Secondary Primary Malignancies in Multiple Myeloma: An Old Nemesis Revisited
Open Access
- 19 July 2012
- journal article
- review article
- Published by Hindawi Limited in Advances in Hematology
- Vol. 2012, 1-9
- https://doi.org/10.1155/2012/801495
Abstract
The treatment of myeloma has undergone extraordinary improvements in the past half century. These advances have been accompanied by a concern for secondary primary malignancies (SPMs). It has been known for decades that extended therapy with alkylating chemotherapy agents, such as melphalan, carries an increased risk of therapy-related myelodysplastic syndrome and/or acute myeloid leukemia (t-MDS/AML), with a cumulative risk as high as 10–15%. High-dose chemotherapy with autologous stem cell support became widely accepted for myeloma in the 1990s. Despite the use of high doses of melphalan, the risk of t-MDS/AML with this procedure is estimated to be less than 5%, with much of this risk attributable to pretransplant therapy. Recently, lenalidomide has come under scrutiny for its possible association with SPMs. It is too soon to declare a causal relationship at this time, but there appears to be an increased number of SPMs in reports from several studies using lenalidomide maintenance. Current studies should be amended and future studies planned to better define the risk of SPMs and the risk factors and mechanisms for its development. Patients should be educated regarding this potential concern but the current use of lenalidomide should not generally be altered until further data are available.Keywords
This publication has 64 references indexed in Scilit:
- Cereblon expression is required for the antimyeloma activity of lenalidomide and pomalidomideBlood, 2011
- Risk of acute myeloid leukemia and myelodysplastic syndromes after multiple myeloma and its precursor disease (MGUS)Blood, 2011
- Treatment with lenalidomide does not appear to increase the risk of progression in lower risk myelodysplastic syndromes with 5q deletion. A comparative analysis by the Groupe Francophone des MyelodysplasiesHaematologica, 2011
- Polymorphism of the erythropoietin gene promotor and the development of myelodysplastic syndromes subsequent to multiple myelomaLeukemia, 2011
- How “immunomodulatory” are IMIDs?Blood, 2011
- Lenalidomide and high-dose dexamethasone compared with dexamethasone as initial therapy for multiple myeloma: a randomized Southwest Oncology Group trial (S0232)Blood, 2010
- Lenalidomide mode of action: linking bench and clinical findingsBlood Reviews, 2010
- Mechanism of action of lenalidomide in hematological malignanciesJournal of Hematology & Oncology, 2009
- Cytogenetically defined myelodysplasia after melphalan-based autotransplantation for multiple myeloma linked to poor hematopoietic stem-cell mobilization: the Arkansas experience in more than 3000 patients treated since 1989Blood, 2008
- Enhancement of ligand-dependent activation of human natural killer T cells by lenalidomide: therapeutic implicationsBlood, 2006