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Patients with minimal disease or in whom the diagnosis of malignancy is in doubt should be observed without treatment Most commonly, patients require treatment at diagnosis because of bone pain or other symptoms related to the disease The treatment of myeloma is rapidly changing, and the optimal initial treatment regimen is in flux The most commonly used initial regimen is the combination of thalidomide plus dexamethasone This has been shown to be more effective than VAD chemotherapy for initial disease control and is more convenient, since the agents are given orally, although prophylaxis against deep venous thrombosis is warranted and not all patients tolerate thalidomide Other combinations including the nonchemotherapeutic agents bortezomib and lenalidomide are being explored Bortezomib, available only intravenously, is a proteosome inhibitor and has significant activity in myeloma, either as a single agent or in combination Lenalidomide, an oral agent, is a derivative of thalidomide with both improved efficacy and greatly reduced toxicity However, both of these agents are extremely expensive After initial disease control ( induction therapy ), the optimal consolidation therapy for patients under age 70 years with myeloma is autologous stem cell transplantation Early aggressive treatment prolongs both duration of remission and overall survival Clinical trials are now evaluating the role of posttransplant maintenance therapy with agents such as lenalidomide For young patients with aggressive disease, autologous transplant followed by a reduced-intensity allogeneic transplant is under active investigation Allogeneic transplantation is potentially curative in myeloma, but its role has been limited because of the unusually high mortality rate (30 50%) in myeloma patients Newer and less toxic forms of allogeneic transplantation using nonmyeloablative regimens have produced encouraging results, especially when performed early in the course of disease, such as the minimal disease state following autologous stem cell transplantation Localized radiotherapy may be useful for palliation of bone pain or for eradicating tumor at the site of pathologic fracture Hypercalcemia should be treated aggressively and immobilization and dehydration avoided The bisphosphonates (pamidronate 90 mg or zoledronic acid 4 mg intravenously monthly) reduce pathologic fractures in patients with significant bony disease and are an important adjunct in this subset of patients.



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Then you call the . print () method on the element in Javascript when the PDF is loaded: function printDocument(documentId) { var doc ...

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JavaScript + jQuery 1.6.3. 16. 1. $(document).ready(function() {. 2. //Grabs the Iframe . 3. var ifr = document.getElementById(" PDF ");. 4. ​. 5. // PDF is completely  ...

with a high tumor burden (stage III) have an IgG spike greater than 7 g/dL, hematocrit less than 25%, calcium greater than 12 mg/dL, or more than three lytic bone lesions Median survival for this group was formerly 1 2 years, but early intervention with autologous stem cell transplantation prolongs median survival to 5 6 years in this group The new International Staging System that incorporates 2microglobulin and serum albumin appears to predict outcome better than the traditional staging system The inclusion of other biologic markers, such as cytogenetics, is additional information and may help predict response to specific therapies For example, the finding of the translocation t(4,14) predicts a poor outcome after autologous stem cell transplant, and other approaches need to be explored Patients with hyperdiploidy have a high degree of sensitivity to immunomodulatory agents such as thalidomide and lenalidomide Broader use of immunotherapy with allogeneic transplantation may improve the outlook further, and it is likely that the new biologic agents will lead to additional therapeutic gains





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Then you call the . print () method on the element in Javascript when the PDF is loaded: function printDocument(documentId) { var doc ...

Cavo M et al; Bologna 2002 Study Superiority of thalidomide and dexamethasone over vincristine-doxorubicin-dexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma Blood 2005 Jul 1;106(1):35 9 [PMID: 15761019] Crawley C et al Outcome for reduced-intensity allogeneic transplantation for multiple myeloma: an analysis of prognostic factors from the Chronic Leukaemia Working Party of the EBMT Blood 2005 Jun 1;105(11):4532 9 [PMID: 15731182] Greipp PR et al International staging system for multiple myeloma J Clin Oncol 2005 May 20;23(15):3412 20 [PMID: 15809451] Rajkumar SV et al Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma Blood 2005 Dec 15;106(13):4050 3 [PMID: 16118317] Richardson PG et al Bortezomib or high-dose dexamethasone for relapsed multiple myeloma N Engl J Med 2005 Jun 16;352(24): 2487 98 [PMID: 15958804]

Symptoms nonspecific; splenomegaly common on examination Monoclonal IgM paraprotein Infiltration of bone marrow by plasmacytic lymphocytes Absence of lytic bone disease

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The median survival of patients with myeloma has been 3 years, but the outlook appears to be changing with new treatment approaches The prognosis is markedly affected by a number of prognostic features, with shorter survivals in those with high paraprotein spikes, renal failure, hypercalcemia, or extensive bony disease Patients are said to have a low tumor burden (stage I) if the IgG spike is less than 5 g/ dL, there is no more than one lytic bone lesion, and there is no evidence of hypercalcemia or renal failure Such patients have a median survival of 5 6 years Conversely, patients

Waldenstr m s macroglobulinemia is a malignant disease of B cells that appear to be a hybrid of lymphocytes and plasma cells These cells characteristically secrete an IgM paraprotein, and many clinical manifestations of the disease are related to this macroglobulin

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