Beacon NewsFlashes - September 25, 2013
Being Overweight At Diagnosis Associated With Better Prognosis In Myeloma – In a recent study using data for U.S. veterans, researchers from Washington University in St. Louis found that the extent to which a multiple myeloma patient is overweight at diagnosis may affect their prognosis. Among the patients studied, those who were more overweight at the time of diagnosis had better prognoses. The researchers used data on each patient's body mass index (BMI) and found that overweight patients (BMI of 25 kg/m2 to 29.9 kg/m2) and obese patients (BMI of 30 kg/m2 or above) had the lowest risk of death compared to healthy-weight patients (BMI of 18.5 kg/m2 to 24.9 kg/m2) and underweight patients (BMI below 18.5 kg/m2). Underweight patients had the highest risk of death. BMI is a measure of how overweight, or underweight, a person is. It is calculated based on a person’s height and weight. The researchers also found that weight loss of 10 percent or more in the year leading up to diagnosis was associated with an increased risk of death. For more information, please see the study in the journal The Oncologist (abstract).
Exposure To Dichloromethane May Increase The Risk Of Developing Myeloma – Results of a recent analysis conducted in China show that occupational exposure to the compound dichloromethane, or methylene chloride, increases the risk of developing multiple myeloma. In particular, people exposed to dichloromethane were twice as likely to develop myeloma as those who were not exposed to dichloromethane. However, the results of the analysis also showed that dichloromethane did not increase the risk for non-Hodgkin’s lymphoma, leukemia, and certain solid tumors, such as breast, lung, and brain cancers. dichloromethane is frequently used as a paint stripper and a degreaser; it has also been used in the food industry. For more information, please refer to the study in Cancer Causes & Control (abstract).
Soft-Tissue Extramedullary Disease Is Associated With Particularly Poor Prognosis – Czech researchers recently found that extramedullary disease that develops in the soft tissue of a myeloma patient is associated with poorer prognosis than extramedullary disease that develops adjacent to a bone. However, both negatively impact overall survival. Extramedullary disease occurs when malignant plasma cells form tumors outside the bone, in organs, soft tissue, or adjacent to bones but outside the bone marrow. Such tumors are more common in relapsed/refractory myeloma patients than in newly diagnosed patients. The Czech researchers analyzed data for 226 relapsed/refractory myeloma patients, 24 percent of whom developed extramedullary disease at relapse. They found that the median time from diagnosis to the development of extramedullary disease was similar, regardless of the type of extramedullary disease (21 months for soft tissue disease and 23 months for disease adjacent to the bone). However, overall survival for patients with extramedullary disease in the soft tissue was 30 months from initial myeloma diagnosis, compared to 45 months for patients with extramedullary disease adjacent to a bone. Overall survival from time of diagnosis for patients without extramedullary disease was 109 months (more than nine years). The researchers point out that extramedullary disease remains one of the major challenges in the care of multiple myeloma patients. For more information, please see the study in Haematologica (pdf).
Related Articles:
- Early Use Of Radiation Therapy Associated With Shorter Survival In Multiple Myeloma
- Importance Of Factors Affecting Multiple Myeloma Survival Changes With Patient Age
- Sustained Complete Response To Initial Treatment Associated With Substantial Survival Benefit In Multiple Myeloma
- Revlimid, Velcade, and Dexamethasone, Followed By Stem Cell Transplantation, Yields Deep Responses And Considerable Overall Survival In Newly Diagnosed Multiple Myeloma
- Researchers Shed More Light On Risk Of MGUS In Close Relatives Of People With Multiple Myeloma
Those Czechs are pretty active in myeloma research! And they confirmed that one to two good beers daily have significant prognostic benefits. Goes well with the #1 beer drinking country in the world. Jan
My BMI is 27--in the overweight category.
I had a case of sepsis due to chemo about 6 months after diagnosis. All organs were shutting down and doctors told my family I had a 20% chance of making it. I lost 30 pounds during the 17 days in ICU. I wonder if those situations are why there is a better prognosis if you are overweight?
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater
13 years ago, I bought my first house with my boyfriend who is now my husband and father to our wonderful 7 year old daughter. The house was over 100 years old and needed a lot doing to it. I spent weeks removing paint from the staircase, using a paint stripper product called Nitromars. Guess what the active ingredient was in that? Yep, dichloromethane!
I'm 27 years old, and an OIF Veteran with MM. Luckily they caught it right at stage 1 and I've recently completed a stem cell transplant (auto) in the summer. Over the course of the chemo I've gained about 70 pounds (from 200 to 270, thanks Dexamethasone). This last weekend I Just put in a place my plan to actually lose this weight and get back down to healthy weight, start my diet today..............and then I came for my weekly read up here at the beacon.
So much for the diet.
I think that Stann made a good point about how a cancer patient can suddenly lose weight if they get into an emergency situation. This i suppose it is good to have a little extra to lose (I know I certainly do!!). But I have read articles where it is coming to light that sometimes obese patients may be getting less than an optimum dosing of chemotherapy due to the fact that the dosages are based on lower weights. Also, obesity is actually linked to a greater risk of having MM in the first place, and is linked to other health problems such as heart problems. I add on an article from a scientific review below:
Nat Rev Clin Oncol. 2013 Aug;10(8):451-9. doi: 10.1038/nrclinonc.2013.108. Epub 2013 Jul 16.
Chemotherapy dosing in overweight and obese patients with cancer.
Lyman GH, Sparreboom A.
Source
Comparative Effectiveness and Outcomes Research, Duke University and the Duke Cancer Institute, 2424 Erwin Road, Suite 205, Durham, NC 27705, USA.
Abstract
Retrospective and prospective preclinical and clinical data have demonstrated an association between chemotherapy dose intensity and both clinical efficacy and toxicity. The optimum tolerable and effective dose and schedule of chemotherapeutic agents is based on data from dose-finding studies and early clinical trials. There is considerable evidence that reductions in the recommended dose intensity often occurs in actual clinical practice, particularly among overweight and obese patients with cancer. With increasing rates of obesity, and variation and uncertainty about appropriate dosing of chemotherapy in obese patients, ASCO has generated clinical practice guidelines for appropriate chemotherapy dosing for obese adult patients with cancer. Without evidence of any increase in treatment-related toxicity among obese patients receiving chemotherapy, the guidelines recommend that, after considering any accompanying comorbidities, chemotherapy dosing should be calculated based on body surface area using actual weight, rather than an estimate or idealization of weight. While further research is needed, pharmacokinetic studies support the use of actual body weight to calculate chemotherapy doses for most chemotherapy drugs in obese patients. We highlight the issue of chemotherapy dosing in this population, how a more personalized approach can be achieved, as well as discussing areas for further research.
Nancy--thanks for the link. When I was first on Revlimid I questioned the doctors and also called Celgene with my concerns about my dose. I'm 6'4" 220 pounds and I was getting the same dose as my friend who is 5'8" and 150 pounds. They all gave me the same answer..."it's how the studies are done". But it seems obvious to me that a larger framed person is going to have more bone marrow than a smaller person, hence 10 mg of Revlimid is a lower rate/concentraion in a large person than 10 mg in a small person. I think most of the other chemo takes into account body weight though.
It makes sense that underweight patients are at higher risk of MM progression due to their inability to tolerate chemo. However weight gain in other groups has an adverse effect on many other factors, and certainly is not suggested!
Stann and Nancy make good points about the need to individualize doses of novel agents based on weight, among many other factors. I know most oncologists, including mine, do so, and do not blindly follow recommended doses from studies. That is an important disadvantage in being in most prospective studies: the lack of dose individualization.