High risk MM2019-01-29T13:16:56+00:00

HIGH RISK ARTIKELEN

MEDPAGETODAY:

Nieuwe behandelingen – Novel targets
Moet je Smoldering Myeloma behandelen
Diagnose van MM
Weten wannner je moet gaan behandelen

VAN BELANG VOOR MIJ

Very low lambda

Although experts continue to debate the value of genetic markers and experimental drug regimens, Drs Ghobrial and Landgren explain that there already exists a subpopulation of patients with high-risk SMM who do warrant treatment and should be managed as if they already have symptomatic disease, namely patients with a “myeloma defining event.” These events include bone marrow plasmacytosis at or above 60%; abnormal free light chain (FLC) ratio of 100 or above (involved kappa) or less than 0.01 (involved lambda); or 2 or more focal lesions on magnetic resonance imaging (MRI) or positron emission tomography–computed tomography (PET-CT). Bron: Moet je Smoldering Myeloma behandelen

lenalidomide and dexamethasone

One of the most thought-provoking studies that may bring about a paradigm shift compared a course of lenalidomide and dexamethasone to abstention in 119 patients with high-risk SMM. The open-label, randomized trial found that patients on chemotherapy had significantly better progression-free survival and overall survival.3 More specifically, María-Victoria Mateos, MD, and her colleagues found that “3 years after study entry, 77% of the patients in the treatment group versus 30% of those in the observation group had progression-free survival (hazard ratio

[HR] for progression, 0.18; P<.001).” Similarly, 94% of patients on medication were still alive at the end of 3 years, compared to 80% in the watch-and-wait group (HR for death, 0.31; 95% confidence interval [CI] 0.10 – 0.91; P=.03.) Other clinical trials using other medications are underway to determine if a chemotherapy regimen can replace watch-and-wait bron Moet je Smoldering Myeloma behandelen

Li fraumeni

“In particular, novel immunotherapies with vaccines, checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapy, monoclonal antibodies and IMiDs, alone and especially in combination, can enhance host anti-MM immunity, even in high-risk MM,” they wrote. “These and other novel strategies are necessary to treat patients with unfavorable prognostic factors, such as chromosome 17p deletions and/or TP53 mutations, and to target specific tumoral abnormalities in subsets of patients with MM Bron: Nieuwe behandelingen – Novel targets