Second primary malignancies in multiple myeloma: an overview and IMWG consensus (https://www.myeloma.org/imwg/second-primary-malignancies-multiple-myeloma)

This document discusses the risk of second primary malignancies (SPMs) in patients with multiple myeloma (MM) and the impact of different therapies on SPM development. ​ The risk of SPMs in MM is influenced by both host-related and disease-related factors. ​ Host-related risk factors include older age, male sex, ethnicity, genetics, and prior or synchronously different malignancies (PSMs). ​ Disease-related risk factors include adverse cytogenetics, advanced disease stage, and certain MM subtypes. ​ Prolonged exposure to melphalan has been associated with an increased risk of hematologic SPMs, particularly MDS/AML. ​ Lenalidomide administration, either following or concurrently with oral melphalan, is associated with an increased incidence of SPMs. ​ Lenalidomide maintenance following high-dose melphalan also increases the risk, although to a lesser degree. ​ On the other hand, lenalidomide plus dexamethasone (without melphalan) and bortezomib plus oral melphalan, dexamethasone, or thalidomide do not increase the incidence of SPMs. ​ The risk of SPMs should not alter the current therapeutic decision-making process in MM. ​​ The risk of death from MM is higher than the risk of death from SPMs when lenalidomide is used, suggesting a survival benefit. ​ However, the risk of SPMs should be carefully discussed with the patient in the context of the benefits and risks of different treatment options. ​ Population-based studies have generally found no overall increase in SPM risk among patients with MM. ​ However, an augmented incidence of MDS, AML, and NHL has been observed. ​ The estimated overall risk of SPMs in MM is relatively small, ranging from 1% to 10%. ​ Well-designed, registry-based, population studies with long follow-up may be more effective in determining therapy-associated SPM risk than some randomized trials. ​

Important Points:

  1. Host-related risk factors for SPMs in MM include older age, male sex, ethnicity, genetics, and prior or synchronously different malignancies (PSMs). ​
  2. Disease-related risk factors for SPMs in MM include adverse cytogenetics, advanced disease stage, and certain MM subtypes. ​
  3. Prolonged exposure to melphalan increases the risk of hematologic SPMs, particularly MDS/AML. ​
  4. Lenalidomide administration, either following or concurrently with oral melphalan, is associated with an increased incidence of SPMs. ​
  5. Lenalidomide maintenance following high-dose melphalan also increases the risk of SPMs, although to a lesser degree. ​
  6. Lenalidomide plus dexamethasone (without melphalan) and bortezomib plus oral melphalan, dexamethasone, or thalidomide do not increase the incidence of SPMs. ​
  7. The risk of SPMs should not alter the current therapeutic decision-making process in MM. ​​
  8. The risk of death from MM is higher than the risk of death from SPMs when lenalidomide is used, suggesting a survival benefit. ​
  9. The risk of SPMs should be carefully discussed with the patient in the context of the benefits and risks of different treatment options. ​
  10. Population-based studies have generally found no overall increase in SPM risk among patients with MM. ​
  11. An augmented incidence of MDS, AML, and NHL has been observed in MM patients. ​
  12. The estimated overall risk of SPMs in MM is relatively small, ranging from 1% to 10%. ​
  13. Well-designed, registry-based, population studies with long follow-up are effective in determining therapy-associated SPM risk. ​

 

Authors:

P. Musto K. C. Anderson M. Attal P. G. Richardson A. Badros J. Hou R. Comenzo J. Du B. G. M. Durie J. San Miguel H. Einsele W. M. Chen L. Garderet G. Pietrantuono J. Hillengass R. A. Kyle P. Moreau J. J. Lahuerta O. Landgren H. Ludwig A. Larocca A. Mahindra M. Cavo A. Mazumder P. L. McCarthy A. Nouel S. V. Rajkumar A. Reiman E. R. Serra O. Sezer E. Terpos I. Turesson S. Usmani B. M. Weiss A. Palumbo on behalf of the International Myeloma Working Group

Learn more at:

Annals of Oncology, Volume 28, Issue 2, 1 February 2017, Pages 228–245, (https://academic.oup.com/annonc/article/28/2/228/2676895)
https://doi.org/10.1093/annonc/mdw606 (https://academic.oup.com/annonc/article/28/2/228/2676895)

click here to view article (https://academic.oup.com/annonc/article/doi/10.1093/annonc/mdw606/2676895/Second-primary-malignancies-in-multiple-myeloma-an)
Source URL: https://www.myeloma.org/imwg/second-primary-malignancies-multiple-myeloma