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Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Changes to This Summary (09 / 24 / 2013)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Plasma Cell Neoplasms

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Added text to include a list of clinical symptoms and signs of primary amyloidosis: fatigue, purpura, enlarged tongue, diarrhea, edema, and lower-extremity paresthesias.

Revised text to state that elevated serum levels of cardiac troponins, amino-terminal fragment brain-type natriuretic peptide, and serum-free light chains are poor prognostic factors.

Stage Information About Plasma Cell Neoplasms

Revised text to state that newer clinical investigations are stratifying patients with multiple myeloma into so-called good-risk, intermediate-risk, and high-risk groups (cited Avet-Loiseau et al. as reference 8).

Treatment for Amyloidosis Associated With Plasma Cell Neoplasms

Revised text to state that treatment options for amyloidosis associated with plasma cell neoplasms includes chemotherapy, IMiDs (immunomodulatory drugs), and proteasome inhibitors.

Added Kumar et al., Venner et al., and Wechalekar et al. as references 7, 8 and 9.

Treatment for Multiple Myeloma

Revised text to state that multiple therapeutic agents are available for induction therapy, either alone or in combinations and included: IMiDs, such as thalidomide, lenalidomide, and promalidomide; and, proteasome inhibitors, such as bortezomib and carfilzomib.

Added text to state that a retrospective review of almost 4,000 relapsed or refractory patients who received lenalidomide in 11 clinical trials suggested an increased incidence of nonmelanoma skin cancers (cited Dimopoulos et al. as reference 37). Also added that uncontrolled trials have added clarithromycin to lenalidomide and dexamethasone with a claim of increased response rates; controlled studies are required to establish the value of this approach (cited Rossi et al. as reference 39).

Added Pomalidomide as a new subsection.

Revised text about bortezomib-related evidence to state that with a median follow-up of 60 months, the median overall survival (OS) favored the bortezomib arm (cited San Miguel et al. as reference 43 and level of evidence 1iiA).

Added text to state that two studies compared bortezomib plus thalidomide plus dexamethasone versus thalidomide plus dexamethasone after stem cell transplantation (SCT) and showed improved progression-free survival (PFS) but no difference in OS (cited Cavo et al. and Garderet et al. as references 47 and 48, respectively and level of evidence 1iiDiii).

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