The Experts below are selected from a list of 237 Experts worldwide ranked by ideXlab platform

Angela Dispenzieri - One of the best experts on this subject based on the ideXlab platform.

  • Clinical course and prognosis of Non-Secretory multiple Myeloma.
    European journal of haematology, 2015
    Co-Authors: Sagar Chawla, Angela Dispenzieri, Shaji Kumar, Alexandra J Greenberg, Dirk R Larson, Robert A Kyle, Martha Q Lacy, Morie A Gertz, S. Vincent Rajkumar
    Abstract:

    Objective To determine the prognosis of patients with Non-Secretory Myeloma. Methods: We studied 124 patients diagnosed with multiple Myeloma who had no monoclonal protein detected on serum and urine immunofixation at diagnosis and on all subsequent follow up testing (Non-Secretory Myeloma). The overall survival (OS) of patients with Non-Secretory Myeloma was compared with 7075 patients with typical Myeloma seen during the same time period in whom a monoclonal protein was detected at the time of diagnosis. Results One hundred and twenty four patients met criteria for Non-Secretory multiple Myeloma. The median follow-up was 102 months (range, 1-204 months). The median progression free survival with initial therapy was 28.6 months, and the median OS was 49.3 months. There was a significant improvement in OS since 2001; median survival 99.2 versus 43.8 months (prior to 2001) versus 99.2 months (2001-2012), P

  • clinical course and prognosis of Non Secretory multiple Myeloma
    European Journal of Haematology, 2015
    Co-Authors: Sagar Chawla, Angela Dispenzieri, Shaji Kumar, Alexandra J Greenberg, Dirk R Larson, Robert A Kyle, Martha Q Lacy, Morie A Gertz, Vincent S Rajkumar
    Abstract:

    Objective To determine the prognosis of patients with Non-Secretory Myeloma. Methods: We studied 124 patients diagnosed with multiple Myeloma who had no monoclonal protein detected on serum and urine immunofixation at diagnosis and on all subsequent follow up testing (Non-Secretory Myeloma). The overall survival (OS) of patients with Non-Secretory Myeloma was compared with 7075 patients with typical Myeloma seen during the same time period in whom a monoclonal protein was detected at the time of diagnosis. Results One hundred and twenty four patients met criteria for Non-Secretory multiple Myeloma. The median follow-up was 102 months (range, 1-204 months). The median progression free survival with initial therapy was 28.6 months, and the median OS was 49.3 months. There was a significant improvement in OS since 2001; median survival 99.2 versus 43.8 months (prior to 2001) versus 99.2 months (2001-2012), P<0.001. OS was superior in patients with a normal baseline FLC ratio (n=10) compared to patients with an abnormal ratio (n=19), medians not reached in both groups. Prior to 2001, OS was similar in Non-Secretory Myeloma (n=86) and Secretory Myeloma (n=4011), median 3.6 versus 3.5 years, respectively, P=0.63. However, among patients diagnosed between 2001-2012, OS was superior in Non-Secretory Myeloma (n=36) compared to Secretory Myeloma (n=2942), median 8.3 versus 5.4 years, respectively, P=0.03. Conclusions Non-Secretory Myeloma is an uncommon subtype of multiple Myeloma. In the last decade, there has been an improvement in the survival of Non-Secretory Myeloma, and appears superior to Secretory Myeloma. This article is protected by copyright. All rights reserved.

  • International Myeloma Working Group guidelines for serum-free light chain analysis in multiple Myeloma and related disorders
    Leukemia, 2009
    Co-Authors: Angela Dispenzieri, Reuben Kyle, J. S. Miguel, Soumya Jagannath, Alessandro Palumbo, Joan Blade, Giampaolo Merlini, Roman Hájek, Heiko Ludwig, Sumit Lonial
    Abstract:

    The serum immunoglobulin-free light chain (FLC) assay measures levels of free kappa and lambda immunoglobulin light chains. There are three major indications for the FLC assay in the evaluation and management of multiple Myeloma and related plasma cell disorders (PCD). In the context of screening, the serum FLC assay in combination with serum protein electrophoresis (PEL) and immunofixation yields high sensitivity, and negates the need for 24-h urine studies for diagnoses other than light chain amyloidosis (AL). Second, the baseline FLC measurement is of major prognostic value in virtually every PCD. Third, the FLC assay allows for quantitative monitoring of patients with oligoSecretory PCD, including AL, oligoSecretory Myeloma and nearly two-thirds of patients who had previously been deemed to have Non-Secretory Myeloma. In AL patients, serial FLC measurements outperform PEL and immunofixation. In oligoSecretory Myeloma patients, although not formally validated, serial FLC measurements reduce the need for frequent bone marrow biopsies. In contrast, there are no data to support using FLC assay in place of 24-h urine PEL for monitoring or for serial measurements in PCD with measurable disease by serum or urine PEL. This paper provides consensus guidelines for the use of this important assay, in the diagnosis and management of clonal PCD.

Robert A Kyle - One of the best experts on this subject based on the ideXlab platform.

  • clinical course and prognosis of Non Secretory multiple Myeloma
    European Journal of Haematology, 2015
    Co-Authors: Sagar Chawla, Angela Dispenzieri, Shaji Kumar, Alexandra J Greenberg, Dirk R Larson, Robert A Kyle, Martha Q Lacy, Morie A Gertz, Vincent S Rajkumar
    Abstract:

    Objective To determine the prognosis of patients with Non-Secretory Myeloma. Methods: We studied 124 patients diagnosed with multiple Myeloma who had no monoclonal protein detected on serum and urine immunofixation at diagnosis and on all subsequent follow up testing (Non-Secretory Myeloma). The overall survival (OS) of patients with Non-Secretory Myeloma was compared with 7075 patients with typical Myeloma seen during the same time period in whom a monoclonal protein was detected at the time of diagnosis. Results One hundred and twenty four patients met criteria for Non-Secretory multiple Myeloma. The median follow-up was 102 months (range, 1-204 months). The median progression free survival with initial therapy was 28.6 months, and the median OS was 49.3 months. There was a significant improvement in OS since 2001; median survival 99.2 versus 43.8 months (prior to 2001) versus 99.2 months (2001-2012), P<0.001. OS was superior in patients with a normal baseline FLC ratio (n=10) compared to patients with an abnormal ratio (n=19), medians not reached in both groups. Prior to 2001, OS was similar in Non-Secretory Myeloma (n=86) and Secretory Myeloma (n=4011), median 3.6 versus 3.5 years, respectively, P=0.63. However, among patients diagnosed between 2001-2012, OS was superior in Non-Secretory Myeloma (n=36) compared to Secretory Myeloma (n=2942), median 8.3 versus 5.4 years, respectively, P=0.03. Conclusions Non-Secretory Myeloma is an uncommon subtype of multiple Myeloma. In the last decade, there has been an improvement in the survival of Non-Secretory Myeloma, and appears superior to Secretory Myeloma. This article is protected by copyright. All rights reserved.

  • Clinical course and prognosis of Non-Secretory multiple Myeloma.
    European journal of haematology, 2015
    Co-Authors: Sagar Chawla, Angela Dispenzieri, Shaji Kumar, Alexandra J Greenberg, Dirk R Larson, Robert A Kyle, Martha Q Lacy, Morie A Gertz, S. Vincent Rajkumar
    Abstract:

    Objective To determine the prognosis of patients with Non-Secretory Myeloma. Methods: We studied 124 patients diagnosed with multiple Myeloma who had no monoclonal protein detected on serum and urine immunofixation at diagnosis and on all subsequent follow up testing (Non-Secretory Myeloma). The overall survival (OS) of patients with Non-Secretory Myeloma was compared with 7075 patients with typical Myeloma seen during the same time period in whom a monoclonal protein was detected at the time of diagnosis. Results One hundred and twenty four patients met criteria for Non-Secretory multiple Myeloma. The median follow-up was 102 months (range, 1-204 months). The median progression free survival with initial therapy was 28.6 months, and the median OS was 49.3 months. There was a significant improvement in OS since 2001; median survival 99.2 versus 43.8 months (prior to 2001) versus 99.2 months (2001-2012), P

  • Criteria for the classification of monoclonal gammopathies, multiple Myeloma and related disorders: a report of the International Myeloma Working Group
    British journal of haematology, 2003
    Co-Authors: Robert A Kyle, Joan Blade, Bart Barlogie, J. Anthony Child, Kenneth C. Anderson, Régis Bataille, William I. Bensinger, Mario Boccadoro, William S. Dalton, Meletios A. Dimopoulos
    Abstract:

    The monoclonal gammopathies are a group of disorders associated with monoclonal proliferation of plasma cells. The characterization of specific entities is an area of difficulty in clinical practice. The International Myeloma Working Group has reviewed the criteria for diagnosis and classification with the aim of producing simple, easily used definitions based on routinely available investigations. In monoclonal gammopathy of undetermined significance (MGUS) or monoclonal gammopathy, unattributed/unassociated (MG[u]), the monoclonal protein is < 30 g/l and the bone marrow clonal cells < 10% with no evidence of multiple Myeloma, other B-cell proliferative disorders or amyloidosis. In asymptomatic (smouldering) Myeloma the M-protein is greater than or equal to 30 g/l and/or bone marrow clonal cells greater than or equal to 10% but no related organ or tissue impairment (ROTI)(end-organ damage), which is typically manifested by increased calcium, renal insufficiency, anaemia, or bone lesions (CRAB) attributed to the plasma cell proliferative process. Symptomatic Myeloma requires evidence of ROTI. Non-Secretory Myeloma is characterized by the absence of an M-protein in the serum and urine, bone marrow plasmacytosis and ROTI. Solitary plasmacytoma of bone, extramedullary plasmacytoma and multiple solitary plasmacytomas (+/- recurrent) are also defined as distinct entities. The use of these criteria will facilitate comparison of therapeutic trial data. Evaluation of currently available prognostic factors may allow better definition of prognosis in multiple Myeloma.

Gareth J. Morgan - One of the best experts on this subject based on the ideXlab platform.

  • Efficacy and outcome of autologous transplantation in rare Myelomas
    Haematologica, 2010
    Co-Authors: Curly Morris, M. Drake, J. Apperley, Simona Iacobelli, A. Van Biezen, Bo Björkstrand, H. Goldschmidt, J. L. Harousseau, Gareth J. Morgan, T. De Witte
    Abstract:

    Background As rare Myelomas, i.e. the IgD, IgE, IgM and Non-Secretory forms, constitute only a small proportion of any study, relatively little is known about their prognosis in the era of peripheral stem cell transplantation. Design and Methods We used the European Group for Blood and Marrow Transplantation Myeloma Database to compare the outcome following autologous transplantation of over 20,000 patients with common Myelomas (IgG, IgA and light chain Myeloma) with the outcome of patients with rare Myelomas: 379 IgD, 13 IgE, 72 IgM and 976 Non-Secretory cases. Results The study confirms the multiple adverse prognostic factors seen in IgD Myeloma. Somewhat surprisingly, patients with IgD and Non-Secretory Myeloma both had higher complete remission rates before and after transplantation than patients with common Myelomas. However, while the overall survival of patients with Non-Secretory Myeloma was similar to that of the patients with common Myelomas, the survival of patients with IgD Myeloma was significantly worse (although better than survival rates reported for Non-transplanted patients); this was due to higher transplant-related mortality and relapse/progression rates. The post-transplantation survival of patients with IgE or IgM Myeloma appears to be very poor. Conclusions This study provides data on the biological features of rare Myelomas. The overall survival of patients with IgD, IgE or IgM Myeloma is poor following autologous transplantation but substantially better than that reported for patients who were not transplanted.

  • Serum free light chains for monitoring multiple Myeloma.
    British journal of haematology, 2004
    Co-Authors: Graham P. Mead, Gareth J. Morgan, Hugh D. Carr-smith, Mark T. Drayson, J. A. Child, Arthur R. Bradwell
    Abstract:

    Monoclonal immunoglobulin free light chains (FLC) are found in the serum and urine of patients with a number of B-cell proliferative disorders, including multiple Myeloma. Automated immunoassays, which can measure FLC in serum, are useful for the diagnosis and monitoring of light chain (AL) amyloidosis, Bence Jones Myeloma and Non-Secretory Myeloma patients. We report the results of a study investigating the utility of serum FLC measurements in Myeloma patients producing monoclonal intact immunoglobulin proteins. FLC concentrations were measured in presentation sera from 493 multiple Myeloma patients with monoclonal, intact immunoglobulin proteins. Serial samples were assayed from 17 of these patients and the FLC measurements were compared with other disease markers. Serum FLC concentrations were abnormal in 96% of patients at presentation. FLC concentrations fell more rapidly in response to treatment than intact immunoglobulin G (IgG) and showed greater concordance with serum beta2 microglobulin concentrations and bone marrow plasma cell assessments. It was concluded that serum FLC assays could be used to follow the disease course in nearly all multiple Myeloma patients. In addition, because of their short serum half-life, changes in serum FLC concentrations provide a rapid indication of the response to treatment.

Guy Pratt - One of the best experts on this subject based on the ideXlab platform.

  • is daily lenograstim from day 7 of autologous peripheral blood stem cell transplantation apbsct is as effective as pegfilgrastim in patients with Myeloma
    Blood, 2013
    Co-Authors: Ben Bailiff, Vidhya Murthy, Lynn Bratby, Kathy Holder, Emmanuel Nikolousis, Bhuvan Kishore, Guy Pratt, R. Lovell, Neil Phillips, Joanne Ewing
    Abstract:

    High dose melphalan conditioned APBSCT after induction therapy is thestandard of carefor patients with Myeloma with good performance status. Busy haematology units are in the lookout for safe and effective strategies to hasten neutrophil engraftment, decrease inpatient stay and ease financial burden. Growth factors have been helpful in this regard. We describe our experience with the use of different growth factors in patients with Myeloma undergoing APBSCT. Aims of the study To identify whether once daily lenograstimfrom day + 7 following APBSCT is as efficacious as one dose of pegfilgrastim on day +1with regards to neutrophil engraftment, inpatient stay, days of antibiotic use and outcomes as compared no G-CSF use. Materials and Methods Patients had induction treatment followed by autologous PBSC mobilisation with G-CSF alone or by cyclophosphamide (3g/m2) + G-CSF schedule. APBSCT with high dose melphalan (140 or 200 mg/ m2) conditioning was carried out as per standard indications and the day of stem cell re-infusion was termed day 0. Statistical analysis was carried out using GraphPad Prism 4 and IBM SPSS 19 for Windows. Our retrospective study included 112 patients (71male&41 female) with a median age at transplantation of 61 years (range 38-72) with Myeloma betweenJanuary2006 and December 2012. 35%patients did not receive any G-CSF, 19% received pegfilgrastim and46% received lenograstim.58 % patients had IgG, 21 % IgA, 17 % light chain and 4 % had Non-Secretory Myeloma. At transplant 7% patients were in complete remission, 20% in partial remission and 73% in very good partial remission. Results Median time for neutrophil engraftment was 14, 12 and 13 days in the no G-CSF, peg-filgrastim and lenograstim respectively. Median inpatient stay was 18, 16 and 16 days in the no G-CSF, peg-filgrastim and lenograstim respectively. Median days of broad spectrum intravenous antibiotic use were 6, 5 and 5 days in the no G-CSF, peg-filgrastim and lenograstim respectively. Median dose of stem cells infused was 3.1, 2.7 and 2.5 CD 34 + cells per kg body weight in the no G-CSF, peg-filgrastim and lenograstim respectively.There was no difference in the overall survival (Log Rank test; p value: 0.844) or progression free survival (Log Rank test; p value: 0.155) between the three cohorts. Summary Results of retrospective analysis suggests that the use of daily lenograstim from day +7 is an effective strategy as day + 1 peg-filgrastim in patients with Myeloma undergoing APBSCTin reducing the time to neutrophil engraftment, duration of inpatient stay and antibiotic useand superior to no G-CSF use. Our data confirms daily lenograstim from day +7 is a cost effective alternative strategy to pegfilgrastimmaking use of use of lenograstim post autologous stem cell transplantation as a standard practice. ![Figure][1] ![Figure][1] Disclosures: No relevant conflicts of interest to declare. [1]: pending:yes

  • The evolving use of serum free light chain assays in haematology
    British journal of haematology, 2008
    Co-Authors: Guy Pratt
    Abstract:

    Over the last few years new immunoassays have emerged that allow the measurement of free immunoglobulin light chains (FLCs) in serum to a level of 2-4 mg/l and provide a much greater sensitivity than older methods, such as immunofixation, which is able to detect FLCs at a minimum concentration of 100-150 mg/l. The new FLC assay has enabled the detection of monoclonal protein in some patients with Non-Secretory Myeloma and amyloidosis that were previously undetectable. FLC measurements are quantitative, correlating with disease activity, and are an advance in monitoring light chain only multiple Myeloma, AL amyloidosis, Non-Secretory and oligo-Secretory multiple Myeloma. Serum FLC concentrations also reflect the disease course in the majority of Myeloma patients producing intact monoclonal immunoglobulin proteins and have been incorporated into the new response criteria. The rapid half life of lambda and kappa free light chains means that FLC assays may provide a more rapid indication of the response to treatment but their clinical utility in this setting needs further study. An abnormal FLC ratio has been shown to be a risk factor for progression of monoclonal gammopathy of undetermined significance, smouldering Myeloma and solitary plasmacytoma of bone and is prognostic in multiple Myeloma.

T. De Witte - One of the best experts on this subject based on the ideXlab platform.

  • Efficacy and outcome of autologous transplantation in rare Myelomas
    Haematologica, 2010
    Co-Authors: Curly Morris, M. Drake, J. Apperley, Simona Iacobelli, A. Van Biezen, Bo Björkstrand, H. Goldschmidt, J. L. Harousseau, Gareth J. Morgan, T. De Witte
    Abstract:

    Background As rare Myelomas, i.e. the IgD, IgE, IgM and Non-Secretory forms, constitute only a small proportion of any study, relatively little is known about their prognosis in the era of peripheral stem cell transplantation. Design and Methods We used the European Group for Blood and Marrow Transplantation Myeloma Database to compare the outcome following autologous transplantation of over 20,000 patients with common Myelomas (IgG, IgA and light chain Myeloma) with the outcome of patients with rare Myelomas: 379 IgD, 13 IgE, 72 IgM and 976 Non-Secretory cases. Results The study confirms the multiple adverse prognostic factors seen in IgD Myeloma. Somewhat surprisingly, patients with IgD and Non-Secretory Myeloma both had higher complete remission rates before and after transplantation than patients with common Myelomas. However, while the overall survival of patients with Non-Secretory Myeloma was similar to that of the patients with common Myelomas, the survival of patients with IgD Myeloma was significantly worse (although better than survival rates reported for Non-transplanted patients); this was due to higher transplant-related mortality and relapse/progression rates. The post-transplantation survival of patients with IgE or IgM Myeloma appears to be very poor. Conclusions This study provides data on the biological features of rare Myelomas. The overall survival of patients with IgD, IgE or IgM Myeloma is poor following autologous transplantation but substantially better than that reported for patients who were not transplanted.

  • Efficacy and outcome of autologous transplantation in rare Myelomas
    'Ferrata Storti Foundation (Haematologica)', 2010
    Co-Authors: Morris C., Drake M., Apperley J., Iacobelli S., Biezen A. Van, Bjorkstrand B., Goldschmidt H., Harousseau J.l., Morgan G., T. De Witte
    Abstract:

    Background As rare Myelomas, i.e. the IgD, IgE, IgM and Non-Secretory forms, constitute only a small proportion of any study, relatively little is known about their prognosis in the era of peripheral stem cell transplantation. Design and Methods We used the European Group for Blood and Marrow Transplantation Myeloma Database to compare the outcome following autologous transplantation of over 20,000 patients with common Myelomas (IgG, IgA and light chain Myeloma) with the outcome of patients with rare Myelomas: 379 IgD, 13 IgE, 72 IgM and 976 Non-Secretory cases. Results The study confirms the multiple adverse prognostic factors seen in IgD Myeloma. Somewhat surprisingly, patients with IgD and Non-Secretory Myeloma both had higher complete remission rates before and after transplantation than patients with common Myelomas. However, while the overall survival of patients with Non-Secretory Myeloma was similar to that of the patients with common Myelomas, the survival of patients with IgD Myeloma was significantly worse (although better than survival rates reported for Non-transplanted patients); this was due to higher transplant-related mortality and relapse/progression rates. The post-transplantation survival of patients with IgE or IgM Myeloma appears to be very poor. Conclusions This study provides data on the biological features of rare Myelomas. The overall survival of patients with IgD, IgE or IgM Myeloma is poor following autologous transplantation but substantially better than that reported for patients who were not transplanted.Development and application of statistical models for medical scientific researc