Good morning, myeloma world. Welcome to a new feature here at The Myeloma Beacon: Myeloma Morning.

Starting today, you can come to The Beacon every morning of the week, and a new edition of Myeloma Morning will be waiting for you. Each edition will in­clude summaries of the latest myeloma-related re­search and myeloma-related news from the business world. We'll also make sure to keep you posted on any in­ter­est­ing conversations going on in the Beacon's myeloma discussion forum.

Our coverage of re­search devel­op­ments will focus – as it always has here at The Beacon – on what has been pub­lished in peer-reviewed medical journals and in abstracts for medical conferences. In fact, each edition of Myeloma Morning will in­clude a list of new myeloma-related journal articles.

Likewise, what we say about what's going on in the business world will draw heavily on pri­mary sources, such as com­pany press releases.

All of this is part of the Beacon's emphasis on ensuring that the news and perspectives we provide you are as objective, bal­anced, and fact-based as possible.

Today's Look At New Myeloma-Related Research

A group of Italian re­searchers has reviewed re­search about the possible use of the drug Nexavar (sorafenib) as a treat­ment for multiple myeloma (abstract). Nexavar is approved in the United States and elsewhere as a treat­ment for liver, kidney, and thyroid cancer. It also has been in­ves­ti­gated as a poten­tial treat­ment for multiple myeloma, but it is not approved by any regu­la­tory authority for that pur­pose. The Italian re­searchers write that data from Phase 1/2 trials show that Nevavar has “a good safety profile but minimal anti-myeloma activity as a single agent in re­lapsed / re­frac­tory patients.” They there­fore look for­ward to results of Phase 2 studies investigating Nexavar in com­bi­na­tion with existing myeloma ther­a­pies, such as Velcade (bor­tez­o­mib) and Revlimid (lena­lido­mide).

Austrian re­searchers have found that a protein known as MIG (or CXCL9) may provide insights into the prog­nosis of newly diag­nosed multiple myeloma patients (abstract). The re­searchers measured levels of MIG in the blood of more than 100 newly diag­nosed patients. They found that high levels of the protein were typically found in patients with markers of more ad­vanced dis­ease and in patients who ex­peri­enced shortened over­all sur­vival. Further statistical tests de­ter­mined that MIG appears to have an independent effect on patient sur­vival, separate from how it is correlated with other factors affecting sur­vival.

Two studies in today's set of myeloma-related re­search focus on the spinal injury that can occur as a result of multiple myeloma. One article is a case study involving a 37-year-old man in England with multiple myeloma (abstract). The authors of the study describe how they were able to suc­cess­fully use a brace to address the spinal cord compression and related side effects ex­peri­enced by the man as a result of lesions in his spine.

The second study is also from researchers in England. They retro­spec­tive­ly in­ves­ti­gated whether balloon kyphoplasty, a pro­ce­dure often used in myeloma patients to reduce pain and discomfort from spinal lesions, can be carried out in patients not nor­mally con­sidered can­di­dates for the pro­ce­dure (abstract). They conducted the pro­ce­dure in two sets of patients – one group routinely viewed as eli­gible for the pro­ce­dure, and one with “posterior vertebral body wall in­volve­ment,” a type of damage to the spine that typically excludes a patient from balloon kyphoplasty, and which often occurs in myeloma patients who might other­wise con­sider balloon kyphoplasty. The re­searchers found that pain alleviation and im­prove­ment in quality of life was com­parable in both groups of patients, “with no appreciable in­crease in risk” for the patients who would not nor­mally be eli­gible for the pro­ce­dure.

We asked Beacon Medical Advisor Dr. Luciano Costa of the University of Alabama at Birmingham for his feedback re­gard­ing the study. He noted that the study was valuable in that it showed how both groups of patients could ex­peri­ence a reduction in pain and im­prove­ment in quality of life. The chal­lenge with such studies, he also ex­plained, is that they “may be operator dependent and not reproducible.” In addi­tion, he noted that there was no comparator arm in the study – that is, no group of patients that did not re­ceive a kyphoplasty, but had their pain man­aged in other ways. Also, the rate of cement leakage in the patients who would not nor­mally have undergone the pro­ce­dure “was con­cern­ing,” he said.

Although it was pub­lished earlier this month, we want to be sure to call attention to a review of whole body imaging techniques used in the diag­nosis and man­agement of multiple myeloma patients. The review is by a team of Italian authors, and the full text of the review is avail­able online (full text). The authors note that whole body, low-dose CT scans should be the imaging pro­ce­dure of choice “at base­line”, but they believe that whole body MRI and PET/CT “represent the most trustworthy and efficacious imaging modalities for a com­plete and correct work-up and design of in­di­vid­ualized ther­a­pies” for multiple myeloma patients.

(For those looking for some­thing less lengthy to read about the dif­fer­en­t imaging pro­ce­dures in multiple myeloma, we rec­om­mend the extended Beacon forum posting, “To PET or not to PET”, by Beacon Medical Advisor Dr. Prashant Kapoor of the Mayo Clinic.)

A team of U.S. re­searchers has in­ves­ti­gated a rare form of chronic anemia known as pure red cell aplasia. They found that, in a cohort of about 50 patients with the pure red cell aplasia, a quarter also had evi­dence of low level plasma cells in their bone mar­row sug­gesting that there could be an association be­tween plasma cell disorders and pure red cell aplasia (abstract). When three of the patients were treated with Velcade or Revlimid, their anemia was reduced to the point that they no longer needed blood transfusions. One of the co-authors of the study, Dr. Ola Landgren of Memorial Sloan-Kettering Cancer Center in New York City, tells The Beacon that the results of the new study may prompt new re­search into what causes anemia in people with multiple myeloma.

A group of Australian myeloma specialists has written an editorial to accompany a study by re­searchers at Mt. Sinai hos­pi­tal in New York City about myeloma found in the brain or spinal cord (“myeloma with central nervous sys­tem in­volve­ment”). The Australian authors note that this form of myeloma is rare, occurring in about 1 per­cent of myeloma patients, and, unfortunately, it is very dif­fi­cult to treat (editorial; abstract of article by Mt. Sinai re­searchers).

Finally, Japanese re­searchers have found that mangiferin, which is found in a variety of plants, in­clud­ing mangos, is toxic to multiple myeloma cells in laboratory tests (abstract).

Myeloma-Related Business News

The Swedish com­pany Active Biotech announced earlier today that it will be devel­op­ing the drug tasquinimod as a poten­tial new treat­ment for multiple myeloma (press release). Thus far, devel­op­ment of tasquinimod has focused on its possible use as a treat­ment for prostate cancer.

Activity in the Beacon Myeloma Discussion Forum

Beacon Medical Advisor Dr. Edward Libby of the University of Washington responded to a question from a myeloma patient about the possible impact on her dis­ease of having her thymus removed. Two other forum par­tic­i­pants also shared their ex­peri­ences with having had their thymus removed.

In addi­tion, Debbie shared an update on Day+5 of her ongoing au­tol­o­gous stem cell trans­plant, gmarv asked if anyone has lytic lesions in the bones of their lower arms or lower legs, and Deborah is still waiting for feedback from people who have ex­peri­enced withdrawal symp­toms after going off of dexa­meth­a­sone or pred­ni­sone.

New myeloma-related re­search articles

1. Bolomsky, A. et al., “Monokine induced by interferon gamma (MIG/CXCL9) is an independent prognostic factor in newly diagnosed myeloma” in Leukemia And Lymphoma, March 21, 2016 (abstract)
2. Fosenka, C.L. et al., “A case of multiple myeloma presenting as a distal renal tubular acidosis with extensive bilateral nephrolithiasis” in BMC Hematology, March 17, 2016 (full text)
3. Gentile, M. et al., “Sorafenib for the treatment of multiple myeloma” in Expert Opinion on Investigational Drugs, March 21, 2016 (abstract)
4. Gokaraju, K. et al., “Multiple myeloma presenting with acute bony spinal cord compression and mechanical instability successfully managed non-operatively” in The Spine Journal, March 17, 2016 (abstract)
5. Harrison, S.J. et al., “Myeloma of the central nervous system - an ongoing conundrum!” in Leukemia And Lymphoma, March 21, 2016 (abstract)
6. Korde, N. et al., “Monoclonal gammopathy-associated pure red cell aplasia” in The British Journal of Haematology, March 21, 2016 (abstract)
7. Molloy, S. et al., “Is balloon kyphoplasty safe and effective for cancer-related vertebral compression fractures with posterior vertebral body wall defects” in the Journal of Surgical Oncology, March 21, 2016 (abstract)
8. Rubini, G. et al., “Myeloma bone and extra-medullary disease: Role of PET/CT and other whole-body imaging techniques” in Critical Reviews In Oncology Hematology, March 5, 2016 (full text)
9. Takeda, T. et al., “Mangiferin induces apoptosis in multiple myeloma cell lines by suppressing the activation of nuclear factor kappa B-inducing kinase” in Chemico-Biological Interactions, March 17, 2016 (abstract).