Second primary malignancies in multiple myeloma: an overview and IMWG consensus
P Musto 1 , K C Anderson 2 , M Attal 3 , P G Richardson 2 , A Badros 4 , J Hou 5 , R Comenzo 6 , J Du 5 , B G M Durie 7 , J San Miguel 8 , H Einsele 9 , W M Chen 10 , L Garderet 11 , G Pietrantuono 12 , J Hillengass 13 , R A Kyle 14 , P Moreau 15 , J J Lahuerta 16 , O Landgren 17 , H Ludwig 18 , A Larocca 19 , A Mahindra 20 , M Cavo 21 , A Mazumder 22 , P L McCarthy 23 , A Nouel 24 , S V Rajkumar 14 , A Reiman 25 , E Riva 26 , O Sezer 27 , E Terpos 28 , I Turesson 29 , S Usmani 30 , B M Weiss 31 , A Palumbo 19 , International Myeloma Working Group
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.
CITA DEL ARTÍCULO Ann Oncol. 2017 Feb 1;28(2):228-245.