Second primary malignancies in multiple myeloma: An overview and IMWG consensus

Musto P, Anderson KC, Attal MM, Richardson PG, Badros A, Hou J, Comenzo R, Du J, Durie BGM, San Miguel J, Einsele H, Chen WM, Garderet L, Pietrantuono G, Hillengass J, Kyle RA, Moreau P, Lahuerta JJ, Landgren O, Ludwig H, Larocca A, Mahindra A, Cavo M, Mazumder A, Mccarthy PL, Nouel A, Rajkumar SV, Reiman A, Serra ER, Sezer O, Terpos E, Turesson I, Usmani S, Weiss BM, Palumbo A (2017)

Publication Type: Journal article, Review article

Publication year: 2017

Journal

Book Volume: 28

Pages Range: 228-245

Journal Issue: 2

DOI: 10.1093/annonc/mdw606

Abstract

Background: Therapeutic advancements following the introduction of autologous stem cell transplantation and 'novel' agents have significantly improved clinical outcomes for patients with multiple myeloma (MM). Increased life expectancy, however, has led to renewed concerns about the long-term risk of second primary malignancies (SPMs). This review outlines the most up-to-date knowledge of possible host-, disease-, and treatment-related risk factors for the development of SPMs in patients with MM, and provides practical recommendations to assist physicians. Design: A Panel of International Myeloma Working Group members reviewed the most relevant data published in the literature as full papers, or presented at meetings of the American Society of Clinical Oncology, American Society of Hematology, European Hematology Association, or International Myeloma Workshops, up to June 2016. Here, we present the recommendations of the Panel, based on this literature review. Results: Overall, the risk of SPMs in MM is low, multifactorial, and partially related to the length of patients' survival and MM intrinsic susceptibility. Studies suggest a significantly increased incidence of SPMs when lenalidomide is administered either following, or concurrently with, oral melphalan. Increased SPM incidence has also been reported with lenalidomide maintenance following high-dose melphalan, albeit to a lesser degree. In both cases, the risk of death from MM was significantly higher than the risk of death from SPMs, with lenalidomide possibly providing a survival benefit. No increase in SPM incidence was reported with lenalidomide plus dexamethasone (without melphalan), or with bortezomib plus oral melphalan, dexamethasone, or thalidomide.Conclusion: In general, the risk of SPMs should not alter the current therapeutic decision-making process in MM. However, regimens such as lenalidomide plus dexamethasone should be preferred to prolonged exposure to lenalidomide plus oral melphalan. SPM risk should be carefully discussed with the patient in the context of benefits and risks of different treatment options.

Involved external institutions

Centro di Riferimento Oncologico della Basilicata (CROB) Italy (IT) Dana–Farber Cancer Institute United States (USA) (US) Toulouse Oncopole Cancer University Institute (IUCT-O) / Institut universitaire du cancer de Toulouse Oncopole (IUCT-O) France (FR) University of Maryland United States (USA) (US) Second Military Medical University (SMMU) / 第二军医大学 China (CN) Tufts University United States (USA) (US) Universitätsklinikum Würzburg Germany (DE) University of Turin / Università degli Studi di Torino (UNITO) Italy (IT) Cedars-Sinai Medical Center United States (USA) (US) Clínica Universidad de Navarra Spain (ES) Hôpital Saint-Antoine France (FR) Mayo Clinic United States (USA) (US) Memorial Sloan Kettering Cancer Center United States (USA) (US) Capital University of Medical Sciences / 首都医科大学 China (CN) Ruprecht-Karls-Universität Heidelberg Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Hospital Universitario 12 de Octubre Spain (ES) Wilhelminenspital Austria (AT) University of California San Francisco (UCSF) United States (USA) (US) University of Bologna / Università di Bologna Italy (IT) NYU Langone Medical Center United States (USA) (US) Roswell Park Cancer Institute United States (USA) (US) Memorial Hospitals Group Turkey (TR) National and Kapodistrian University of Athens Greece (GR) Skåne University Hospital / Skånes universitetssjukhus Sweden (SE) Carolinas HealthCare System United States (USA) (US) University of Pennsylvania United States (USA) (US)

How to cite

APA:

Musto, P., Anderson, K.C., Attal, M.M., Richardson, P.G., Badros, A., Hou, J.,... Palumbo, A. (2017). Second primary malignancies in multiple myeloma: An overview and IMWG consensus. Annals of Oncology, 28(2), 228-245. https://doi.org/10.1093/annonc/mdw606

MLA:

Musto, P., et al. "Second primary malignancies in multiple myeloma: An overview and IMWG consensus." Annals of Oncology 28.2 (2017): 228-245.

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