Some interesting ideas and food for thought given that we are moving to a new era where novel drugs are increasingly playing a larger (and in some cases, an exclusive) role in treating multiple myeloma patients.
"New Staging System Viable for Myeloma Treated With Novel Therapies"
Researchers from Japan believe they have identified a novel staging system based on hemoglobin and plasmacytoma that may help to stratify patients with multiple myeloma who are treated with novel therapeutics, according to their results published recently in European Journal of Haematology.
“Our study suggested that a new staging system consisting of anemia and plasmacytoma, both of which are simply determined in the routine clinical examination, is more useful than international staging system in the era of novel agents,” wrote Hirono Iriuchishima, MD, of the department of medicine and clinical science at Gunma University, Japan, and colleagues.
http://www.cancernetwork.com/multiple-myeloma/new-staging-system-viable-myeloma-treated-novel-therapies
Related journal article:
Iriuchishima H et al., "A new staging system to predict prognosis of patients with multiple myeloma in an era of novel therapeutic agents", Eur J Haematol. 2014 Jun 30. doi: 10.1111/ejh.12407. [Epub ahead of print]
Abstract:
Various prognostic markers for multiple myeloma (multiple myeloma) have been identified, and stratification using these markers is considered important to optimize treatment strategies. The international staging system (ISS) is now a widely accepted prognostic staging system for multiple myeloma patients; however, its validity is controversial in the era of new therapeutic regimens, since ISS had been established before introduction of new agents. We retrospectively reviewed prognostic factors in order to seek out an alternative staging system more suitably applied to multiple myeloma patients treated with novel agents. We analyzed 178 newly diagnosed multiple myeloma patients who received either conventional chemotherapy without novel agents (CT; n=79) or chemotherapy with novel agents (NT; n=99). Although median overall survival (OS) of patients treated with CT is significantly different depending on stages of ISS, ISS had no effect on OS among patients treated with NT. Meanwhile, we identified hemoglobin (Hb) and plasmacytoma as independent risk factors for OS in patients who received NT. Using these two parameters, we stratified NT patients into three stages; stage 1 (Hb≥10 g/dl and absence of plasmacytoma), stage 2 (not stage 1 or 3), and stage 3 (Hb < 10 g/dl and presence of plasmacytoma). We found that there were significant differences in median OS among the three stages (8.13, 5.95, and 2.45 years for stages 1, 2, and 3, respectively). This preliminary study suggests that this alternative staging system based on Hb and plasmacytoma is a simple and useful way to predict prognosis of multiple myeloma patients in the novel agent era.
http://onlinelibrary.wiley.com/doi/10.1111/ejh.12407/abstract
Forums
6 posts
• Page 1 of 1
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Alternative multiple myeloma staging proposal
This is quite interesting Multibilly. Thank you for posting it.
I know you have read a great deal and I'm still trying to learn more (but I find all of this very complicated). Is plasmacytoma the same thing as finding a lesion on the bone or in the marrow? (see, I really have a lot to learn!). I think it is, but I'm not sure.
So this study is a newer way to look at staging and prognosis. Interesting that this study is in Japan as the demographics indicate the lowest incidence of multiple myeloma in that population.
I know you have read a great deal and I'm still trying to learn more (but I find all of this very complicated). Is plasmacytoma the same thing as finding a lesion on the bone or in the marrow? (see, I really have a lot to learn!). I think it is, but I'm not sure.
So this study is a newer way to look at staging and prognosis. Interesting that this study is in Japan as the demographics indicate the lowest incidence of multiple myeloma in that population.
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Alternative multiple myeloma staging proposal
Thanks MB for posting this:
I have always felt that the patient population needs to be continuously "re-classified" for the ISS staging/ survivability to make any true sense. ...especially with the advent of novel drugs in 2008-2010, and thereafter.
Given the fact that SEER data are atleast 3-4 years behind ( today), the Japanese may have something to forward to the ISS for consideration.
Otherwise, it is akin to a replay of a scene in "Space -Balls"......When? when is "Now", no Then--"That was yesterday"; Go back to then--"We can't"; but what about in 5 minutes--"That is the future".
http://www.imdb.com/title/tt0094012/quotes
I'll just keep "combing the desert".
Good luck.
I have always felt that the patient population needs to be continuously "re-classified" for the ISS staging/ survivability to make any true sense. ...especially with the advent of novel drugs in 2008-2010, and thereafter.
Given the fact that SEER data are atleast 3-4 years behind ( today), the Japanese may have something to forward to the ISS for consideration.
Otherwise, it is akin to a replay of a scene in "Space -Balls"......When? when is "Now", no Then--"That was yesterday"; Go back to then--"We can't"; but what about in 5 minutes--"That is the future".
http://www.imdb.com/title/tt0094012/quotes
I'll just keep "combing the desert".
Good luck.
-
Rneb
Re: Alternative multiple myeloma staging proposal
Toni: Regarding "Is plasmacytoma the same thing as finding a lesion on the bone or in the marrow? (see, I really have a lot to learn!). I think it is, but I'm not sure.
The simplistic way I look at it is that there are three different kinds of plasmacytomas.
1, First, you can have a solitary plasmacytoma develop as a bone lesion with no evidence of multiple myeloma elsewhere in the bone marrow (i,e. the person has normal plasma cell percentage from a BMB, but you have a single lytic lesion) These are often treated initially with radiation.
2,You can have plasmacytomas present as multiple lytic lesions with multiple myeloma bone disease involvement (i.e. abnormal plasma cell percentages from a BMB test). These are what multiple myeloma patients (including myself) typically worry about and what we typically look for when we get our various radiological imaging tests done periodically.
3. Lastly, you can have plasmactyomas developing in ones' soft tissues and not in or on the bones (these are known as extramedullary plasmacytomas) and they can be difficult to treat.
At least this is the way I've come to know the major classifications. I may not have gotten this 100% right, but I believe I'm fairly accurate in how I recall all this. Somebody may correct me on some of my details.
The simplistic way I look at it is that there are three different kinds of plasmacytomas.
1, First, you can have a solitary plasmacytoma develop as a bone lesion with no evidence of multiple myeloma elsewhere in the bone marrow (i,e. the person has normal plasma cell percentage from a BMB, but you have a single lytic lesion) These are often treated initially with radiation.
2,You can have plasmacytomas present as multiple lytic lesions with multiple myeloma bone disease involvement (i.e. abnormal plasma cell percentages from a BMB test). These are what multiple myeloma patients (including myself) typically worry about and what we typically look for when we get our various radiological imaging tests done periodically.
3. Lastly, you can have plasmactyomas developing in ones' soft tissues and not in or on the bones (these are known as extramedullary plasmacytomas) and they can be difficult to treat.
At least this is the way I've come to know the major classifications. I may not have gotten this 100% right, but I believe I'm fairly accurate in how I recall all this. Somebody may correct me on some of my details.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Alternative multiple myeloma staging proposal
Thanks MB. I think I kind of learned that from my reading, but you have a way of breaking things down into manageable pieces. That helps a lot!
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Alternative multiple myeloma staging proposal
I believe they are referencing disease burden in the marrow when indicating "plasmacytoma", however they don't specify if it is the percent of total plasma cells (absolute plasma cell) or the number of cells that are cancerous and their proliferation rate ... a test not widely used here yet in the US and only performed at the larger cancer centers to my knowledge.
This ambiguity isn't what is most concerning in this abstract, though. There is no reference to other organ damage or failure, only anemia, and I believe that there are people with some pretty significant myeloma symptoms that are not anemic.
It seems as though myeloma's various staging symptoms are more prognostic indicators and they fail to provide diagnostic criteria that can be used in combination with risk stratification to establish TREATMENT standards. The entire classification should be rethought. There are plenty of us smolderers with symptoms.
J
This ambiguity isn't what is most concerning in this abstract, though. There is no reference to other organ damage or failure, only anemia, and I believe that there are people with some pretty significant myeloma symptoms that are not anemic.
It seems as though myeloma's various staging symptoms are more prognostic indicators and they fail to provide diagnostic criteria that can be used in combination with risk stratification to establish TREATMENT standards. The entire classification should be rethought. There are plenty of us smolderers with symptoms.
J
-
jhorner - Name: Magpie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 49
6 posts
• Page 1 of 1