Risk factors and causes of early mortality in patients with newly diagnosed multiple myeloma in a "real-world" study: experiences of the Polish Myeloma Group.

INTRODUCTION Despite the progress made in the treatment of multiple myeloma (MM), approximately 10% to 15% of patients die within the first year of diagnosis. OBJECTIVES The aim of the study was to determine risk factors of early mortality in patients with newly diagnosed MM treated with new drugs in clinical practice. PATIENTS AND METHODS This multicenter analysis included 197 patients with symptomatic MM, diagnosed between October 2006 and November 2019, with a survival of less than 12 months. RESULTS The median overall survival was 2.5 months. The most common causes of early mortality were infections (35%), MM progression (23.8%), and cardiovascular disease (14.2%). In a multivariable analysis, the Zubrod performance score (P = 0.02), history of cardiovascular disease (P = 0.04), dependence on renal dialysis (P = 0.03), and MM response (P <0.001) were associated with early mortality. CONCLUSIONS Early mortality in MM patients requires further studies. When qualifying patients with newly diagnosed MM for chemotherapy, it is necessary to consider performance status and the history of comorbidities, including cardiovascular diseases.

Intraoral manifestation of systemic AL amyloidosis with unique microscopic presentation of intracellular amyloid deposition in striated muscles.

We report the history of a 59-year old patient with systemic AL amyloidosis of intraoral manifestation. The patient first presented with complaints about dysphagia and remarkable enlargement of the tongue with highly reduced mobility, as well as bilateral submucosal thickenings on the cheeks. Histopathological examination of the incisional biopsy of the buccal mucosa and underlying tissues revealed AL amyloidosis. The microscopic presentation was, however, unique, as the amyloid deposits were present intracellularly in the striated muscles. The subsequent bone marrow biopsy confirmed the diagnosis of primary amyloidosis/multiple myeloma - associated amyloidosis.

Liposomal cytarabine in the prophylaxis and treatment of CNS lymphoma: toxicity analysis in a retrospective case series study conducted at Polish Lymphoma Research Group Centers.

Lymphomas with primary or secondary involvement of central nervous system (CNS) have poor prognosis despite specific treatment protocols which include whole brain radiotherapy and high-dose systemic and/or intrathecal chemotherapy. Toxicity of intrathecal liposomal cytarabine-based regimens collected between November 2006 and January 2012 was assessed retrospectively. Data from 120 adult lymphoma patients with, or at high risk of CNS involvement who received intrathecal liposomal cytarabine-based regimens at six Polish Lymphoma Research Group centres between November 2006 and January 2012 were assessed retrospectively. Patients were divided into three cohorts: A (high risk of CNS disease, n = 88), B (cerebrospinal fluid pleocytosis without neurological symptoms or pathological imaging findings, n = 7), and C (CNS disease/neurological involvement; n = 25). In all examined groups, toxicity of treatment was found to be acceptable (including the prophylactic setting). None of the patients in cohorts A or B who took intrathecal liposomal cytarabine 50 mg, repeated every 2-4 weeks (mean 3.8 doses) had experienced a CNS relapse at a median follow-up time of 3 years. Patients in cohort C had a 76 % overall neurological response rate (including a 40 % complete response rate) and median overall survival of 4.8 years. Regimens incorporating liposomal cytarabine seem to be safe and effective treatments for lymphomas with CNS involvement.

[Liposomal cytarabine in prophylaxis of the central nervous system involvement in rare aggresive lymphomas]. / Liposomalna cytarabina w profilaktyce zajEcia centralnego systemu nerwowego w rzadkich chloniakach agresywnych.

UNLABELLED: The involvement of central nervous system in the course of lymphoma is an adverse prognostic factor, therefore primary prevention is a standard of care of aggressive lymphoma subtypes. The aim of the paper is the safety and efficiency, retrospective analysis of liposomal cytarabine used profilactically in patients with rare aggressive lymphomas. MATERIALS AND METHODS: In the analysis we included 19 patients with aggressive lymphomas: LBL (lymphoblastic lymphoma), BL (Burkitt lymphoma) and PTCL (peripheral T- cell lymphoma) from three PLRG (Polish Lymphoma Research Group) centers, who received liposomal cytarabine as primary prevention of central nervous system involvement. All the included patients had a high risk of CNS due to histological subtype (10 patients with LBL, 4 patients with BL), the specific location of the disease (N=3) or the presence of at least 2 risk factors for CNS involvement (elevated LDH, IPI 3-5 or involvement of at least 2 extranodal sites, N = 16). In this group, 18 patients were subjected to prophylaxis during the 1-st line therapy and one after relapse. None of the patients had symptoms of central nervous system involvement at the time of diagnosis. The median age was 43 years (the range of 20-60 years). In this group there were 14 males (73.68%) and 5 females (26.32%). The patients were treated with liposomal cytarabine every 2 to 4 weeks during the systemic chemotherapy. The median number of cytarabine doses was 2 (the range of 1-5). RESULTS: Liposomal cytarabine was well-tolerated. 63.1% of patients had transient side effects (nausea, vomiting, fever, dizziness) in grade 1-2, 5.2% of patients experienced a more severe headache (grade 3). During the average follow-up of 18 months, 50% of patients died and 27.7% of systemic recurrences were noted. Only one patient had a relapse in the CSN con comitant with a systemic recurrence. CONCLUSIONS: Lipo somal cytarabine is well-tolerated and effective medicine used in the prevention of CNS relapse in patients with ag gressive lymphoma subtypes.