How I Treat High-risk Multiple Myeloma

Blood ◽  
2021 ◽  
Author(s):  
Elena Zamagni ◽  
Simona Barbato ◽  
Michele Cavo
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
High Risk ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Specific Drug ◽  
Improve Quality

Survival of multiple myeloma (MM) has significantly improved over the last decade; however, a composed group of patients (15-20%), named high-risk (HR) MM, still experience reduced survival. Both tumor biology and suboptimal/absent responses to therapy may underlie HR definition and a clear uniform identification of risk factors is crucial for a proper management of these patients. In biologic-HRMM, MRD negativity attainment and sustain, inside and outside BM, should be the primary goal and therapy should be adapted in patients with frailty to reduce toxicity and improve quality of life. MM treatment has traditionally been tailored on age and more recently frailty or comorbidities, but very rarely on the biology of the disease, mainly because of the lack of a clear benefit derived from a specific drug/combination, inhomogeneity in HR definition and lack of data coming from prospective, properly designed clinical trials. Some attempts have been successfully made recently in this direction. In this review, we are discussing the current different definitions of HR and the need for a consensus, the results of available trials in HR patients and the way through risk-adapted treatment strategies. For this purpose, we are proposing several clinical cases of difficult-to-treat patients throughout different treatment phases.

Exercise and Physical Activity for Older Adults

2014 ◽  
Vol 3 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Wojtek J. Chodzko-Zajko
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Risk Factors ◽  
Older Adults ◽  
Chronic Diseases ◽  
Successful Aging ◽  
Healthy Aging ◽  
Improve Quality ◽  
Reduce Risk

For more than half a century fellows of the National Academy of Kinesiology have enthusiastically advocated for the promotion and adoption of physically active lifestyles as an affordable and effective means to prevent chronic diseases and conditions, and enhance independence and high quality of life for older adults. It is possible to discern distinct evolutionary stages when examining scholarship related to the role of physical activity in the promotion of healthy aging. Research into physical activity and aging began with critical early studies that established the underlying scientific evidence for a relationship between physical activity and healthy aging. More recent work has addressed such topics as building consumer demand, developing policies and legislation to support active aging, and understanding the complex interrelationships between physical activity and other lifestyle factors in the prevention and treatment of chronic diseases and conditions. It is increasingly apparent that strategies to promote active and successful aging must be integrated into an effective public policy. Kinesiologists and other health professionals, working in collaboration with colleagues from other disciplines, can help to reduce risk factors for chronic disease and improve quality of life for older adults by building awareness of the importance of physical activity and by assisting with the development and implementation of appropriate and effective interventions that reduce risk factors and improve quality of life.

scholarly journals Comprehensive Geriatric Assessment in Consecutive Newly-Diagnosed Elderly Multiple Myeloma Patients in China: A Multicentered, Prospective, Non-Interventional Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5493-5493
Author(s):  
Yuan Yao ◽  
Dehui Zou ◽  
Aijun Liao ◽  
Xiaoxia Chu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Geriatric Assessment ◽  
Real World ◽  
Comprehensive Geriatric Assessment ◽  
Newly Diagnosed ◽  
Frail Patients

Background: Multiple Myeloma (MM) is a disease of the elderly, whose prognoses are highly heterogeneous. Hence International Myeloma Working Group (IMWG) proposed geriatric assessment (GA) in 2015, including daily activity and comorbidity status, to better discriminate between fit and frail patients (Palumbo et al, 2015). However, IMWG recruited patients from clinical trials instead of real world practices. Therefore we studied GA in elderly MM patients consecutively in China, along with other perspectives which are known to be problematic in elderly population that were previously left unnoticed, such as nutrition status, risk of cognitive impairment, risk of depression, and quality of life. Aim: Our study centers on the feasibility to perform a more comprehensive geriatric assessment (cGA) in elderly MM patients, current cGA status in elderly MM patients in China, and the cGA difference between Chinese patients and patients in the IMWG study. Method: From August 2017 to April 2019, we continuously recruited 336 newly diagnosed elderly (age ≥ 65) MM patients from 21 centers in China. cGA was performed at diagnosis, after treatment cycle 1, after cycle 4, and 1 year after treatment. cGA includes physical conditions (ECOG), activities of daily living (ADL), instrumental ADL (IADL), mini-nutritional assessment (MNA-SF), geriatric depression scale (GDS), mini-mental state examination (MMSE), quality of life (SF-36) and Charlson comorbidity index (CCI). Staging was assessed at baseline (International Staging System (ISS) & Revised ISS) and hematological responses were evaluated along with each cGA timepoint. Results: We pool-analyzed data of 336 newly-diagnosed elderly MM patients. The median age was 70 (range 65-88) and 25.5% of patients were older than 75 years. 336 (100%) patients were able to complete cGA, and median assessment time was 40 minutes (range 20-70). Upon diagnosis, only 34% and 37.5% of patients had full ADL and IADL respectively. 38.5% of patients had moderate to high risk of depression (GDS ≥ 6). 13.2% of patients were malnourished (MNA-SF ≤ 7), while 46.3% of patients were at risk of malnutrition (8 ≤ MNA-SF ≤ 11). 41% of patients had at least one comorbidity (CCI ≥ 1). 45.7% of patients had moderate to intermediate risk of cognitive impairment (MMSE ≤ 26). Grouping by IMWG-GA index, our study identified 59.9% patients in frail group (vs 39% in IMWG study), 15.8% in intermediate (vs 31% in IMWG) and 24.3% in fit (vs 30% in IMWG). 69% of patients received proteasome inhibitor-containing regimens and 20.7% of patients received lenalidomide-containing regimens. Best hematological responses in fit and intermediate groups were better than responses in frail group (≥ PR rate: 88.5% in fit, 94.4% in intermediate vs 77.5% in frail). Median follow up time was 10 months. To date, 215 (64%) patients have finished the cGA after cycle 1; 164 (48.8%) patients have finished the cGA after cycle 4; 91 (27.1%) patients has finished all 4 planned cGA and improvements in cGA were observed in the majority of these patients. Conclusion: Our study showed significant CGA heterogeneity in elderly MM patients. Even in the IMWG-GA "fit" group, nutrition, depression and cognitive impairment remain problems. Frail patients took up a larger proportion in Chinese elderly MM patients compared to IMWG study. Our study strongly justifies the necessity for cGA in elderly patients with MM, more so in the real world MM patients than in the clinical trials. Disclosures No relevant conflicts of interest to declare.

scholarly journals Parathyroid gland disorders and cardiovascular disease

2021 ◽  
Vol 27 (1) ◽  
pp. 64-72
Author(s):  
Tatiana L. Karonova ◽  
Karina A. Pogosian ◽  
Liubov G. Yanevskaya ◽  
Olga D. Belyaeva ◽  
Elena N. Grineva
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Parathyroid Gland ◽  
Cardiac Risk ◽  
Improve Quality ◽  
Disease Pathogenesis ◽  
Pth Level

The review provides systematic information on the relation between pathology of parathyroid glands and cardiovascular disease (CVD). Recent studies have shown that actions of parathyroid hormone (PTH) and calcium affect the heart and vasculature through downstream actions of their receptors in the myocardium and endothelial cells, which lead to higher incidence of CVD among patients with parathyroid gland disorders (PGD). The mechanisms underlying this association also include insulin resistance and altered renin-angiotensinaldosterone axis among patients with primary hyperparathyroidism. However, low calcium and PTH level in hypoparathyroid patients are characterized by higher values of arterial stiffness, electrocardiogram abnormalities, vascular atherosclerosis and remodeling. These factors contribute to low quality of life among those patients. Knowledge of cardiovascular disease pathogenesis in patients with hyper- or hypoparathyroidism could help to improve quality of diagnostic and treatment and decrease the burden of cardiac risk factors. This review will be of interest to endocrinologists and cardiologists, and other specialists.

scholarly journals Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

2018 ◽  
Vol 36 (34) ◽  
pp. 3361-3369 ◽  
Author(s):  
Anna L. Godfrey ◽  
Peter J. Campbell ◽  
Cathy MacLean ◽  
Georgina Buck ◽  
Julia Cook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Platelet Count ◽  
High Risk ◽  
Vascular Events ◽  
End Point ◽  
High Risk Factors ◽  
Patient Reported

Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time to first arterial or venous thrombosis, first serious hemorrhage, death, incidence of transformation, and patient-reported quality of life. Results After a median follow-up of 73 months and a total follow-up of 2,373 patient-years, there was no significant difference between the arms in the likelihood of patients reaching the primary end point (hazard ratio, 0.98; 95% CI, 0.42 to 2.25; P = 1.0). The incidence of significant vascular events was low, at 0.93 per 100 patient-years (95% CI, 0.61 to 1.41). There were also no differences in overall survival; in the composite end point of transformation to myelofibrosis, acute myeloid leukemia, or myelodysplasia; in adverse events; or in patient-reported quality of life. Conclusion In patients with ET age 40 to 59 years and lacking high-risk factors for thrombosis or extreme thrombocytosis, preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events, myelofibrotic transformation, or leukemic transformation. Patients age 40 to 59 years without other clinical indications for treatment (such as previous thrombosis or hemorrhage) who have a platelet count < 1,500 × 109/L should not receive cytoreductive therapy.

scholarly journals Stroke risk and its association with quality of life: a cross-sectional study among Chinese urban adults

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Huiqing Yao ◽  
Juhua Zhang ◽  
Yanmei Wang ◽  
Qingqing Wang ◽  
Fei Zhao ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Relative Risk ◽  
High Risk ◽  
Psychosocial Factors ◽  
Stroke Risk ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background Stroke is a leading cause of mortality and disability worldwide. Most stroke risk studies focused on more established biological and pathophysiological risk factors such as hypertension and smoking, psychosocial factors such as quality of life are often under-investigated and thus less reported. The current study aims to estimate stroke risk and explore the impact of quality of life on stroke risk among a community sample of urban residents in Shanghai. Methods This cross-sectional study was conducted in Fengxian District of Shanghai City from December 2018 to April 2019. 4030 representative participants were recruited through a multistage, stratified, probability proportional to size sampling method and completed the study. Stroke risk was assessed using the Rapid Stroke Risk Screening Chart that included 8 risk factors for stroke. Quality of life was measured using the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Results One-third of residents were at risk for stroke, including 14.39% at high risk, and 18.68% at middle risk. The top three most commonly reported risk factors were physical inactivity (37.30%), hypertension (25.38%), and smoking (17.32%). Quality of life and its four domains were all independently and significantly associated with stroke risk. Multinominal logistic regressions showed that a one-unit increase in the quality of life was associated with a decreased relative risk for middle-risk relative to low-risk of stroke by a factor of 0.988 (95% CI:0.979, 0.997, P = 0.007), and a decreased relative risk for high-risk relative to low-risk of stroke by a factor of 0.975 (95% CI:0.966, 0.984, P < 0.001). Conclusions Our findings showed an alarmingly high prevalence of stroke risk among the sample, which may require future intervention programs to focus on improving both biological and behavioral risk factors such as increasing physical activity, early diagnosis and treatment of hypertension, and smoking cessation, as well as improving psychosocial factors such as quality of life.

Multiple Myeloma: New Insights and Therapeutic Approaches

Hematology ◽  
2000 ◽  
Vol 2000 (1) ◽  
pp. 147-165 ◽  
Author(s):  
Kenneth C. Anderson ◽  
Robert A. Kyle ◽  
William S. Dalton ◽  
Terry Landowski ◽  
Kenneth Shain ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Drug Resistance ◽  
Cell Adhesion ◽  
Tumor Cell ◽  
Treatment Strategies ◽  
Tumor Cell Adhesion ◽  
Improve Outcome ◽  
Novel Treatment

Abstract This review discusses the evolution of novel diagnostic and treatment strategies for multiple myeloma based upon increased understanding of basic disease pathogenesis. Although myeloma has remained an incurable illness to date, these new developments will derive treatments to improve outcome and achieve eventual cure. In Section I, Dr. Kyle reviews the results of current therapy for multiple myeloma, including high dose therapy and stem cell transplantation which have proven to achieve improved response rates, event-free, and overall survival. Supportive therapy, such as erythropoietin to treat disease-related anemia, and methods of prophylaxis against infection, which both lessen toxicities of treatment and improve quality of life for patients, are also addressed. In Section II, Dr. Dalton with Drs. Landowski, Shain, Jove and Hazlehurst discusses mechanisms of drug resistance in myeloma, with emphasis on novel treatment approaches to prevent development of drug resistance and to overcome drug resistance. Laboratory studies delineating mechanisms whereby myeloma cells resist drug-induced apoptosis provide the framework for related treatment protocols for patients with refractory disease. In Section III, Dr. Berenson reviews the management of complications in bone, which occur in the majority of patients with myeloma and are the major cause of decreased quality of life. New insights into the mediators of bone resorption and new bone formation in the marrow milieu have already derived effective bisphosphonate therapy. These drugs not only reduce bone complications and related pain, thereby improving quality of life, but also may have intrinsic anti-tumor activity by virtue of inducing tumor cell adherence to marrow, reducing interleukin-6 secretion, inducing tumor cell apoptosis, or inhibiting angiogenesis. In the last section, Dr. Anderson explores the potential for future therapies which offer great promise to improve patient outcomes. First, drugs which alter the marrow microenvironment include thalidomide and its derivative immunomodulatory drugs, which act directly on tumor cells to induce apoptosis or G1 growth arrest, alter tumor cell adhesion to marrow stroma, inhibit angiogenesis, and trigger a cellular anti-tumor response. The proteasome inhibitors both act directly on tumor cells and also inhibit the transcription factor NFκB-dependent upregulation of IL-6 secretion triggered by tumor cell adhesion. Second, delineation of both growth and apoptotic pathways has derived novel treatment strategies. Third, the preclinical basis and early clinical trial results using vaccination and adoptive immunotherapy to harness autoimmune and alloimmune anti-myeloma responses are presented. This review sets the stage for an evolving new biologically based treatment paradigm in myeloma targeting both the tumor and its microenvironment to improve outcome and achieve eventual cure.

Persistent Challenges with Treating Multiple Myeloma Early

Blood ◽  
2020 ◽  
Author(s):  
Aaron Michael Goodman ◽  
Myung S Kim ◽  
Vinay Prasad
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
High Risk ◽  
Early Treatment ◽  
Organ Damage ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Smoldering Myeloma

Over the last decade, two strategies have advanced the treatment of patients with multiple myeloma and precursor diseases. First, the definition has changed to include patients without end organ damage, who previously would not be treated. Second, there is widespread enthusiasm to treat high risk smoldering myeloma. In this commentary, we explore the evidence supporting these therapeutic expansions. While treating early adds cost and therapeutic burden, it remains unknown whether survival or health related quality of life is improved from early treatment. Herein, we consider the implications of diagnostic expansion in multiple myeloma.

scholarly journals KUSTA DI PROVINSI LAMPUNG: STUDI EKOLOGI BERDASARKAN TREN WAKTU

2019 ◽  
Vol 18 (2) ◽  
pp. 88-98
Author(s):  
Nurhalina Sari ◽  
Eliza Eka Nurmala
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Data Analysis ◽  
Spatial Analysis ◽  
High Risk ◽  
Ecological Study ◽  
Secondary Data ◽  
Poor People ◽  
Study Designs

ABSTRACT  Leprosy is a disease that can cause pain and disability, which in the end can affect a person's quality of life. Through the 2013 Bangkok Declaration, Indonesia declared itself that 2020 was a leprosy-free country. However, until 2015, there were still reports of leprosy cases, including in Lampung Province. This study aims to analyze spatial leprosy and its risk factors to get priority areas for leprosy handling in Lampung Province. The study used ecological study designs. The sources of leprosy data and risk factors came from secondary data at the Central Statistics Agency and Health Office in Lampung for the year 2011 to 2015. Data analysis using spatial analysis. The analysis shows that leprosy cases are divided into two categories, namely paucibacillary and multibacillary. Spatial analysis results for 5 years indicate that leprosy cases are dominant in Central Lampung and East Lampung Districts. Based on population density, number of poor people, sanitation, nutritional status, and health facilities, several districts have a high risk of leprosy. The conclusion of this study is the priority in handling leprosy cases should be focused in the Central Lampung District and East Lampung District. Keywords: Leprosy, Lampung, spatial analysis, ecological study   ABSTRAK Kusta merupakan penyakit yang dapat menyebabkan kesakitan dan kecacatan,  yang pada akhirnya dapat mempengaruhi kualitas hidup seseorang. Melalui Deklarasi Bangkok 2013, Indonesia menyatakan bahwa tahun 2020 menjadi negara bebas kusta. Namun, hingga 2015 masih terdapat laporan kasus kusta, termasuk di Provinsi Lampung. Penelitian ini bertujuan menganalisis secara spasial  kusta dan faktor risikonya untuk mendapatkan prioritas penanganan kusta di Provinsi Lampung dengan desain studi ekologi. Sumber data kusta dan faktor risiko berasal dari data sekunder di Badan Pusat Statistik dan Dinas Kesehatan di Lampung 2011 sampai dengan 2015. Analisis data menggunakan analisis spasial. Hasil analisis menunjukkan bahwa kasus kusta terbagi dalam dua kategori yaitu pausibasiler (PB) dan multibasiler (MB).Hasil analisis spasial selama 5 tahun menunjukkan bahwa kasus kusta dominan di Kabupaten Lampung Tengah dan Kabupaten Lampung Timur. Berdasarkan kepadatan penduduk, jumlah orang miskin, sanitasi, status gizi, dan fasilitas kesehatan, beberapa kabupaten memiliki risiko tinggi terhadap kasus kusta. Kesimpulan penelitian ini adalah prioritas penanganan kasus kusta sebaiknya difokuskan di wilayah Kabupaten Lampung Tengah dan Kabupaten Lampung Timur. Kata kunci: Kusta, Lampung, analisis spasial, studi ekologi

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