Presse Medicale最新文献

Treatment of elderly and frail myeloma patients. 治疗年老体弱的骨髓瘤患者。

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-12 DOI: 10.1016/j.lpm.2024.104266

Steven Chun-Min Shih, Alissa Visram, Hira Mian

{"title":"Treatment of elderly and frail myeloma patients.","authors":"Steven Chun-Min Shih, Alissa Visram, Hira Mian","doi":"10.1016/j.lpm.2024.104266","DOIUrl":"https://doi.org/10.1016/j.lpm.2024.104266","url":null,"abstract":"<p><p>Multiple myeloma (MM) is an incurable cancer of older adults. Given the aging population, the prevalence of older adults with MM is expected to further increase over the next decade. Challenges in treating older adults result from the heterogeneity of both aging itself and the disease. Over the past two decades, tremendous progress has been made in improving the outcome in this age group with novel therapeutics, including immunomodulatory drugs, proteasome inhibitors, and more recently anti-CD38 monoclonal antibodies, becoming an integral part of initial treatment. Further improvements are expected over the next decade with novel immunotherapy, including T-cell engagers and chimeric antigen receptor therapies. With additional novel treatments, assessment of patient frailty will become increasingly important in balancing the optimal treatment of patients. In this review, we focus on the treatment of elderly and frail older adults with MM. The first part of our review will focus on pertinent investigations, considerations for treatment initiation and initial risk stratification, including frailty assessment prior to treatment initiation. In the second part, we will focus on the overall goals of treatment and therapeutic options for newly diagnosed and those with relapsed/refractory MM, including novel immunotherapy and supportive care. Lastly, we will end this review by highlighting current knowledge gaps and providing suggestions for future directions to further improve outcomes among older adults with MM.</p>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":" ","pages":"104266"},"PeriodicalIF":3.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

PRIMARY SYSTEMIC AMYLOIDOSIS: A BRIEF OVERVIEW.

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-11 DOI: 10.1016/j.lpm.2024.104267

Michael Sang Hughes, Suzanne Lentzsch

引用次数: 0

Imaging in Multiple Myeloma.

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-09 DOI: 10.1016/j.lpm.2024.104263

Jas Virk, Jens Hillengass

{"title":"Imaging in Multiple Myeloma.","authors":"Jas Virk, Jens Hillengass","doi":"10.1016/j.lpm.2024.104263","DOIUrl":"https://doi.org/10.1016/j.lpm.2024.104263","url":null,"abstract":"<p><p>Multiple myeloma (MM) is the second most common adult hematologic malignancy, characterized by clonal proliferation of malignant plasma cells mostly in the bone marrow. The presence of destructive changes of the mineralized bone is a hallmark feature of the condition and a sign of end-organ damage. Due to this, imaging plays an integral role in the diagnosis, prognostication, and treatment monitoring of patients undergoing therapy for MM as well as surveillance of patients with early-stage disease. While conventional radiography has traditionally been the mainstay of initial evaluation of patients suspected of having MM, the advent of more sensitive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have taken its place in assessing patients. While either CT alone or as part of a PET/CT examination is the initial radiographic method of choice, MRI remains the gold-standard modality in assessing bone marrow involvement, especially in early disease stages. PET/CT also provides valuable information regarding assessment of response to therapy and extramedullary manifestations of the disease. There is however increasing evidence that functional MRI techniques, albeit limitedly available, might be superior to PET/CT for treatment monitoring. This review summarizes current knowledge on the use of different imaging techniques in monoclonal plasma cell disorders and discusses future developments in this area of research.</p>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":" ","pages":"104263"},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Kidney disease in multiple myeloma.

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-09 DOI: 10.1016/j.lpm.2024.104264

Frank Bridoux, Nelson Leung, Samih H Nasr, Arnaud Jaccard, Virginie Royal

{"title":"Kidney disease in multiple myeloma.","authors":"Frank Bridoux, Nelson Leung, Samih H Nasr, Arnaud Jaccard, Virginie Royal","doi":"10.1016/j.lpm.2024.104264","DOIUrl":"https://doi.org/10.1016/j.lpm.2024.104264","url":null,"abstract":"<p><p>Renal disease is a frequent complication of symptomatic multiple myeloma, that increases morbidity and reduces quality of life and overall survival. It may result from various lesions, the most frequent being light chain cast nephropathy (LCCN), related to precipitation of monoclonal free light chains (FLC) with uromodulin in distal tubules. Rapid identification of the type of kidney disease with appropriate management is key. LCCN typically reveals the underlying myeloma and manifests with severe acute kidney injury, high serum FLC level (>500 mg/l) and predominant light chain proteinuria (urine albumin/creatinine ratio <10%). Urgent therapy is required, based on vigorous fluid expansion, correction of precipitating factors and introduction of efficient anti-myeloma therapy which choice should consider renal elimination of each agent and patient frailty. Early and deep reduction in serum FLC level conditions renal recovery, warranting assessment of efficacy by serial serum FLC level monitoring. In newly diagnosed patients, the combination of bortezomib, high-dose dexamethasone and an anti-CD38 monoclonal antibody is commonly used. The benefit to risk balance of quadruplets incorporating cyclophosphamide or an immunodulatory agent requires to be evaluated in prospective studies. In patients with severe acute kidney injury, reinforcing chemotherapy with FLC removal through plasma exchange or high-cutoff hemodialysis may increase the probability of renal response, despite controversial data from randomized trials. Histological assessment of the extent of cast formation and interstitial fibrosis/tubular atrophy may help evaluating renal prognosis and refining therapy. Thanks to improved overall survival, renal transplantation may be considered in selected candidates with end-stage kidney disease.</p>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":" ","pages":"104264"},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Minimal Residual Disease in Multiple Myeloma.

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-09 DOI: 10.1016/j.lpm.2024.104261

Nour Moukalled, Florent Malard, Ali Bazarbachi, Mohamad Mohty

{"title":"Minimal Residual Disease in Multiple Myeloma.","authors":"Nour Moukalled, Florent Malard, Ali Bazarbachi, Mohamad Mohty","doi":"10.1016/j.lpm.2024.104261","DOIUrl":"https://doi.org/10.1016/j.lpm.2024.104261","url":null,"abstract":"<p><p>Minimal Residual Disease (MRD) in multiple myeloma has emerged as a significant prognostic factor, guiding treatment strategies and enhancing patient outcomes. Despite advancements in therapies such as proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, CAR-T cell therapy, and bispecific antibodies, complete eradication of malignant plasma cells remains challenging. MRD refers to a small number of residual cancer cells that persist after treatment and require sensitive methods like next-generation flow cytometry (NGF) and next-generation sequencing (NGS) for detection. MRD negativity has been associated with improved progression-free survival (PFS) and overall survival (OS), making it a key marker in clinical trials. The clinical utility of MRD lies in its ability to predict outcomes, with sustained MRD negativity linked to prolonged survival. Furthermore, it will likely help in tailoring treatment approaches, such as therapy escalation for high-risk patients or de-escalation for those achieving MRD negativity. Despite its prognostic value, challenges remain in standardizing MRD testing, ensuring its widespread availability, and addressing variability in results based on different detection methods. Future research aims to refine MRD-guided treatment and explore novel detection techniques, such as liquid biopsies, to improve patient monitoring in multiple myeloma.</p>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":" ","pages":"104261"},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evolving Strategies in the Management of Transplant-Eligible Patients with Newly Diagnosed Multiple Myeloma.

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-09 DOI: 10.1016/j.lpm.2024.104262

Aurore Perrot

{"title":"Evolving Strategies in the Management of Transplant-Eligible Patients with Newly Diagnosed Multiple Myeloma.","authors":"Aurore Perrot","doi":"10.1016/j.lpm.2024.104262","DOIUrl":"https://doi.org/10.1016/j.lpm.2024.104262","url":null,"abstract":"<p><p>Multiple myeloma treatment has evolved significantly with the introduction of triplet and quadruplet regimens, notably incorporating anti-CD38 antibodies. While autologous stem cell transplantation remains a cornerstone of therapy, its role in the context of increasingly effective upfront treatments is debated. Current guidelines still recommend transplant for all eligible patients, especially those with high-risk features at diagnosis, despite concerns regarding the lack of overall survival benefits and the potential long-term toxicities associated with high-dose melphalan. Delaying transplantation until first relapse has been proposed, but this approach carries the risk of patients becoming ineligible for transplantation due to worsening health or disease progression. Consolidation therapy after transplant is not strongly endorsed in recent guidelines, and studies show mixed results regarding its efficacy. Some data suggests a progression-free survival advantage with post-ASCT consolidation; others found no significant differences in outcomes among various strategies. Nonetheless, tandem transplant may be beneficial for high-risk patients. Maintenance therapy, particularly with lenalidomide, has proven effective, offering substantial progression-free and overall survival benefits. While lenalidomide remains the standard, emerging data indicate that combinations with proteasome inhibitors or anti-CD38 antibodies could enhance outcomes, particularly in high-risk populations. As our understanding of myeloma biology deepens, tailoring treatment approaches based on risk profiles and response depth will be crucial for optimizing patient outcomes.</p>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":" ","pages":"104262"},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bispecific antibody and chimeric antigen receptor (CAR) modified T-cell in the treatment of multiple myeloma: where do we stand today?

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-12-09 DOI: 10.1016/j.lpm.2024.104265

Xiang Zhou, K Martin Kortuem, Leo Rasche, Hermann Einsele

引用次数: 0

Preventative and curative treatment of venous thromboembolic disease in cancer patients 癌症患者静脉血栓栓塞性疾病的预防和治疗。

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-09-07 DOI: 10.1016/j.lpm.2024.104242

Marc Carrier , Laurent Bertoletti , Philippe Girard , Sylvie Laporte , Isabelle Mahé

{"title":"Preventative and curative treatment of venous thromboembolic disease in cancer patients","authors":"Marc Carrier , Laurent Bertoletti , Philippe Girard , Sylvie Laporte , Isabelle Mahé","doi":"10.1016/j.lpm.2024.104242","DOIUrl":"10.1016/j.lpm.2024.104242","url":null,"abstract":"<div><div>Cancer-associated venous thromboembolism (CAT) is common in patients with cancer and associated with significant morbidity and mortality. The incidence of CAT continues to rise, complicating patient care and burdening healthcare systems. Patients with cancer experiencing VTE face poorer prognoses, making prevention and effective management imperative. This narrative review synthesizes evidence on thromboprophylaxis in ambulatory patients with cancer receiving systemic therapy and acute treatment strategies for CAT. Risk assessment models (e.g., Khorana score) aid in identifying high-risk patients who may benefit from thromboprophylaxis. Pharmacological thromboprophylaxis with low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) has been shown to reduce the risk of CAT without significantly increasing the risk of bleeding complications. However, implementation of risk-based strategies remains limited in clinical practice. For acute CAT management, LMWHs have been the standard of care, but DOACs are increasingly favored due to their convenience and efficacy. However, challenges persist, including bleeding risks and drug interactions. Emerging therapies targeting Factor XI inhibitors present promising alternatives, potentially addressing current limitations in anticoagulation management for CAT.</div></div>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":"53 4","pages":"Article 104242"},"PeriodicalIF":3.2,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of thrombophilia on venous thromboembolism management 血栓性疾病对静脉血栓栓塞治疗的影响。

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-09-06 DOI: 10.1016/j.lpm.2024.104247

Joseph Emmerich , Stéphane Zuily , Isabelle Gouin-Thibault , Pierre-Emmanuel Morange , Francis Couturaud , Menno Huisman

{"title":"Impact of thrombophilia on venous thromboembolism management","authors":"Joseph Emmerich , Stéphane Zuily , Isabelle Gouin-Thibault , Pierre-Emmanuel Morange , Francis Couturaud , Menno Huisman","doi":"10.1016/j.lpm.2024.104247","DOIUrl":"10.1016/j.lpm.2024.104247","url":null,"abstract":"<div><div>Hypercoagulable states, also called thrombophilia, can either be congenital or acquired. Congenital thrombophilia, associated mainly with venous thrombosis, is either secondary to coagulation-inhibitor deficiencies, i.e., antithrombin, protein C and Protein S, or gain of function mutations, i.e., factor V Leiden and prothrombin G20210A mutations. Despite the relative frequency of these two mutations, they have not been associated with venous thrombosis recurrence. Most prevalent thrombophilia have a limited impact and usually does not change indications for duration of antithrombotic treatment or prophylaxis compared to decisions based on clinical factors. However, rare inherited thrombophilia such as antithrombin deficiency could justify a long-term anticoagulation. The main acquired thrombophilia, the Antiphospholipid syndrome (APS), is associated with both arterial and venous thrombosis. Its impact on patient management is significant: choice of the anticoagulant (DOAC vs. warfarin), duration of anticoagulation, screening of any organ involvement and systemic autoimmune disease, introduction of immunosuppressive therapy.</div></div>","PeriodicalId":20530,"journal":{"name":"Presse Medicale","volume":"53 4","pages":"Article 104247"},"PeriodicalIF":3.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Elderly patients with venous thromboembolism: Insights from the RIETE registry 静脉血栓栓塞症老年患者：RIETE 登记的启示。

IF 3.2 3区医学

Presse Medicale Pub Date : 2024-09-06 DOI: 10.1016/j.lpm.2024.104246

Patrick Mismetti , Laurent Bertoletti , Isabelle Gouin , Joseph Emmerich , Manuel Monreal

引用次数: 0