Supportive Care in Multiple Myeloma.

PURPOSE OF REVIEW: As novel therapies are expanding the life expectancy of patients with multiple myeloma, appropriate supportive care has become critical in the management of these patients. This review aims to outline the key principles of supportive care of patients with myeloma, including management of bone disease, renal disease, anemia, peripheral neuropathy, infections, and venous thromboembolism. RECENT FINDINGS: The results from large randomized, controlled trials on the use of high-cutoff hemodialysis in the removal of free light chains in renal disease and the use of levofloxacin in the prevention of infections have recently been published. These results, along with updated guidelines from professional societies on the use of bisphosphonates and erythropoietin stimulating agents, have provided guidance on more effective management strategies for myeloma patients. Integration of these updated guidelines and supportive care strategies into clinical practice will help to ensure quality of life for patients with myeloma.

A Phase I/II Trial of the Combination of Azacitidine and Gemtuzumab Ozogamicin for Treatment of Relapsed Acute Myeloid Leukemia.

INTRODUCTION: Treatment with hypomethylating agent therapy might enhance anti-CD33 monoclonal antibody-mediated cytotoxicity against acute myeloid leukemia (AML) blasts through epigenetic effects on Syk and SHP-1 expression. PATIENTS AND METHODS: In the present phase I/II study, we treated patients with relapsed or refractory AML with azacitidine, followed by 2 doses of gemtuzumab ozogamicin (GO) at 6 mg/m2, the Food and Drug Administration-approved dose and schedule at study initiation. We sought to determine the maximum tolerated dose and clinical activity of this combination therapy. Secondarily, we aimed to determine whether baseline Syk and SHP-1 expression can be used as predictive biomarkers of treatment response. RESULTS: The established maximum tolerated dose was azacitidine 75 mg/m2 daily for 6 consecutive days, followed by GO 6 mg/m2 on days 7 and 21. Of the 50 evaluable patients, 12 (24%) obtained complete remission (CR) or CR with incomplete peripheral blood recovery (CRp). No dose-limiting toxicities were observed in phase I, and no patient developed hepatic sinusoidal obstructive syndrome. Although no significant correlation was found between Syk and SHP-1 expression and the clinical response to combination therapy, in vitro studies repeatedly demonstrated that azacitidine-treated AML cells had an increased response to GO treatment. CONCLUSION: Our study found that the combination of GO with azacitidine is relatively well tolerated, with response rates similar to those with GO monotherapy at higher doses. Differences in the GO drug schedule, dose level, and frequency might explain the discrepant response rates between our study and others, suggesting that the optimal GO dose remains unclear, especially when combined with hypomethylating agent therapy.

Critical Analysis of Primary Literature in a Master's-Level Class: Effects on Self-Efficacy and Science-Process Skills.

The ability to think analytically and creatively is crucial for success in the modern workforce, particularly for graduate students, who often aim to become physicians or researchers. Analysis of the primary literature provides an excellent opportunity to practice these skills. We describe a course that includes a structured analysis of four research papers from diverse fields of biology and group exercises in proposing experiments that would follow up on these papers. To facilitate a critical approach to primary literature, we included a paper with questionable data interpretation and two papers investigating the same biological question yet reaching opposite conclusions. We report a significant increase in students' self-efficacy in analyzing data from research papers, evaluating authors' conclusions, and designing experiments. Using our science-process skills test, we observe a statistically significant increase in students' ability to propose an experiment that matches the goal of investigation. We also detect gains in interpretation of controls and quantitative analysis of data. No statistically significant changes were observed in questions that tested the skills of interpretation, inference, and evaluation.