ABSTRACT
The role of auto-SCT in the treatment of multiple myeloma (MM) in the era of novel agents continues to evolve. It is now clear that the depth of response and clinical outcomes have significantly improved as a result of the combination of these strategies. However, not all patients with MM who undergo auto-SCT are able to sustain a meaningful response and 20% of patients relapse shortly after auto-SCT. In this study, we aimed to assess the impact of early relapse (ER) after auto-SCT on OS for MM patients undergoing single auto-SCT who had received novel agent-based induction regimens. All consecutive patients with MM undergoing single auto-SCT from January 2002 to September 2012 who had novel induction therapy were evaluated. A total of 184 patients were identified. The median OS and PFS for the group of transplanted patients were 93 and 25.4 months, respectively. Median time to relapse was 17.2 months with 40% having relapsed at the time of analysis. ER (<12 months post auto-SCT) was seen in 27 (36%) out of 75 patients who had relapsed, and median OS was significantly shorter than in those with non-ER. Multivariate analysis showed ER as the major independent prognostic factor for OS. On the basis of these findings, we conclude that not only attainment of a good response, but sustainability of it, appears to be a major prognostic variable in MM in the era of novel therapy. Patients with ER post auto-SCT should biologically be characterized in prospective studies to better understand the mechanisms of resistance associated with this particular entity.
Subject(s)
Induction Chemotherapy/methods , Multiple Myeloma/mortality , Multiple Myeloma/therapy , Stem Cell Transplantation , Autografts , Disease-Free Survival , Female , Humans , Male , Middle Aged , Recurrence , Survival Rate , Time FactorsABSTRACT
Light chain deposition disease (LCDD) is a monoclonal gammopathy characterized by nonamyloid deposition of immunoglobulin light chains in various organs. Most cases present with renal dysfunction, a ubiquitous feature of this disease, and in some instances, it may progress to end-stage renal disease. Unfortunately, until now, no standard treatment has been established. The use of alkylating agents and steroids has been extensively reported. However, conventional chemotherapy response is generally limited with minor effects on kidney function. The use of novel agents such as bortezomib has shown a more rapid response with a dramatically important reduction of light chains in serum and/or urine in small series of cases. Furthermore, autologous stem cell transplantation has been reported as a feasible strategy in LCDD, able to prolong the dialysis-free survival. Nonetheless, toxicity from these therapies should be considered carefully because most of patients might present with kidney dysfunction that could limit the use of some agents.
Subject(s)
Immunoglobulin Light Chains/metabolism , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Multiple Organ Failure/physiopathology , Multiple Organ Failure/therapy , Boronic Acids/therapeutic use , Bortezomib , Female , Hematopoietic Stem Cell Transplantation , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/drug therapy , Male , Middle Aged , Multiple Organ Failure/complications , Multiple Organ Failure/drug therapy , Pyrazines/therapeutic useABSTRACT
The lymphomas are the seventh most common causes of death from cancer in the United States. There is a steady increase in the incidence of non-Hodgkin's Lymphoma from childhood through the age 80, and in the United States, is more common in males than in females. The etiology of the lymphomas is unknown. Molecular biology techniques have allowed the elucidation of many cellular function involved in tumorigenesis. Clinical presentation of non-Hodgkin's lymphoma are varied, and depend on the histologic subtype, the extent (or stage) of the disease, and the primary site of the tumor, most often present lymph node disease, children typically have extranodal disease involving the mediastinum, abdomen or head and neck. Non-Hodgkin's lymphoma are categorized as low, intermediate, or high grade, on the basis of their clinical aggressiveness. Low and intermediate grade tumors predominate in adults, whereas more than 90 percent of children with non Hodgkin's lymphoma have a high grade tumor. The field of cancer therapy has progressed rapidly. In the most recent era, treatment has included multiagent chemotherapy directed to the stage and histologic subtype of the disease. Gene therapy has now become a standard experimental approach for treating cancer were conventional therapies have failed.
