UMLS:C0026764 - FACTA Search

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Query: UMLS:C0026764 (multiple myeloma)
36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical features and response to therapy of 32 Chinese patients with localised plasmacytoma are presented, and a comparison between extramedullary plasmacytoma (EMP) and solitary plasmacytoma of bone (SPB) is made. Twenty-two patients had SPB and ten had EMP, accounting for 9% of all of our plasma cell neoplasms. Both groups had a male predominance with a median age of 54 years for SPB and 63 years for EMP. The common sites of SPB included vertebral bodies (15) and the skull (4). Most EMPs occurred in the oronasopharynx (6) and paranasal sinuses (2). An M-protein was detected in eight patients with SPB and in six with EMP. Seventeen patients with SPB and seven with EMP received radiation therapy, and all achieved initial local control. The pattern of failure in 22 patients with SPB manifested as local recurrence in two, multiple bone metastases without bone marrow plasmacytosis in two, multiple EMP progression in two, and development of multiple myeloma (MM) in one. There were two local recurrences, one further solitary bone involvement and one MM conversion in the EMP group. Local recurrence or dissemination was associated with the appearance of M-protein or an increase in the M-protein level in both groups. There was no significant difference in M-protein status or incidence and patterns of failure between the two groups. Patients with EMP had a more favourable overall survival than those with SPB (P = 0.03). The 5 year disease-free survival rate was 79% for EMP and 58% for SPB (P = 0.53). Patients aged less than 60 years had a better overall survival in the SPB group, but location of tumour, presence of M-protein, radiation dose and chemotherapy did not influence prognosis in either group. Our results indicate that adequate local therapy can result in long-term survival with a low frequency of MM progression for patients with localised plasmacytomas, and both EMP and SPB appear to be similar in terms of frequency and patterns of failure.
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PMID:Localised plasmacytomas in Taiwan: comparison between extramedullary plasmacytoma and solitary plasmacytoma of bone. 781 27

Normal skeletal integrity is maintained by physiological bone turnover through a coupled process of bone resorption, mediated by osteoclasts, followed by new bone formation, mediated by osteoblasts. Major features of the pathogenesis of cancer-associated skeletal destruction are enhanced osteoclast-mediated bone resorption and disruption of normal bone formation. In this article, the literature on the pathogenesis and clinical manifestations of metastatic bone disease is discussed. Animal and clinical trials investigating novel bone targeted agents, emphasizing the bisphosphonates, are critically assessed. The most frequent clinical manifestations of bone metastases are pain, fracture, immobility, spinal cord compression, and hypercalcemia. New treatments under study for patients with bone metastases include agents specifically targeted to the skeleton such as bone-seeking radioisotopes and bisphosphonates. Studies in animal models of metastatic bone disease show that these bisphosphonates are able to inhibit tumor-induced osteolysis and are potentially useful in this condition. Bisphosphonates have been investigated in several clinical trials of patients with skeletal metastases from breast cancer, prostate cancer, and multiple myeloma. Overall, the studies investigating bone targeted radioisotopes or bisphosphonates for the treatment of morbidity due to skeletal metastases have been inconclusive. An improved understanding of the pathogenesis of metastatic bone disease and preclinical studies with bisphosphonates suggest that these agents may have a role in the treatment of this disorder. Additional trials of new generation bisphosphonates, employing a rigorously controlled, randomized study design with adequate numbers of subjects, are needed to demonstrate the safety and efficacy of this class of agents in this setting.
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PMID:New bisphosphonates in the treatment of bone metastases. 824 77

Diphosphonates are potent inhibitors of bone resorption, they have been evaluated in several clinical trials for bone metastases. We performed a clinical study to evaluate the therapeutic effect of Disodium Pamidronate over pain and radiologic evolution in bone metastases (Breast Cancer and Multiple Myeloma patients). The results regarding the first 10 patients concluded that there is good drug tolerability and significant analgesic activity in 6 patients, with sclerosis of lytic skull lesions in one breast cancer patient.
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PMID:[Disodium pamidronate (APD) in the treatment of bone metastases]. 848 64

We report the performance characteristics of an assay for determination of bone alkaline phosphatase (ALP) activity after immunoadsorption in microplate wells. Between-run imprecision was between 7.1% and 11.2%. The detection limit was 1.0 U/L. Comparisons with an immunoradiometric test for determination of bone ALP mass concentrations yielded the following regression equation: y = 3.11 + 1.33x with y, the bone ALP activity concentration (U/L) (and x, the bone ALP mass concentration microgram/L) (r +=0.974, n = 103). Using sera from patients with liver diseases and sera from patients with secondary hyperparathyroidism yielded a cross-reactivity of 20% for circulating liver ALP (and its membrane-bound isoform). In patients receiving renal transplants, Z-score analysis revealed that after transplantation the increase in bone ALP activity is more pronounced than total ALP activity. In tumor patients, receiver-operating characteristic analysis revealed that bone ALP activity shows the same diagnostic efficacy as total ALP activity in the detection of bone metastases (as assessed by bone scintigraphy). In multiple myeloma patients, suppressed osteoblast activity was well detectable by bone ALP activity determination.
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PMID:Method for determination of bone alkaline phosphatase activity: analytical performance and clinical usefulness in patients with metabolic and malignant bone diseases. 859 12

Frequent complications of bone metastases include pain, pathologic fracture, hypercalcemia and spinal cord compression. Lytic bone metastases result from excessive activation of osteoclasts by tumor-produced cytokines. Aredia (pamidronate) is a potent bisphosphonate that inhibits osteoclast activation. In two dose-seeking phase I trials in patients with breast cancer and prostate cancer, repeated intravenous infusion of Aredia was shown to be safe and effective in reducing bone resorption and pain. In a randomized phase III trial of 377 patients with multiple myeloma, Aredia was administered in a dosage of 90 mg i.v. every 4 weeks. Compared with placebo, treatment with Aredia was associated with a significant decrease in bone pain and in the incidence and time to development of all skeleton-related events. Data from two phase III breast cancer trials each involving 300 patients are now being analyzed. The newer bisphosphonates can safely be used together with standard anticancer therapy to provide effective palliation of symptoms caused by lytic bone metastases.
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PMID:The role of bisphosphonates in the treatment of bone metastases--the U.S. experience. 873 55

Bone sialoprotein (BSP) is a phosphorylated glycoprotein with a M(r) of 70-80 kDa that accounts for approximately 5-10% of the noncollagenous proteins of bone. Due to its relatively restricted distribution to mineralized tissues, BSP may serve as a potential marker of bone metabolism. Employing a recently developed RIA, serum BSP was measured in 133 healthy subjects, aged 20-80 yr, and in patients with primary hyperparathyroidism (pHPT; n = 26), Paget's disease of bone (PD; n = 14), untreated multiple myeloma (MM; n = 32), and breast cancer with bone metastases (BC; n = 19). Results were compared to clinical and laboratory data, including serum total alkaline phosphatase as a marker of bone formation, and the urinary cross-links pyridinoline (PYD) and deoxypyridinoline (DPD) as markers of bone resorption. In healthy adults, serum BSP values ranged between 5.0-21.6 ng/mL (5-95% interval), with a median of 10.5 ng/mL (total group). In healthy females, a linear correlation was found between serum BSP and age (r = 0.51; P < 0.001), with significantly higher values in postmenopausal than in premenopausal women (13.3 +/- 4.8 vs. 9.0 +/- 3.8; P < 0.01). In the healthy group, BSP values did not change with body mass index, lumbar bone mineral density, serum calcium, serum creatinine, or serum total alkaline phosphatase levels. In contrast, a weak, but significant, correlation was observed between serum BSP and the urinary excretion of PYD and DPD. Compared to those in healthy controls, serum BSP levels were significantly higher in patients with pHPT, PD, MM, or BC (P < 0.01 for all groups). These differences remained after analyses were adjusted for age and sex. In pHPT, serum BSP levels were closely correlated to urinary PYD and DPD (r = 0.87 and 0.83, respectively; P < 0.01), whereas in PD, no correlation was observed between any of the bone markers. Serum BSP levels were highest in patients with MM, and there was a significant difference between early and advanced stages of the disease (30.2 +/- 8.0 vs. 64.3 +/- 6.8; P < 0.01). In a subgroup of 15 patients with metastatic BC, iv bisphosphonate treatment resulted in a rapid reduction of serum BSP levels to 40% of the baseline values within 4 days of treatment. In conclusion, BSP appears to be a sensitive marker of bone turnover, and the present data suggest that its serum levels predominantly reflect processes related to bone resorption.
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PMID:Serum immunoreactive bone sialoprotein as a new marker of bone turnover in metabolic and malignant bone disease. 878 85

Clinical research over the last decade has confirmed the helpful role of bisphosphonates in the management of patients with bone metastases secondary to breast cancer and other malignancies. This role is also expanding in myeloma and in the management of osteoporosis. Current clinical research in oncology is focusing on their potential for the prevention of skeletal complications of malignant disease and the development of bone metastases while basic researchers are developing compounds of higher potency and, perhaps, higher therapeutic efficacy. One of the earliest agents to be investigated, etidronate, is effective in the management of malignant hypercalcemia and, when used orally and intermittently, results in reduced bone loss in osteoporosis. However, it does not appear to reduce pain in patients with malignant disease. Clodronate has been shown to be an effective agent in the management of hypercalcemia and can be used as a single intravenous infection for this purpose. Clodronate is also effective in some patients in reducing bone pain and improving mobility. When used orally, it can, as can pamidronate, reduce the skeletal complications of breast cancer such as hypercalcemia, bone fractures and bone pain. It may have fewer gastrointestinal side effects than oral pamidronate. There is emerging evidence that bisphosphonates may delay or prevent the clinical appearance of bone metastases as well as reduce other skeletal complications. Trials of adjuvant bisphosphonates such as clodronate and pamidronate in operable breast cancer are currently under way in Europe and North America.
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PMID:Role of bisphosphonates in prevention and treatment of bone metastases from breast cancer. 885 26

Bone sialoprotein (BS), a protein synthesized by osteoblasts and osteoclasts and highly modified posttranslationally, constitutes a predominant fraction of the noncollagenous organic matrix in human bone. We report an assessment of serum concentrations of BS in patients with malignant bone diseases. In patients with bone metastases (according to scintigraphic criteria), serum BS concentrations were greater than in patients without bone metastases (P <0.05). However, ROC curve analysis revealed that serum BS was inferior to serum bone alkaline phosphatase in discriminating between patients with and without bone metastases. Patients with bone metastases showed a weak correlation between serum BS concentrations and bone formation markers. Only "traditional" markers of bone formation-but not BS-were correlated with urinary deoxypyridinoline (P <0.01). Liver and kidney dysfunction had no significant influence on BS values in these patients (as assessed by analysis of variance; P >0.05). In multiple myeloma patients treated with corticosteroids and bisphosphonates, BS concentrations were lower than in tumor patients without bone metastases (P <0.001), and the correlation between BS concentrations and the number of bisphosphonate courses applied was significant (r = -0.578; P <0.05). In postmenopausal women, serum BS concentrations averaged 142% greater than in premenopausal women. Further studies should be done, therefore, to elucidate whether serum BS is able to predict high bone turnover after menopause.
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PMID:Bone sialoprotein in serum of patients with malignant bone diseases. 899 Feb 27

To arrive at a reasonable estimate of the total need for radiotherapy, the various descriptions of population trends and measures of cancer trends must be studied concurrently. Incidence and mortality are well documented by official statistics. All prognoses are based on these measures, the official population statistics, and the 1989 population prognosis from Statistics Sweden. Incidence, mortality, and prevalence may be considered either individually or together as indirect measures of the need for radiotherapy at different stages for different types of cancer. Incidence, ie, the number of cases of disease onset during a given period, shows the indirect need for curative radiotherapy, eg, for breast cancer, laryngeal cancer, gynecological tumor types, and head and neck cancer. The projected average annual mean increase in total incidence is 1.0%. Mortality may be used as an indirect measure of the need for palliative treatment for recurring cancer, eg, for bone metastases, prostate cancer, lung cancer, or breast cancer. The mean increase is estimated at 0.9% per year. Likewise, prevalence can be an indirect measure of the need for palliative treatment for cancer diseases of a chronic nature, eg, prostate cancer and multiple myeloma. The total mean increase per year has been estimated at 2.0%. The total need for radiotherapy in the future should be viewed against the background of all these descriptive measures. Assessment must also consider numerous other factors that directly influence need. A change in the indications for treatment can quickly increase the need for radiotherapy, eg, the benefits of radiotherapy for noninvasive breast cancer are currently being studied. Even a change in the indications for surgical intervention for small tumors in the breast influence the need for primary curative radiotherapy in this large group of patients. Likewise, a shift in staging the primary diagnosis, eg, in head and neck cancer, and changes in fractionation (hyperfractionation) may substantially influence need. This is addressed further in another section of the report. The largest single group of cancer patients who receive radiotherapy are those with bone metastases (25% of the total). The size of this group, and thereby the potential unsatisfied need, is largely unknown since no statistics show the prevalence of metastases in the population. This group is comprised mainly of patients that were primarily diagnosed with prostate cancer, breast cancer, and lung cancer. Concerning lung cancer, incidence trends probably provide the best measure of changes in the number of bone metastases over time. The annual increase in incidence has been estimated at 1.5%. As for breast cancer and prostate cancer, mortality trends provide more information about trends in the number of bone metastases. Both types of cancer increased by 1.9% per year. Chapter 6 presents the types of cancer for which radiotherapy is usually given. The projected trends show that each of these cancer diagnoses, except lung cancer in men and cervical cancer in women, are expected to increase in number until the year 2010. Prevalence is expected to increase even more, particularly cancer in the rectum, breast, and prostate. Also, the number of cases of non-Hodgkin's lymphoma is expected to nearly double by 2010.
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PMID:Cancer trends in Sweden until 2010. 915 84

We have been studying bisphosphonates since the early 1980s, initially investigating etidronate in the management of hypercalcaemia and, since the mid-1980s, clodronate in the management of hypercalcaemia, bone pain, and skeletal complications in patients with bone metastases. We have also recently reported that bone metastases can be prevented or delayed in patients without evidence of bone disease but with recurrent disease at other sites. Bisphosphonates are now the standard therapy for hypercalcaemia after rehydration. For patients with bone metastases and bone pain, a trial of clodronate 600-1500 mg i.v. in 500 ml normal saline over 3 h given every 1-2 weeks is worth-while in association with other modalities such as radiotherapy and analgesic medications. Oral clodronate or intravenous pamidronate should be given as a preventive measure in patients with established bone metastases from breast cancer and myeloma. In patients with no evidence of bone metastases, it may be that bisphosphonates can delay the emergence of bone metastases; at present this remains under clinical investigation and our pioneer trials require confirmation. Clinical trials of bisphosphonates in the treatment of hypercalcaemia, bone pain, management of patients with bone metastases and management of patients with recurrent cancer but no evidence of bone metastases will be discussed.
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PMID:Should bisphosphonates be standard therapy for bone pain? 917 65

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