Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
Multiple Myeloma

Home

Should we treat or not???
Performace Status
Antiemetics
Growth Factors
Calculations
Chemo Precautions
TOXICITY CRITERIA
Antidepressants
Chemoprotection
MESNA
Dexrazoxane
Radioprotectants
Hypercalcemia of malignancy
Mucositis
Neutropenic Fever
Palliative Care
Radiation Oncology
<<<<<<<<<>>>>>>>>>
ALL
AML
Anal
Bladder Cancer
Brain Cancer
Breast (risk category)
Breast (adjuvant)
Breast (metastatic)
Breast (Xeloda)
Breast (hormonal)
Breast Cancer Genetics
Carcinoid
CLL
CML
COLON CANCER
Endometrial
Esophagous
Gastric
Gestational Trophoblastic Disease
Germ Cell (Ovary)
Hairy Cell Leukemia
Head/Neck
Head/Neck: ChemoRT abstracts
Head/Neck: Larynx
Head/Neck:Nasopharyngeal
Hodgkins
Islet Cell Tumors
Kidney
Liver
LUNG, NSC
Stage III Unresectable NSC Lung Cancer
Lung, SC
Lymphoma, Aggressive
Lymphoma, AIDS
Lymphoma, Burkitts
Lymphoma, CNS
Lymphoma, Cutaneous
Lymphoma, Indolent
Lymphoma, MALT
Lymphoma, Mantle cell
Lymphoma, Mediastinal B-Cell
Lymphoma, Refractory NHL
Melanoma
Mesothelioma
Multiple Myeloma
MDS
NHL
Ovarian
Pancreas
Prostate
Prostate (Hormonal)
Rectal Cancer
Sarcoma
Sarcoma, Ewing's
Sarcoma, Osteogenic
Skeletal Metastasis
Testicular Cancer
Thymoma
Thyroid Cancer
Waldenstrom's
Unknown Primary
<<<<<<<<<>>>>>>>>>
Molecular Genetics
Oncogenes, the list!
Immunoperoxidase stains
Tumor Markers
Bleomycin
Cisplatin
Etoposide
Ifosfamide
Methotrexate
Temazolamide
Mechanism of Action
Dose Modifications (Renal)
Dose Modifications (hepatic)
MDR

1. Treatments:
----Untreated myeloma
----Resistant myeloma
2. Classification of plasma cell dyscrasias
3. Staging multiple myeloma

MP:

MELPHALAN 8 mg/m2 po + PREDNISONE 100 mg/day PO DAYS 1-4
NOTE: Do not use if patient considered for myeloablative therapy

____________________________________________________________
VAD:
VINCRISTINE 0.4 mg/day IV
ADRIAMYCIN 9 mg/m2/day IV
BOTH DRUGS TO BE GIVEN BY CONTINUOUS INFUSION ON DAYS 1-4, & WITH DEXAMETHASONE 20 mg/m2 ON DAYS 9-12, & 17-20.

With Spinal XRT:
DEXAMETHASONE 20 mg/m2/day PO on DAYS 1-4, 9-12, 17-20

____________________________________________________________


RESISTANT MYELOMA

Use alternatives above or

Use Thalidomide:
Thalidomide escalating dosage schedule from 200 mg to 800 mg a day.
Toxicities include: Constipation, sedation, & symptoms of peripheral neuropathy.
____________________________________________________________

Thalidomide + Decadron

Thalidomide 200 mg/day with
Dexamethasone 40 mg/day orally on days 1-4, 9-12, & 19-20 in the ODD cycles and, on the EVEN cycles, only on days 1-4

RESULTS: RR 64%. Using the cut-off level of a 25% reduction in paraprotein to define response, RR 92%. Complications: DVT in 10% of patients, constipation in 8%, & rash in 6%. Three patients died while on treatment; 1 from pancreatitis, 1 from PE, & 1 from infection.

REF: Rajkumar S, Hayman S, Gertz M, et al. Combination therapy with thalidomide plus dexamethasone (THAL/DEX) for newly diagnosed myeloma (MM). Program and abstracts of the 43rd Annual Meeting of the American Society of Hematology; December 7-11, 2001; Orlando, Florida. Abstract 3525.
____________________________________________________________

___________________________________________

Classification of plasma cell dyscrasias:

MGUS
--Absence of lytic lesions, anemia, hypercalcemia, renal insufficiency, & stability of the monoclonal protein during follow up.
--serum monoclonal protein <3 g/dL
--min or absent light chain excretion

SMOLDERING MYELOMA
--monoclonal paraprotein <5 g/dL
--min marrow plasmacytosis <30%
--mild anemai
--no renal insufficiency or lytic bone lesions

INDOLENT MYELOMA
--Stage I multiple myeloma except patients are asymptomatic & <3 asymptomatic small lytic bone lesions.

EXTRAMEDULLARY OR SOLITARY PLASMACYTOMA OF BONE

PLASMA CELL LEUKEMIA

___________________________________________

STAGE:

I
Hgb>10
Serum Ca=<12
Normal bone or solitary plasmacytoma on X-ray
Low M-component production rate (IgG<5g/dl,IgA<3g/dl,BJ<4g/24hr)

II
Neither I or III!

III
Hgb<8.5
Serum Ca>12
Multiple lytic lesions on X-ray
High M-component production rate(IgG>7, IgA>5, BJ>12)
____________________________________________________________
Subclassification:
A---normal renal function (serum creat <2.0)
B---abnormal renal function (serum creat >2.0)