Multiple Myeloma

BOSTON-Laboratory studies assessing the effect of potent thalidomide analogs on multiple myeloma cells suggest they have potential for the treatment of multiple myeloma, investigators from Dana-Farber Cancer Institute and Harvard Medical School reported.

Thalidomide (Thalomid) is a potent teratogen and sedative that inhibits angiogenesis. Based on the activity of this agent in patients with multiple myeloma, we initiated a phase II study in Waldenstrom’s macroglobulinemia.

Hematopoietic Cell Transplantation, edited by Drs. Thomas, Blume, and Forman, is an excellent updated second edition of their comprehensive textbook designed for both practitioners involved in transplantation and those interested in the science of stem-cell transplantation.

NEW ORLEANS-High-dose radiation targeted to bone by 166Ho-DOTMP combined with melphalan (Alkeran) with or without total body radiation (TBI) is safe and effective in patients with multiple myeloma, according to clinical trial results presented at the 36th Annual Meeting of the American Society of Clinical Oncology (ASCO).

NEW YORK-Researchers at the Joan and Sanford I. Weill Medical College of Cornell University have identified a collection of distinct chromosome translocations associated with monoclonal gammopathy of undetermined significance (MGUS), a benign preclinical phase of multiple myeloma.

New clinical data presented at the 41st meeting of the American Society of Hematology (ASH) expand on previously published results on the use of thalidomide (Thalomid) in treating advanced and refractory multiple myeloma. The studies

CLEVELAND-Patient education can be improved through the use of new technologies such as computer networks and CD-ROMs. At the Cleveland Clinic Foundation, a website provides disease information and clinical trial updates for multiple myeloma patients. At the Princess Margaret Hospital (Toronto), cancer information for both patients and professionals is offered on its local “intranet” and on CD-ROMs. These cancer education efforts were described at the 33rd annual meeting of the American Association for Cancer Education.

NEW ORLEANS -Age should not be a contraindication for high-dose therapy based on melphalan (Alkeran) in patients with multiple myeloma, according to an analysis by researchers at the Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock.

NEW ORLEANS-Multiple myeloma cells can be fused to dendritic cells and the resulting fusion cells used to selectively kill myeloma tumor cells in vitro, according to a poster presentation at the 41st annual meeting of the American Society of Hematology (ASH).

NEW ORLEANS -Based on an analysis of prognostic factors in a large European registry study, it appears that autologous stem cell transplantation is most effective when applied early in the course of multiple myeloma in younger, responsive patients.

Mayo Clinic investigators confirmed a recent study showing the activity of thalidomide (Thalomid) in advanced multiple myeloma. Although the drug needs to undergo further clinical trials, it may provide myeloma patients with a new treatment

An Arkansas Cancer Research Center study, published in the November 18, 1999, issue of The New England Journal of Medicine, found that thalidomide (Thalidomid) effectively reduced or, in some cases, eliminated tumor activity in multiple myeloma patients who had not responded previously to other agents.

B cells, plasma cells, or both may act as clonogenic cells in multiple myeloma. Circulating CD20-positive B cells bearing identical immunoglobulin H (IgH) rearrangements as autologous plasma cells circulate in most multiple myeloma patients. In

Rituximab (Rituxan) therapy is successfully used to treat many B-cell malignancies. Absent or diminished CD20 expression on certain B-cell tumors may limit the efficacy of CD20-directed serotherapies

Multiple myeloma is a neoplastic disease characterized by the expansion of monoclonal plasma cells that seed throughout the bone marrow. Induction regimens for multiple myeloma result in a 60% to 70% response rate. In vitro studies suggest

LITTLE ROCK-Durable complete remissions “as a prelude to cure” can be obtained in more than half of good-risk multiple myeloma patients who are optimally treated. This conclusion was based on findings from 1,000 consecutive multiple myeloma patients enrolled from 1988 to 1998 in tandem melphalan-based high-dose therapy (HDT) trials with autologous hematopoetic stem cell support. The study was conducted by Bart Barlogie, MD, and colleagues from the Myeloma and Transplantation Research Center, University of Arkansas for Medicine Sciences, and reported at the ASH meeting.

LITTLE ROCK-High-dose chemotherapy with bone-marrow transplant produces complete remissions in about 40% of multiple myeloma patients, but current maintenance therapy is not able to maintain this response. New preliminary data, however, show that multiple myeloma patients who receive a purified immunoglobulin idiotype protein as a vaccine after high-dose chemotherapy and transplant are likely to have improved event-free survival. Nikhil C. Munshi, MD, of the University of Arkansas for Medical Sciences reported these preliminary results at the ASH meeting.

NEW ORLEANS-Thalidomide’s value in managing multiple myeloma has been solidified by reports from two cancer centers presented at the ASH meeting.

STANFORD, California-Idiotype (Id) vaccination using dendritic cells induced Id-specific T-cell responses in multiple myeloma and was associated with a decrease in the myeloma protein level, according to Stanford University researchers, who reported their results at the ASH meeting.

NEW ORLEANS-Vaccinating multiple myeloma patients with their own idiotype-loaded dendritic cells appears to be a safe way of stimulating immune responses against the cancers, according to two poster presentations at the ASH meeting.

BOSTON-Multiple myeloma remains one of the more intractable problems in oncology. Although about 60% of patients respond to current standard treatment with melphalan and prednisone, median survival is only 2 to 3 years, and toxicity is significant. Nearly all multiple myeloma patients treated with melphalan/prednisone ultimately die of progressive disease. About 25% of patients survive for 5 years or longer, but 10-year survival is less than 5%. High-dose chemotherapy followed by stem-cell transplantation produces higher remission rates but no cures.

BOSTON-Interferon-gamma (IFN-g) triggers expression of CD20 on otherwise non-expressing multiple myeloma cells and may set them up for destruction by anti- CD20 monoclonal antibodies such as rituximab (Rituxan), Steven P. Treon, MD, PhD, of Dana-Farber Cancer Institute reported at the ASH meeting. Rituximab is an appealing therapeutic agent because of its relative lack of toxicity, but other studies have shown that in multiple myeloma, it is effective primarily in patients with CD20+ cells.

CLEVELAND-Rituximab (Rituxan) as a single agent appears to be active in a subset of multiple myeloma patients who have CD20+ plasma cells. That finding, reported at the ASH meeting, came as a result of a study by Mohamad A. Hussein, MD, and colleagues at the Cleveland Clinic Taussig Cancer Center to evaluate the effectiveness of rituximab in improving the response rate to melphalan/prednisone (Alkeran/Deltasone) as well as progression-free survival.

NANTES, France-As the conditioning regimen for autologous transplantation in multiple myeloma, high-dose melphalan (Alkeran) 200 mg/m² is as effective as, but less toxic than, melphalan 140 mg/m² plus total body irradiation. This approach should be considered as the standard conditioning regimen, French investigators contended at the ASH meeting.

NEW YORK-New therapies, immunotherapy, and enhanced prognostic indicators were some of the developments in multiple myeloma discussed at a symposium co-sponsored by the Multiple Myeloma Research Foundation (MMRF) and St. Vincents Comprehensive Cancer Center.

LUGANO, Switzerland-A debate at the VII International Conference on Malignant Lymphoma proved to be less controversial than expected when the two opposing speakers came close to agreeing that the possibility of high-dose chemotherapy with hematopoietic support should be weighed in all patients with symptomatic multiple myeloma.

Research investigating the use of thalidomide in multiple myeloma report that 34% of patients treated with the drug experienced a reduction in tumor burden. Some patients experienced more than a 7,500-fold reduction in tumor growth,

MIAMI BEACH-By conventional karyotyping, the frequency of c-myc dysregulation in multiple myeloma is low. Now, using molecular karyotyping techniques, researchers have found c-myc chromosomal abnormalities in multiple myeloma cell lines.

TORONTO-CD34+ selection of peripheral blood stem cells (PBSCs) significantly reduces tumor cell contamination while providing safe and rapid hematologic recovery for multiple myeloma patients receiving myeloablative therapy, Dr. A.K. Stewart, of Toronto Hospital, reported at ASH.

LONDON-Although age is currently used as an eligibility criteria for inclusion in transplant protocols, a retrospective study from the Royal Marsden Hospital, London, suggests that multiple myeloma patients in their 60s and 70s can safely undergo high-dose chemotherapy with autologous bone marrow or stem cell transplantation.