 143.3 vs. 61.0 vs. 42.2 months (p < 0.001). The improvement was apparent in all patients regardless of age at diagnosis. In addition, 132 (13.2%) patients were long-term survivors (median OS ≥ 10 years). Some independent clinical predictors of long-term survival were identified: ECOG < 1, age at diagnosis ≤ 65 years, non-IgA subtype, ISS-1 and standard-risk cytogenetic. Achieving CR and undergoing ASCT were positively associated with >10 years of survival. (4) Conclusions: The combination of novel agents appears to be the main factor for the improvement in survival in MM, which is becoming a chronic and even curable disease in a subtype of patients without high-risk features. Full article
(This article belongs to the Special Issue Novel Insights in Myeloma)
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Review

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20 pages, 690 KiB  
Review
Treatment Strategy for Ultra-High-Risk Multiple Myelomas with Chromosomal Aberrations Considering Minimal Residual Disease Status and Bone Marrow Microenvironment
by Kazuhito Suzuki and Shingo Yano
Cancers 2023, 15(9), 2418; https://doi.org/10.3390/cancers15092418 - 22 Apr 2023
Viewed by 2631
Abstract
Despite the development of anti-myeloma therapeutics, such as proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and autologous stem cell transplantation (ASCT), multiple myeloma remains incurable. A trial treatment combining four drugs—daratumumab, carfilzomib, lenalidomide, and dexamethasone—followed by ASCT frequently results in minimal residual disease [...] Read more.
Despite the development of anti-myeloma therapeutics, such as proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and autologous stem cell transplantation (ASCT), multiple myeloma remains incurable. A trial treatment combining four drugs—daratumumab, carfilzomib, lenalidomide, and dexamethasone—followed by ASCT frequently results in minimal residual disease (MRD) negativity and prevents progressive disease in patients with standard- and high-risk cytogenetics; however, it is insufficient to overcome the poor outcomes in patients with ultra-high-risk chromosomal aberration (UHRCA). In fact, MRD status in autografts can predict clinical outcomes after ASCT. Therefore, the current treatment strategy might be insufficient to overcome the negative impact of UHRCA in patients with MRD positivity after the four-drug induction therapy. High-risk myeloma cells lead to poor clinical outcomes not only by aggressive myeloma behavior but also via the generation of a poor bone marrow microenvironment. Meanwhile, the immune microenvironment effectively suppresses myeloma cells with a low frequency of high-risk cytogenetic abnormalities in early-stage myeloma compared to late-stage myeloma. Therefore, early intervention might be key to improving clinical outcomes in myeloma patients. The purpose of this review is to improve clinical outcomes in patients with UHRCA by considering MRD assessment results and improvement of the microenvironment. Full article
(This article belongs to the Special Issue Novel Insights in Myeloma)
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11 pages, 589 KiB  
Review
Role of Anti-B-Cell Maturation Antigen (BCMA) in the Management of Multiple Myeloma
by Ikhwan Rinaldi, Abdul Muthalib, Brenda Cristie Edina, Lowilius Wiyono and Kevin Winston
Cancers 2022, 14(14), 3507; https://doi.org/10.3390/cancers14143507 - 19 Jul 2022
Cited by 2 | Viewed by 2801
Abstract
Over the past few decades, treatment options have become more advanced for multiple myeloma (MM), one of the most prevalent hematological cancers; however, multiple myeloma remains an incurable disease due to its poor response to therapy and high rates of resistance, which cause [...] Read more.
Over the past few decades, treatment options have become more advanced for multiple myeloma (MM), one of the most prevalent hematological cancers; however, multiple myeloma remains an incurable disease due to its poor response to therapy and high rates of resistance, which cause relapsed/refractory or multiple myeloma. Researchers have described anti-BCMA (B-cell maturation antigen) as a promising treatment regimen that targets the BCMA biomarker in the affected plasma cells. BCMA is a protein that is specifically expressed in plasma-cell neoplasms by using several mechanisms, such as CAR T cells (Chimeric Antigen Receptor T cells), antibody-drug conjugates, and bispecific T-cell engagers, thus allowing for a rapid response in the treatment of resistant or relapsed/refractory multiple myeloma patients. Anti-BCMA treatment is novel and specific in its mechanisms of action, with noninferior complete responses, higher overall survival rates, and fewer reported adverse events compared to other currently available treatment of MM. In this review, we compared anti-BCMA mechanisms with those of previously available therapies, such as those using immunomodulators and proteasome inhibitors, and discussed the advantages of using anti-BCMA as a potential first-line treatment for multiple myeloma patients. Full article
(This article belongs to the Special Issue Novel Insights in Myeloma)
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