Changes to This Summary (05/01/2012)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Plasma Cell Neoplasms ¹

Updated statistics ² with estimated new cases and deaths for 2012 (cited American Cancer Society as reference 1).

Revised text ³ in Table 1 under clinical presentation to include asymptomatic for isolated plasmacytoma of bone and extramedullary plasmacytoma.

Added Bird et al. as reference 18 ⁴.

Stage Information About Plasma Cell Neoplasms ⁵

Added Kumar et al. as reference 7 ⁶.

Added text ⁶ to state that plasma cell leukemia has a particularly poor prognosis (cited Ramsingh et al. as reference 8).

Treatment Option Overview for Plasma Cell Neoplasms ⁷

Added text ⁸ to state that increasing anemia is the most reliable indicator of progression (cited Bladé et al. as reference 4).

Treatment for Amyloidosis Associated With Plasma Cell Neoplasms ⁹

Added text ¹⁰ about the Southwest Oncology Group trial for dexamethasone alone and in combination, and added melphalan and bortezomib as treatments combined with thalidomide, cyclophosphamide, and lenalidomide (cited Kastritis et al. as reference 7 and Moreau et al. as reference 8).

Treatment for Monoclonal Gammopathy of Undetermined Significance (MGUS) ¹¹

Added text ¹² to state that new therapies have not been proven to prevent or delay the progression of MGUS to a plasma cell dyscrasia (cited Bird et al. as reference 2).

Added Bladé et al. as reference 3 ¹².

Treatment for Multiple Myeloma ¹³

Added Raab et al. as reference 2 ¹⁴.

Added Rajkumar et al. and Mateos et al. as references 5 and 6 ¹⁵, respectively.

Added Bladé et al. as reference 10 ¹⁶.

Added Kumar et al. as reference 11 ¹⁶.

Revised text ¹⁷ to state that there were ten randomized prospective studies involving more than 4,500 patients that examined the introduction of thalidomide as induction therapy (cited Cavo et al. as reference 23 and Lokhorst et al. as reference 24).

Revised text ¹⁸ to state that only two of the ten randomized studies reported a survival advantage using thalidomide, and the patients in these trials were older than 65 or 75 years.

Revised text ¹⁸ to state that a lower dose of thalidomide and a lower dose of steroids were administered than in the other studies.

Added Weber et al. as reference 27 ¹⁹.

Revised text ²⁰ to state that with a median follow-up of 36 months, the Eastern Cooperative Oncology Group's (ECOG) E4A03 trial showed improved overall survival (OS) for patients in the low-dose dexamethasone arm.

Added text ²⁰ about a retrospective analysis of 353 patients who received lenalidomide and high-dose dexamethasone (cited Zangari et al. as reference 32 and level of evidence 3iiiA).

Added text ²¹ to state that the greater the number of risk factors for deep vein thrombosis, the more intense the recommendation for prophylactic anticoagulation; also, as a result of predominant renal clearance, lenalidomide doses need to be reduced in the setting of impaired renal function (cited 2010 Dimopoulos et al. as reference 33).

Added Richardson et al. as reference 37 ²².

Revised text ²³ to state that the benefit from bortezomib appears to be maintained across risk groups but not reproducibly in all studies (cited Avet-Loiseau et al. as reference 43).

Added 2009 Dimopoulos et al. and Morabito et al. as references 44 and 45 ²⁴, respectively.

Added text ²⁴ to state that bortezomib administered once weekly had less grade 3 to 4 peripheral neuropathy with no loss of efficacy compared with standard biweekly administration (cited Bringhen et al. as reference 46).

Added text ²⁵ to the list of trials of combination regimens to include ECOG-E1A06: Thalidomide + melphalan + prednisone versus lenalidomide + melphalan + prednisone.

Revised text ²⁶ in the options for combination regimens to include bortezomib + liposomal doxorubicin +/- dexamethasone (cited Jakubowiak et al. as reference 67).

Added text ²⁷ to state that upon review of eight updated trials encompassing more than 3,100 patients, at 10 years' follow-up, there was a 10% to 35% event-free survival rate and a 20% to 50% OS rate (cited Barlogie et al. as reference 72).

Added text ²⁸ to state that the role of autologous stem cell transplantation has been questioned with the advent of novel induction therapies with high complete-remission rates (cited Giralt et al. as reference 83 and Harousseau as reference 84).

Revised text ²⁹ to state that myeloablative allogeneic stem cell transplantation has significant toxic effects, but the possibility of a potent and possibly curative graft-versus-myeloma effect in a minority of patients may offset the high transplant-related mortality (cited Lokhorst et al. as reference 102).

Added text ³⁰ to state that the lower transplant-related mortality from nonmyeloablative approaches has been accompanied by a greater risk of relapse, and it remains debatable whether allogeneic stem cell transplantation should be offered in the first-line setting outside the context of a clinical trial.

Added text ³¹ to state that clinical trials exploring thalidomide as maintenance therapy have contradictory results.

Revised text ³² to state that maintenance interferon-alpha therapy has been reported to prolong initial remission duration after conventional chemotherapy.

Added text ³² to state that a randomized study compared maintenance interferon with maintenance thalidomide in 103 previously untreated and treated patients who had at least a minimal response to induction chemotherapy with thalidomide, pegylated liposomal doxorubicin, and dexamethasone; with a median follow-up of 30 months, the thalidomide maintenance arm was better (cited Offidani et al. as reference 115 and level of evidence 1iiA).

Added text ³² to state that in a trial of 556 previously untreated patients induced with thalidomide, doxorubicin, dexamethasone, and followed by high-dose melphalan with stem cell support, patients were randomly assigned to alpha interferon or to thalidomide maintenance (cited Lokhorst et al. as reference 24 and level of evidence 1iiA).

Added text ³² about a trial of 269 patients with newly diagnosed myeloma who were given maintenance thalidomide plus prednisolone versus prednisolone alone following both induction therapy and high-dose melphalan with allogeneic stem cell transplantation and showed a benefit in favor of the thalidomide arm after a median follow-up of 3 years (cited Spencer et al. as reference 118 and level of evidence 1iiA).

Added text ³³ to state that the optimal use and duration of bisphosphonates for bony involvement in myeloma have not been studied (cited Terpos et al. as reference 126).

Added text ³⁴ about a double-blind, randomized, controlled trial with 504 patients with newly diagnosed multiple myeloma that compared 30 mg of pamidronate to 90 mg of pamidronate and found no difference in skeletal-related events; however, less osteonecrosis was seen in the low-dose group (cited Gimsing et al. as reference 127 and level of evidence 1iDiv).