Hello, myeloma world. It's too late to wish you a good morning, but we do hope you had a nice day.

We were right on the mark yesterday when we worried about a “tidal wave” of new myeloma-related research ^[1] hitting sometime soon. The wave has hit. Today's list of new research studies – see the bottom of this article – may be longer than it's ever been.

Processing that list has taken quite a bit of time, and we won't even try to cover all of the studies in today's report. Instead, we are going to focus on one study, give you highlights from the rest of the list, and then work our way back to some of the highlighted studies in future editions of Myeloma Morning.

Very Short Survival (Early Mortality) In Multiple Myeloma Patients

The study we will focus on today addresses the important subject of "early mortality,” or very short survival, in multiple myeloma patients.

When researchers discuss “early mortality”, they are referring to the fact that some myeloma patients do not live very long after their myeloma diagnosis. Unfortunately, more myeloma patients than many people realize do not live longer than 12 months after diagnosis.

A new study by researchers in Granada, Spain investigates a database of 621 patients diagnosed with multiple myeloma between January 1985 to December 2015. The researchers analyze, in particular, whether additional health problems people have when they are diagnosed with multiple myeloma affect whether they experience very short survival (abstract ^[2]).

The patient database explored by the Spanish researchers is noteworthy for several reasons. It includes everyone in Granada who was diagnosed with multiple myeloma during the period covered by the study. In addition, it includes information about a patient's general health – including other health problems – at diagnosis. And, for patients who died during the period covered by the study, their exact date of death is in the database.

This information makes it possible for the Spanish researchers to investigate what additional health problems affected a patient's risk of very short survival. Furthermore, the researchers could investigate if different factors affected whether patients lived different short lengths of time after diagnosis. In particular, they look at survival for 2, 6, or 12 months after diagnosis.

The authors found that older patients and patients with kidney failure at diagnosis were more likely than other patients to die within all three of the short periods after diagnosis that they investigated – 2, 6, and 12 months.

Having lung disease primarily affected whether a patient died very early after diagnosis (within 2 months). Having liver disease negatively affected the chance of surviving 6 months after diagnosis. And having Stage 3 disease at diagnosis, or having hepatitis C, was associated with a lower chance of surviving until 12 months after diagnosis.

The researchers also found good news, and bad news, when it comes to trends in early mortality. The good news is that there has been a downward trend over time in early death from multiple myeloma, particularly death within 12 months of diagnosis. The bad news is that early mortality is still high.

Early in their study, about a third of all the myeloma patients in the Spanish researchers' sample died within a year of diagnosis. Later in the study, that proportion was down to about a quarter.

There was also a drop in the share of newly diagnosed patients dying within 2 months of diagnosis. However, the drop was not as pronounced. Even in recent years, about 10 percent of all newly diagnosed myeloma patients in the Granada sample died within 2 months of diagnosis.

We asked Beacon Medical Advisor Dr. Luciano Costa for his perspective on the Spanish study. Dr. Costa, a myeloma specialist at the University of Alabama – Birmingham, has conducted research on the topic of early mortality, including a study published last December (full text ^[3]), a poster presentation ^[4] at the 2014 meeting of the American Society of Hematology (ASH), and a related article published early in 2015 (abstract ^[5]).

Dr. Costa noted that the Spanish study is valuable for confirming research from other countries that, unfortunately, early mortality is still an issue among newly diagnosed multiple myeloma patients. The study also highlights that a patient's additional health issues play an important role in the risk of early mortality. Finally, Dr. Costa noted that the study “reminds us that there is still much to be done to improve the early detection and early management of multiple myeloma.”

Other New Studies We Are Looking At

As we work our way through today's long list of new research articles, here are some of the other studies we are taking a closer look at.

First, there is an article by Drs. Sagar Lonial and Ajay Nooka at Emory University about the highly individualized nature of multiple myeloma (abstract ^[6]). It's an overview-type article accompanied by commentaries from leading multiple myeloma thought leaders at Dana-Farber (extract ^[7]) and in Turin, Italy (extract ^[8]).

Second, there is a review of where things stand with chimeric antigen receptor T-cell therapy (CAR T-cell therapy) for multiple myeloma, written by two French researchers (abstract ^[9]). (If you're not familiar with CAR T-cell therapy as a potential treatment for multiple myeloma, allow us to recommend an article on the subject ^[10] The Beacon published last summer.)

Third, a Dutch hematologist has reviewed the latest studies related to preventing blood clots in multiple myeloma patients being treated for their disease, and he's also shared recommendations on how to prevent such clots (abstract ^[11]).

Fourth, a group of researchers affiliated mainly with Case Medical Center in Cleveland, Ohio, have published a review of myeloid-derived suppressor cells and their role in multiple myeloma (abstract ^[12]).

Finally, in the category of new, interesting, but "we're not quite sure what to make of them" studies, there's one on cold atmospheric plasma as a potential multiple myeloma therapy (abstract ^[13]), and another about the possibility of using lidamycin to treat multiple myeloma (full text ^[14]).  Cold atmospheric plasma is not what you probably think it is. Think physics, not physiology. And lidamycin is a potential anticancer drug, developed more than 20 years ago in China from natural sources, which has never been approved by the Food and Drug Administration or regulatory authorities in other western countries.

Quickly Noted

• One of today's new research articles is a very nice summary of the chromosomal abnormalities identified using FISH testing carried out on bone marrow samples from 150 newly diagnosed multiple myeloma patients in Brazil; there are no startling findings in the study, but it nicely documents which abnormalities were found and how often they were found, and the full text of the article ^[15] is available at no charge
• A group of U.S. researchers has taken a detailed look at the link in individual patients between the extent to which Kyprolis (carfilzomib) inhibits proteasome activity and the depth of response achieved in those patients (full text ^[16])
• Beacon forum member MarkW is going to have an outpatient stem cell transplant away from his home sometime in the next few months. He's asked in the forum what sort of things he and his wife should pack to have with them at the apartment where he'll be staying for the transplant (link to forum discussion ^[17])
• Have you experienced numb lips after receiving an infused or injected myeloma treatment? If so, Jo Anne would be interested to hear more about your experience. She's been having numbness after Velcade injections (link to forum discussion ^[18])
• A new Beacon forum member has an M-spike, but he has not yet received a final initial diagnosis. He has asked whether it would be okay to have MRI imaging done instead of an xray skeletal survey (link to forum discussion ^[19]) 

New Myeloma-Related Research Articles

1. Ansa-Addo, E. A. et al., “Clients and oncogenic roles of molecular chaperone gp96/grp94” in Current Topics in Medicinal Chemistry, April 13, 2016 (abstract ^[20])
2. Cox, E., DeGraauw, C., and Klein, E., “Pathological burst fracture in the cervical spine with negative red flags: a case report” in Journal of the Canadian Chiropractic Association, March 2016 (PDF ^[21])
3. D’Agostino, M. and Palumbo, A. , “Moving toward a tailored therapy in multiple myeloma” in the Journal of Oncology Practice, April 1, 2016 (extract ^[8])
4. Lee, S. J. et al., “Clinical activity of carfilzomib correlates with inhibition of multiple proteasome subunits: application of a novel pharmacodynamic assay” in the British Journal of Haematology, April 12, 2016 (full text ^[16])
5. Leebeek, F. W., “Update of thrombosis in multiple myeloma” in Thrombosis Research, April 2016 (abstract ^[11])
6. Lonial, S. and Nooka, A. K., “Myeloma is not a single disease” in the Journal of Oncology Practice, April 1, 2016 (abstract ^[6])
7. Malek, E. et al., “Myeloid-derived suppressor cells: the green light for myeloma immune escape” in Blood Reviews, April 12, 2016 (abstract ^[12])
8. Martínez-Cingolani, C. et al., “Development of chimeric antigen receptors for multiple myeloma” in the Biochemical Society Transactions, April 15, 2016 (abstract ^[9])
9. Richardson, P. G., “The future of myeloma therapy: one size does not fit all” in the Journal of Oncology Practice, April 1, 2016 (extract ^[7])
10. Ríos-Tamayo, R. et al., “Early mortality in multiple myeloma: the time-dependent impact of comorbidity. A population-based study in 621 real-life patients” in the American Journal of Hematology, April 13, 2016 (abstract ^[2])
11. Segges, P. et al., “Genetic aberrations in multiple myeloma characterized by cIg-FISH: a Brazilian context” in the Brazilian Journal of Medical and Biological Research, April 8, 2016 (full text ^[15])
12. Vick, E. and Mahadevan, D., “Programming the Immune Checkpoint to Treat Hematologic Malignancies” in Expert Opinion on Investigational Drugs, April 12, 2016 (abstract ^[22])
13. Windrichova, J. et al., “Testing of a novel cancer metastatic multiplex panel for the detection of bone-metastatic disease - a pilot study” in Anticancer Research, April 2016 (abstract ^[23])
14. Xu, D. et al., “The effects of cold atmospheric plasma on cell adhesion, differentiation, migration, apoptosis and drug sensitivity of multiple myeloma” in Biochemical and Biophysical Research Communications, April 8, 2016 (abstract ^[13])
15. Zhen, Y. et al., “Antitumor efficacy of lidamycin against human multiple myeloma RPMI 8226 cells and the xenograft in nonobese diabetic/severe combined immunodeficiency mice” in the Journal of Cancer Research and Therapeutics, April 13, 2016 (full text ^[14])