Clinical Lymphoma and Myeloma最新文献

{"title":"Expanding Our Mission: Clinical Lymphoma, Myeloma & Leukemia","authors":"Bruce D. Cheson MD , Jorge E. Cortés MD , Sundar Jagannath MD","doi":"10.3816/CLM.2009.n.054","DOIUrl":"10.3816/CLM.2009.n.054","url":null,"abstract":"with the interests of our readership. Since our debut as Clinical Lymphoma in June 2000, we have striven to provide physicians and healthcare professionals with the most up-to-date, clinically relevant information available to enhance their ability to provide optimal care for their patients. As our publication grew within the oncology space, our audience demanded that we address other hematologic malignancies as well. Thus, in September 2005, we added multiple myeloma content to the journal. Once again, to meet the growing demand from our readership, we are broadening our scope to include the leukemias. Clinical Lymphoma, Myeloma & Leukemia publishes original articles describing various aspects of clinical and translational research of hematologic malignancies. The journal is devoted to articles on the detection, diagnosis, and treatment of lymphoma, myeloma, leukemia, and related disorders including macroglobulinemia, amyloidosis, and plasma cell dyscrasias. We welcome original studies, comprehensive reviews, perspectives, and current trials on these topics. In order to ensure the highest quality manuscripts, beginning with this issue, we would like to welcome Dr. Jorge E. Cortés as our Editor-in-Chief for leukemia content along with Drs. Morton Coleman, Raymond Comenzo, Guillermo Garcia-Manero, Jeffrey Lancet, and Steven Treon as our newest associate editors. We are very excited to have them join our team and extremely grateful for their commitment to this new expansion. As you all know, individually they are each considered to be leaders in the field of hematologic malignancies, and collectively, they bring tremendous prestige and a wealth of experience to our publication. We also wish to thank our existing associate editors, who include Drs. Brian Durie, Francine Foss, Jonathan Friedberg, Morie Gertz, Jean-Luc Harousseau, Brad Kahl, John Leonard, and Sagar Lonial, as well as the staff of CIG Media Group, LP. It has been through their long-standing dedication and commitment that we have been able to make Clinical Lymphoma & Myeloma (and now with Leukemia) such an outstanding journal. We look forward to working closely with our editorial board and our readership to ensure that this expansion in the scope of Clinical Lymphoma & Myeloma is a successful one.","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10647839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aging, Acute Myelogenous Leukemia, and Allogeneic Transplantation: Do They Belong in the Same Sentence?","authors":"Stefan O. Ciurea ,&nbsp;Morgani Rodrigues ,&nbsp;Sergio Giralt ,&nbsp;Marcos de Lima","doi":"10.3816/CLM.2009.n.057","DOIUrl":"10.3816/CLM.2009.n.057","url":null,"abstract":"<div><p>Acute myelogenous leukemia is a disease of the elderly. Disease biology and functional status of this patient population contribute to poorer treatment outcomes with standard therapy. Allogeneic hematopoietic stem cell transplantation is associated with an immunologic “graft-versus-tumor” effect. However, transplantation was restricted until recently to younger patients because of prohibitive treatment-related mortality. The development of reduced-intensity preparative regimens and improvements in supportive care now allow older patients with myeloid leukemia a greater opportunity for cure with transplantation. Donor availability, graft-versus-host disease, delayed immune recovery, and the high prevalence of relapsed or refractory disease remain important obstacles to be overcome in the future. Herein, we review the current literature on transplantation for older patients with this myeloid malignancy.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10593096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cladribine in the Treatment of Acute Myeloid Leukemia: A Single-Institution Experience","authors":"Mike G. Martin,&nbsp;John S. Welch,&nbsp;Kristan Augustin,&nbsp;Lindsay Hladnik,&nbsp;John F. DiPersio,&nbsp;Camille N. Abboud","doi":"10.3816/CLM.2009.n.058","DOIUrl":"10.3816/CLM.2009.n.058","url":null,"abstract":"<div><h3>Background</h3><p>Despite advances in novel therapeutics, supportive care, and postremission therapy, the outcome of high-risk and elderly patients as well as those with relapsed/refractory acute myeloid leukemia (AML) remains poor. There is likely still room for improvement through optimizing conventional chemotherapy.</p></div><div><h3>Patients and Methods</h3><p>Through a pharmacy database search we identified all patients with AML treated at Washington University with cladribine-based regimens.</p></div><div><h3>Results</h3><p>Twenty-four patients were identified that were treated with 2 cladribine-based regimens: CLAG (cladribine [5 mg/m² days 1-5], cytarabine [2 g/m² days 1-5] and granulocyte colony-stimulating factor [G-CSF; 300 μg subcutaneously (s.c.) days 0-5]) and CLAM (cladribine [5 mg/m² days 1-5], cytarabine [2 g/m² days 1-5], G-CSF [300 mg s.c. days 0-5] and mitoxantrone [10 mg/m² days 1-3]). Complete responses were achieved in 53% of patients given induction chemotherapy and 44% of those given salvage chemotherapy. The regimens were well tolerated with minimal extramedullary toxicity.</p></div><div><h3>Conclusion</h3><p>These data suggest that cladrabine-based regimens should be further explored in both the salvage and first-line setting and might offer an attractive backbone on which to add novel therapies.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28372555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bortezomib: The Subtle Line Between Drug-Induced Peripheral Neuropathy and Post-Herpetic Neuralgia","authors":"Daniele Focosi MD","doi":"10.3816/CLM.2009.n.067","DOIUrl":"10.3816/CLM.2009.n.067","url":null,"abstract":"","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28371610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mantle Cell Lymphoma: Biological Insights and Treatment Advances","authors":"John P. Leonard ,&nbsp;Michael E. Williams ,&nbsp;Andre Goy ,&nbsp;Steven Grant ,&nbsp;Michael Pfreundschuh ,&nbsp;Steve T. Rosen ,&nbsp;John W. Sweetenham","doi":"10.3816/CLM.2009.n.055","DOIUrl":"10.3816/CLM.2009.n.055","url":null,"abstract":"<div><p>Mantle cell lymphoma (MCL) exhibits considerable molecular heterogeneity and complexity, and is regarded as one of the most challenging lymphomas to treat. With increased understanding of the pathobiology of MCL, it is proposed that MCL is the result of 3 major converging factors, namely, deregulated cell cycle pathways, defects in DNA damage responses, and dysregulation of cell survival pathways. In the present era of targeted therapies, these biologic insights have resulted in the identification of several novel rational targets for therapeutic intervention in MCL that are undergoing active clinical testing. To date, there is no standard of care in MCL. Several approaches including conventional anthracycline-based therapies and intensive high-dose strategies with and without stem cell transplantation have failed to produce durable remissions for most patients. Moreover, considering the heterogeneity of MCL, it is increasingly being recognized that risk-adapted therapy might be a relevant therapeutic approach in this disease. At the first and second Global Workshops on Mantle Cell Lymphoma, questions addressing advances in the pathobiology of MCL, optimization of existing therapies, assessment of current data with novel therapeutic strategies, and the identification of molecular or phenotypic risk factors for utilization in risk-adapted therapies were discussed and will be summarized herein.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28371611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Multiple Myeloma: A Comprehensive Review","authors":"Robert A. Kyle,&nbsp;S. Vincent Rajkumar","doi":"10.3816/CLM.2009.n.056","DOIUrl":"10.3816/CLM.2009.n.056","url":null,"abstract":"<div><p>Multiple myeloma (MM) is a neoplastic plasma cell disorder that results in end-organ damage (hypercalcemia, renal insufficiency, anemia, or skeletal lesions). Patients should not be treated unless they have symptomatic (end-organ damage) MM. They should be classified as having high-risk or standard-risk disease. Patients are classified as high risk in the presence of hypodiploidy or deletion of chromosome 13 (del[13]) with conventional cytogenetics, the presence of t(4:14), t(14;16), t(14;20) translocations or del(17p) with fluorescence in situ hybridization. High-risk disease accounts for about 25% of patients with symptomatic MM. If the patient is deemed eligible for an autologous stem cell transplantation (ASCT), 3 or 4 cycles of lenalidomide and low-dose dexamethasone, or bortezomib and dexamethasone, or thalidomide and dexamethasone are reasonable choices. Stem cells should then be collected and one may proceed with an ASCT. If the patient has a complete response or a very good partial response (VGPR), the patient may be followed without maintenance therapy. If the patient has a less than VGPR, a second ASCT is encouraged. If the patient is in the high-risk group, a bortezomib-containing regimen to maximum response followed by 2 additional cycles of therapy is a reasonable approach. Lenalidomide and lowdose dexamethasone is another option for maintenance until progression. If the patient is considered ineligible for an ASCT, then melphalan, prednisone, and thalidomide is suggested for the standard-risk patient, and melphalan, prednisone, and bortezomib (MPV) for the high-risk patient. Treatment of relapsed or refractory MM is covered. The novel therapies—thalidomide, bortezomib, and lenalidomide—have resulted in improved survival rates. The complications of MM are also described. Multiple myeloma is a plasma cell neoplasm that is characterized by a single clone of plasma cells producing a monoclonal protein (M-protein). The malignant proliferation of plasma cells produces skeletal destruction that leads to bone pain and pathologic fractures. The M-protein might lead to renal failure, hyperviscosity syndrome, or through the suppression of uninvolved immunoglobulins, recurrent infections. Anemia and hypercalcemia are common complications.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28372554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Patients With Burkitt Lymphoma Older Than Age 40 Treated With Intensive Chemotherapeutic Regimens","authors":"Jennifer L. Kelly ,&nbsp;Stephen R. Toothaker ,&nbsp;Lauren Ciminello ,&nbsp;Dieter Hoelzer ,&nbsp;Harald Holte ,&nbsp;Ann S. LaCasce ,&nbsp;Graham Mead ,&nbsp;Deborah Thomas ,&nbsp;Gustaaf W. Van Imhoff ,&nbsp;Brad S. Kahl ,&nbsp;Bruce D. Cheson ,&nbsp;Ian T. Magrath ,&nbsp;Richard I. Fisher ,&nbsp;Jonathan W. Friedberg","doi":"10.3816/CLM.2009.n.060","DOIUrl":"10.3816/CLM.2009.n.060","url":null,"abstract":"<div><p>Burkitt lymphoma is a highly curable disorder when treated with modern intensive chemotherapy regimens. The majority of adult patients with Burkitt lymphoma in the United States are over age 40 years. Older patients have historically been underrepresented in published clinical trials of modern intensive therapy, and the outcome of these patients has not been systematically reported. We therefore obtained and analyzed primary data from 14 Burkitt lymphoma treatment series and confirmed that older patients (age &gt; 40 years) are underrepresented in the literature. Historically inferior outcomes of this age subgroup have improved substantially over time. We conclude that (1) modern intensive chemotherapy regimens should remain the standard of care for patients &gt; age 40 with Burkitt lymphoma; (2) selected patients &gt; age 40 now have highly favorable outcomes; and (3) future studies should include formal analysis of this subgroup of patients.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28372557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapy-Related Acute Myeloid Leukemia Following HIV-Associated Lymphoma","authors":"Deepthi Mani ,&nbsp;Russell K. Dorer ,&nbsp;David M. Aboulafia","doi":"10.3816/CLM.2009.n.062","DOIUrl":"10.3816/CLM.2009.n.062","url":null,"abstract":"<div><p>In the highly active antiretroviral therapy era, an increasingly large number of HIV-infected patients are developing non—AIDS-defining cancers (NADCs). As patients survive longer, long-term therapy—related complications take on greater importance. Herein, we describe a patient with AIDS who presented to medical attention with pancytopenia 48 months postchemotherapy with etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (R-EPOCH) for diffuse large B-cell lymphoma. Bone marrow biopsy showed a moderately hypocellular marrow; 51% of the nucleated cells were blasts with myelomonocytic differentiation. Cytogenetic studies revealed an abnormal karyotype with deletion of the long arm of chromosome 11 (11_q21) and 2 additional copies of the <em>MLL</em> gene attached to the short arms of chromosome 10 in 80% of the metaphase cells examined. With the diagnosis of therapy-related acute myeloid leukemia (AML) secured, he began induction chemotherapy with idarubicin and cytarabine. Two weeks later, he died of fungal septicemia and multiorgan failure. Through a literature search, we were able to identify 4 additional cases of therapy-related AML in AIDS patients following chemotherapy for lymphomas. The median age of these patients at the time of AML diagnosis was 39 years (range, 33–59 years), the median time from the treatment of lymphoma to AML was 18 months (range, 11–48 months), and the median survival following induction chemotherapy was 4 weeks (range, 2–16 weeks). With many HIV-infected patients surviving alkylator and topoisomerase inhibitor—based treatment and radiation therapy for AIDS-defining cancers and NADCs, long-term follow-up for therapy-related complications assumes greater importance.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28372559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monoclonal Gammopathy of Undetermined Significance: Why Identification of These Patients and Assessment of Their Skeletons Is Important","authors":"James R. Berenson ,&nbsp;Ori Yellin","doi":"10.3816/CLM.2009.n.061","DOIUrl":"10.3816/CLM.2009.n.061","url":null,"abstract":"<div><p>Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell disorder characterized by the presence of a serum monoclonal immunoglobulin (M-protein) at ≤ 3 g/dL. It is an asymptomatic premalignant disorder that can progress to multiple myeloma and related B-cell disorders. Recent studies have suggested the association of MGUS with enhanced bone loss and debilitating skeletal complications, particularly vertebral compression fractures (VCFs) often leading to back pain. Early identification of MGUS and evaluation of bone status will facilitate prophylactic treatment with bisphosphonates to increase bone density and likely reduce the risk of fractures as well as identify patients with VCFs who might benefit from early surgical intervention. With proper diagnostic and treatment strategies, these patients will experience improved outcomes and quality of life.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28372558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversibility of Renal Impairment in Patients With Multiple Myeloma Treated With Bortezomib-Based Regimens: Identification of Predictive Factors","authors":"Meletios A. Dimopoulos,&nbsp;Maria Roussou,&nbsp;Maria Gavriatopoulou,&nbsp;Flora Zagouri,&nbsp;Magdalini Migkou,&nbsp;Charis Matsouka,&nbsp;Despina Barbarousi,&nbsp;Dimitrios Christoulas,&nbsp;Erasmia Primenou,&nbsp;Irini Grapsa,&nbsp;Evangelos Terpos,&nbsp;Efstathios Kastritis","doi":"10.3816/CLM.2009.n.059","DOIUrl":"10.3816/CLM.2009.n.059","url":null,"abstract":"<div><h3>Purpose</h3><p>Renal impairment is a frequent complication of multiple myeloma (MM) and is associated with significant morbidity and increased early death rate. Bortezomib is active and well tolerated in patients with MM who present or develop renal impairment.</p></div><div><h3>Patients and Methods</h3><p>We analyzed 46 consecutive patients who presented with renal impairment in order to evaluate the impact of bortezomib on the improvement of renal function and to identify predictive factors associated with renal response. All patients received bortezomib with dexamethasone with or without other agents.</p></div><div><h3>Results</h3><p>Renal response was documented in 59% of patients within a median of 11 days (range, 8-41 days). Two of 9 patients who required dialysis became dialysis independent. A complete renal response (CRrenal) was documented in 30% of patients. Toxicities were similar to those seen in myeloma patients without renal failure who were treated with bortezomib-based regimens. Patients with light chain—only myeloma had a higher probability of achieving a renal response, and previously untreated patients had a higher probability for complete resolution of renal impairment, while light chain—only myeloma was independently associated with a shorter time to renal response. The degree of renal impairment was not predictive of the probability for renal response or CRrenal; however, in a subset of patients for whom cystatin C was available, a baseline cystatin C &gt; 2 mg/L or cystatin C calculated estimated glomerular filtration rate &lt; 30 mL/min were associated with a lower probability of CRrenal.</p></div><div><h3>Conclusion</h3><p>We conclude that bortezomib-based regimens may improve renal function in the majority of myeloma patients with renal impairment.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28372556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}