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Current Oncology
Special Issues
Current Treatment Strategies for Relapsed and Refractory Multiple Myeloma
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Current Treatment Strategies for Relapsed and Refractory Multiple Myeloma

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Hematology".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 8944

Special Issue Editor

Dr. Guido Bisping

E-Mail Website
Guest Editor
Department of Medicine/Hematology and Oncology, Mathias Spital Rheine, Rheine, Germany
Interests: multiple myeloma; lymphoma; bone marrow stroma – myeloma cell interactions; allogeneic stem cell transplantation; autologous stem cell transplantation; hemostaseology

Special Issue Information

Dear Colleagues, 

Multiple myeloma (MM) is a mostly incurable systemic malignant plasma-cell disease of the bone marrow. The prognosis of MM has significantly improved over the last decade(s). In cases of relapse or a refractory course of multiple myeloma (r/r MM) after primary treatment with or without autologous stem cell transplantation, responses to previous regimens, potential persistent toxicities and prognostic molecular and/or cytogenetic factors should be carefully assessed in order to apply adequate further drug combinations for r/r MM. To date, patients can benefit from variety of drug combinations treating r/r MM. After first-line treatment with Bortezomib (Bor)-based regimens, immunomodulatory drugs (IMiDs) such as Thalidomide (Thal), lenalidomide (Len) are preferred backbones. On the other hand, combinations with second-generation proteasome inhibitors (carfilzomib (Car) and ixazomib (Ixa)) represent an option after first-line IMiD-based therapies. Elotuzumab (Elo) and daratumumab (Dara) or isatuximab (Isa), monoclonal antibodies targeting SLAMF7 (Elo) or CD38 (Dara / Isa), are highly effective partners for triplet combinations. Panobinostat (Pan), ricolinostat, and vorinostat are deacetylase inhibitors (HDACi), whereas pomalidomide (Pom) is another IMiD, one that can be combined with dexamethasone and either Elo, Dara or Ixa in r/r MM. Anti-BCMA CAR-T therapy, another novel method for treating r/r MM, has been applied in clinical settings. CAR-T cells very specifically recognize the targeted molecule B cell maturation antigen (BCMA) and are able to kill BCMA-expressing MM cells. Numerous regimens have shown antimyeloma activity with these new drugs or their respective combinations today, and additional new regimens are being continuously developed.

This issue will outline current and future aspects of the pathophysiology, genetics, signaling networks and differential treatment options of r/r MM in 2023.

Dr. Guido Bisping
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • relapsed and refractory myeloma
  • IMiDs
  • proteasome inhibitors
  • SLAMF7 anttibody
  • anti-CD38-antibody
  • BCMA-directed therapy
  • CAR-T cell therapy
  • autologous transplant
  • allogeneic transplant

Published Papers (2 papers)

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Research

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11 pages, 4283 KiB  
Article
Impact of the Extremities Positioning on the Set-Up Reproducibility for the Total Marrow Irradiation Treatment
by Nicola Lambri, Simone Leopoldo Antonetti, Damiano Dei, Luisa Bellu, Stefania Bramanti, Ricardo Coimbra Brioso, Carmelo Carlo-Stella, Isabella Castiglioni, Elena Clerici, Leonardo Crespi, Chiara De Philippis, Carmela Galdieri, Daniele Loiacono, Pierina Navarria, Giacomo Reggiori, Roberto Rusconi, Stefano Tomatis, Marta Scorsetti and Pietro Mancosu
Curr. Oncol. 2023, 30(4), 4067-4077; https://doi.org/10.3390/curroncol30040309 - 06 Apr 2023
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Abstract
Total marrow (lymph node) irradiation (TMI/TMLI) delivery requires more time than standard radiotherapy treatments. The patient’s extremities, through the joints, can experience large movements. The reproducibility of TMI/TMLI patients’ extremities was evaluated to find the best positioning and reduce unwanted movements. Eighty TMI/TMLI [...] Read more.
Total marrow (lymph node) irradiation (TMI/TMLI) delivery requires more time than standard radiotherapy treatments. The patient’s extremities, through the joints, can experience large movements. The reproducibility of TMI/TMLI patients’ extremities was evaluated to find the best positioning and reduce unwanted movements. Eighty TMI/TMLI patients were selected (2013–2022). During treatment, a cone-beam computed tomography (CBCT) was performed for each isocenter to reposition the patient. CBCT-CT pairs were evaluated considering: (i) online vector shift (OVS) that matched the two series; (ii) residual vector shift (RVS) to reposition the patient’s extremities; (iii) qualitative agreement (range 1–5). Patients were subdivided into (i) arms either leaning on the frame or above the body; (ii) with or without a personal cushion for foot positioning. The Mann-Whitney test was considered (p < 0.05 significant). Six-hundred-twenty-nine CBCTs were analyzed. The median OVS was 4.0 mm, with only 1.6% of cases ranked < 3, and 24% of RVS > 10 mm. Arms leaning on the frame had significantly smaller RVS than above the body (median: 8.0 mm/6.0 mm, p < 0.05). Using a personal cushion for the feet significantly improved the RVS than without cushions (median: 8.5 mm/1.8 mm, p < 0.01). The role and experience of the radiotherapy team are fundamental to optimizing the TMI/TMLI patient setup. Full article
(This article belongs to the Special Issue Current Treatment Strategies for Relapsed and Refractory Multiple Myeloma)
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Review

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26 pages, 899 KiB  
Review
Relapsed/Refractory Multiple Myeloma: A Review of Available Therapies and Clinical Scenarios Encountered in Myeloma Relapse
by Parva Bhatt, Colin Kloock and Raymond Comenzo
Curr. Oncol. 2023, 30(2), 2322-2347; https://doi.org/10.3390/curroncol30020179 - 15 Feb 2023
Cited by 11 | Viewed by 6554
Abstract
Multiple myeloma remains an incurable disease with the usual disease course requiring induction therapy, autologous stem cell transplantation for eligible patients, and long-term maintenance. Risk stratification tools and cytogenetic alterations help inform individualized therapeutic choices for patients in hopes of achieving long-term remissions [...] Read more.
Multiple myeloma remains an incurable disease with the usual disease course requiring induction therapy, autologous stem cell transplantation for eligible patients, and long-term maintenance. Risk stratification tools and cytogenetic alterations help inform individualized therapeutic choices for patients in hopes of achieving long-term remissions with preserved quality of life. Unfortunately, relapses occur at different stages of the course of the disease owing to the biological heterogeneity of the disease. Addressing relapse can be complex and challenging as there are both therapy- and patient-related factors to consider. In this broad scoping review of available therapies in relapsed/refractory multiple myeloma (RRMM), we cover the pharmacologic mechanisms underlying active therapies such as immunomodulatory agents (IMiDs), proteasome inhibitors (PIs), monoclonal antibodies (mAbs), traditional chemotherapy, and Venetoclax. We then review the clinical data supporting the use of these therapies, organized based on drug resistance/refractoriness, and the role of autologous stem cell transplant (ASCT). Approaches to special situations during relapse such as renal impairment and extramedullary disease are also covered. Lastly, we look towards the future by briefly reviewing the clinical data supporting the use of chimeric antigen receptor (CAR-T) therapy, bispecific T cell engagers (BITE), and Cereblon E3 Ligase Modulators (CELMoDs). Full article
(This article belongs to the Special Issue Current Treatment Strategies for Relapsed and Refractory Multiple Myeloma)
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