Quality of life in multiple myeloma: considerations and recommendations.

Introduction: Advances in the management of multiple myeloma have culminated in the availability of novel agents which have resulted in improvement in patient outcomes. Nevertheless, the disease remains largely incurable and attention to long-term toxicity and quality of life is of importance. Limited data have addressed quality-of-life consideration in myeloma and most studies have assessed a finite time period during the course of the disease. Quality-of-life measures that have been used have largely focused on symptom reporting. In general, quality of life seems to deteriorate with increasing duration of the disease and improvements are limited. Areas covered: This manuscript will review quality-of-life tools used in myeloma as well as the differential effect of various stages of the therapy. Expert opinion: In general, depth of response has been associated with improved quality-of-life and may be an important surrogate provided that therapy is well tolerated. However, this traditional approach of using the most effective therapy does not take into considerations psychologic and socioeconomic factors which can result in significant burden to the patient. A multidisciplinary team approach with a focus on shared decision-making based on the patient's goals must thus be emphasized.

Myelosuppression, Bone Disease, and Acute Renal Failure: Evidence-Based Recommendations for Oncologic Emergencies

BACKGROUND: Oncologic emergencies associated with multiple myeloma include myelosuppression (anemia, neutropenia, and thrombocytopenia), bone-related emergencies, and acute renal failure. 
. OBJECTIVES: This article reviews the pathophysiology of these multiple myeloma-associated oncology emergencies and provides a framework for assessment and effective intervention.
. METHODS: A comprehensive review of the levels of evidence, focusing on assessment, diagnosis, comorbidities, treatment, ongoing monitoring, and patient education, are presented to support the plan of care for at-risk patients.
. FINDINGS: Attention to signs and symptoms is the foundation for preventing these emergencies or managing additional escalation of symptoms.

Single agent lenalidomide in newly diagnosed multiple myeloma: a retrospective analysis.

Recently, lenalidomide and low dose dexamethasone were found to result in superior overall survival compared to lenalidomide and high dose dexamethasone. The immune suppressive effects of dexamethasone can antagonize lenalidomide immunomodulatory activity and may explain this observation. We conducted a retrospective analysis to evaluate the single agent activity of lenalidomide in newly diagnosed myeloma. Records of patients with newly diagnosed symptomatic multiple myeloma treated with single agent lenalidomide at H. Lee Moffitt Cancer Center and Roswell Park Cancer Institute were reviewed. Data were collected on disease characteristics, demographics, and treatment outcomes. Responses were assessed as per the International Myeloma Working Group criteria. From March 2007 to July 2009, 17 patients with newly diagnosed multiple myeloma were treated with single agent lenalidomide at both institutions. The median age was 70 years (range 46-84 years). Lenalidomide was generally well tolerated and no grade 4 hematologic toxicities were noted. The overall response rate (> or =partial remission) to lenalidomide alone was 47% at a median follow-up of 7 months (range 1-26). This experience suggests that lenalidomide alone can induce an anti-myeloma effect in previously untreated patients who are considered poor candidates for concurrent dexamethasone.