Good morning, myeloma world.

We have got quite an eclectic mix of myeloma-related research to report on today, ranging from a couple of lengthy review articles to a short case report.

Speaking of case reports, there are several of them, and we'll start with an unusual one. It's from a group of physicians at a hospital in Milan, Italy. They report on a patient with light chain monoclonal gammopathy who tested positive – incorrectly – on a standard test used to determine if someone regularly drinks a lot of alcohol (abstract).

Something to keep in mind whenever your monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma is causing elevated light chain levels.

The second case report is from researchers at the Mayo Clinic's Arizona campus. They report on a patient with extramedullary myeloma in the heart (abstract). In addition to describing this particular case, the authors summarize other published reports of extramedullary disease found in patients' hearts. They identify 34 such cases reported in the medical literature in the past 25 years. Most reports involved patients who were not newly diagnosed, and there was a tendency for the patients to be female rather than male. There is not much information in the case reports, however, suggesting what therapeutic approach to heart-related extra­medullary disease might be best.

As for the brief case report we mentioned earlier, it involves another patient with extramedullary disease – this time, extramedullary disease found at the time of the patient's diagnosis by doctors at New York University. The extramedullary disease was found in a lymph node in the chest cavity, and the patient also had lytic lesions in the skull and vertebrae (full text).

Two articles in today's list of new research examine strategies hospitals can take to reduce the cost of autologous (own) stem cell transplantation for multiple myeloma patients.

One approach is discussed in an article that reports on a hybrid outpatient / inpatient approach to the stem cell transplant process used by a hospital in Augusta, Georgia (abstract). The strategy reduces transplant costs in two ways. First, it allows the hospital to purchase intravenous melphalan at a discounted price. Second, it reduces by one day the number of days transplant patients are in the hospital.

The second approach to (potentially) reducing transplantation costs involves using a “biosimilar” (generic) version of Neupogen (filgrastim), sold under the brand name Zarxio (filgrastim-sndz), during the stem cell mobilization process (abstract).

Swiss researchers carried out stem cell mobilization in two groups of myeloma patients. One group of 44 patients had mobilization facilitated by Neupogen combined with the chemotherapy drug vino­rel­bine. A second group of 61 patients had their mobilization facilitated by Zarxio combined with vinorelbine. Vino­rel­bine is sometimes substituted for cyclo­phos­phamide (Cytoxan) in the stem cell mobilization process.

The Swiss researchers found no significant difference in the stem cell yield, mobilization success rate, or side effects of the two mobilization regimens. Indeed, there was a tendency for the Zarxio-mobilized patients to have greater stem cell yields, and all patients who were administered Zarxio were able to mobilize enough stem cells for their transplant.

We'll close today's look at new myeloma-related research by mentioning three review articles some of our readers may want to dig into.

The first is a detailed – and rather technical – look at research related to possible "multiple myeloma stem cells" (full text: html, pdf). A team of Chinese authors examines the characteristics of such cells and the mechanisms they may use to resist treatment and continue to reproduce.

The second review is a look at research related to Farydak (panobinostat) as a treatment for multiple myeloma (abstract).

The third review is an extended overview of multiple myeloma in general, looking at how the disease develops, how it progresses from MGUS through to symptomatic multiple myeloma, and how it is treated, with an emphasis on the role of the bone marrow environment on both the development and the treatment of the disease (abstract).

As was the case yesterday, we don't have any new business-related myeloma news to report. As for inter­est­ing conversations in the Beacon's forum, Debbie continues to provide updates related to her ongoing autologous stem cell transplant, while another forum member (RadiantTiger), who previously posted in the forum during her own stem cell transplant, has provided a 5-month post-transplant update.

We should mention that Zometa has been a popular topic of discussion in the forum recently – the forum has more than 30 Zometa-related discussions overall. And, last but not least, Marvin has gotten some feed­back from people on his question about bone lesions in the lower parts of arms and legs, and has shared more about his own experience.

New myeloma-related research articles

1. Barbaro, M. et al., “An increased CDT camouflaged a monoclonal light chain gammopathy: An approach for diagnosis” in Clinical Biochemistry, March 18, 2016 (abstract)
2. Clemmons, A. et al., “Mixed outpatient-inpatient autologous stem cell transplant for multiple myeloma: A cost-saving initiative in a resource constrained environment” in Journal of Oncology Pharmacy Practice, March 21, 2016 (abstract)
3. Coakley, M. et al., “Extramedullary cardiac multiple myeloma - a case report and contemporary review of the literature” in Clinical Lymphoma, Myeloma And Leukemia, February 17, 2016 (abstract)
4. Crowley, V. et al., “Development of glucose regulated protein 94-selective inhibitors based on the BnIm and radamide scaffold” in the Journal of Medical Chemistry, March 22, 2016 (abstract)
5. Fairfield, H. et al., “Multiple myeloma in the marrow: pathogenesis and treatments” in Annals of the New York Academy of Sciences, March 22, 2016 (abstract)
6. Gao, M. et al., “Multiple myeloma cancer stem cells” in Oncotarget, March 17, 2016 (full text: html, pdf)
7. Maul, J.-T. et al., “Efficacious and save use of biosimilar filgrastim for hematopoietic progenitor cell chemo-mobilization with vinorelbine in multiple myeloma patients” in the Journal of Clinical Apheresis, March 22, 2016 (abstract)
8. Vlachostergios, P. et al., “Dual light chain extramedullary myeloma presenting with mediastinal lymphadenopathy and lytic bone lesions” in Hematology/Oncology and Stem Cell Therapy, March 17, 2016 (full text)
9. Wahaib, K. et al., “Panobinostat: A histone deacetylase inhibitor for the treatment of relapsed or refractory multiple myeloma” in American Journal of Health-System Pharmacy, April 1, 2016 (abstract)