J. Caers MD, PhD

What is new in MGUS and smoldering multiple myeloma

SUMMARY

Multiple Myeloma (MM) and other plasma cell malignancies initially present as an asymptomatic precursor state, known as monoclonal gammopathy of undetermined significance (MGUS). When confronted to a monoclonal protein in blood or urine tests, physicians should first exclude the presence of a treatment-requiring MM. They should be aware that there are two benign precursor states, that do not require anti-myeloma treatment. Both MGUS and Smoldering Multiple Myeloma (SMM) need an initial visit by a haematologist, with further follow-up tailored to the individual patient and disease characteristics. In the current article we describe both entities, discuss their monitoring and resume the latest publications in their field.

Diagnosis and monitoring of multiple myeloma patients

SUMMARY

The diagnosis of multiple myeloma (MM) can be challenging, especially in patients with light-chain or non-secretory disease. The disease should be excluded in patients presenting with unexplained anaemia or renal failure and suspected in patients with signs of back pain combined with other systemic symptoms, such as fatigue and weight loss, or back pain combined with abnormal blood tests. The diagnosis is based on clinical, biological and radiological abnormalities that are resumed in the current article. At diagnosis, additional cytogenetic testing is important to determine the prognosis and guide physicians in their treatment choices. The disease is generally monitored by quantifying the monoclonal proteins in blood or urine. The follow-up of patients can be further tailored to the patients’ general status, obtained response and disease characteristics.

O5 Inhibition of multiple myeloma exosomes prevents bone loss and reduces tumor growth.

PP22 Maternal embryonic leucine zipper kinase (MELK) inhibitor OTSSP167 has preclinical activity in multiple myeloma bone disease

Multiple myeloma bone disease: from mechanisms to next generation therapy

SUMMARY

Multiple myeloma bone disease is a major cause of morbidity and mortality in multiple myeloma patients and persists even in patients in remission. Multiple myeloma bone disease is caused by an uncoupling of bone remodelling, with increased osteoclast activity and decreased osteoblast activity, culminating in lytic bone destruction. Bisphosphonates are the current standard-of-care but new therapies are needed. As the molecular mechanisms controlling multiple myeloma bone disease are increasingly understood, new therapeutic targets are extensively explored in the preclinical setting and initial clinical trials with novel compounds show promising results. In this review, we provide a comprehensive overview of the biology of multiple myeloma bone disease, summarise its current clinical management and discuss preclinical and clinical data on next generation therapies.

(BELG J HEMATOL 2017;8(2):66–74)

Update on therapy of relapsed and refractory multiple myeloma

SUMMARY

The prognosis for multiple myeloma patients has improved substantially over the past decade with the development of more effective chemotherapeutic agents and regimens that possess a high level of anti-tumour activity. However, nearly all multiple myeloma patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed disease remains a critical aspect of multiple myeloma care and an important area of ongoing research. This manuscript from the Belgian Haematology Society multiple myeloma subgroup provides some recommendations on the management of relapsed disease.

(BELG J HEMATOL 2017;8(2):53–65)

O.3 Maternal Embryonic Leucine Zipper Kinase (MELK) Drives a High-Risk Gene Network and Represents an attractive Novel Drug Target in Multiple Myeloma and its associated Bone Disease