Good morning, myeloma world. Welcome to a new feature here at The Myeloma Beacon: Myeloma Morning ^[1].

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 ^[2].

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 ^[3]). 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 ^[4]). 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 ^[5]). 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 ^[6]). 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 ^[7]). 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 ^[8]”, 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 ^[9]). 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 ^[10]; abstract of article by Mt. Sinai re­searchers ^[11]).

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 ^[12]).

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 ^[13]). 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 ^[14] 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 ^[15] of her ongoing au­tol­o­gous stem cell trans­plant, gmarv asked if anyone has lytic lesions in the bones of their lower arms or lower legs ^[16], and Deborah is still waiting for feedback from people who have ex­peri­enced withdrawal symp­toms after going off of dexa­meth­a­sone or pred­ni­sone ^[17].

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 ^[4])
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 ^[18])
3. Gentile, M. et al., “Sorafenib for the treatment of multiple myeloma” in Expert Opinion on Investigational Drugs, March 21, 2016 (abstract ^[3])
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])
5. Harrison, S.J. et al., “Myeloma of the central nervous system - an ongoing conundrum!” in Leukemia And Lymphoma, March 21, 2016 (abstract ^[10])
6. Korde, N. et al., “Monoclonal gammopathy-associated pure red cell aplasia” in The British Journal of Haematology, March 21, 2016 (abstract ^[9])
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 ^[6])
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 ^[7])
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 ^[12]).