Major Diagnostic Criteria

Transcription

1 Multiple Myeloma Elizabeth Ann Coleman, PhD, RNP, AOCN Professor and Chair, Dept. of Nursing Science Cooper Chair in Oncology Nursing, College of Nursing Professor, Dept. of Internal Medicine, College of Medicine University of Arkansas for Medical Sciences, Little Rock, AR

2 Major Diagnostic Criteria Plasmacytoma on tissue biopsy Bone marrow plasmacytosis with > 30% plasma cells Monoclonal globulin spike on serum electrophoresis > 1.0 gm/24 hr kappa or lambda light chain excretion on urine electrophoresis

3 Minor Diagnostic Criteria Bone marrow plasmacytosis 10-30% Monoclonal globulin spike Lytic bone lesions

4 Supporting Non-specific Disease Anemia Features Hypercalcemia Azotemia Demineralization and compression fractures Hypoalbuminemia

5 Staging Criteria for Stage I, II or III Stage I Stage II Stage III Tumor Mass low intermediate high Hemoglobin > 10.5 gm% < 8.5 gm% Serum Calcium normal > 12 mg% Serum myeloma protein < 5 gm% > 7 gm% Bence Jones protein < 4 gm > 12 gm/24 hr Bone Lesions None > 3 lytic lesions

6 Renal Substage A good function (creatinine < 2 mg %) B poor function (creatinine > 2 mg %)

7 Chromosomal Status at Diagnosis Normal Abnormal 13/hypodiploidy Abnormal other Shaughnessy, 2006

8 Goal of Treatment: Complete Response Absence of M-components in serum and urine Adequate cellular bone marrow Normal serum calcium No new bone lesions or enlargement of existing lesions Requires a minimum of 2 months May be critical to improving long-term survival

9 Response Categories Complete response Near complete response Response Stable disease Progression Relapse Partial response Improvement

10 Goal of Treatment Image not available Barlogie, 2006

11 Goal of Treatment Improve quality of life Supportive care is important

12 Standard Care: Old Dexamethasone or Vincristine, doxorubicin and dexamethasone Melphalan and prednisone or Vincristine, Carmustine, Melphalan, cyclophosamide and prednisone

13 Standard Care: New

14 Emerging Therapies

15 Total Therapy III Velcade up front with thalidomide with high dose melphalan and tandem PBCS transplants

16 Total Therapy III Specifics Induction with VDTPACE (Velcade, dexamethasone, thalidomide, Platinol, Adriamycin, Cytoxan, etoposide) Melphalan (Alkeran) 200mg/m2 and Transplant x2 Consolidation with VDTPACE

17 VDTPACE Induction Reduce Velcade dose for painful peripheral neuropathy or if interferes with ADLs Discontinue dexamethasone for severe GI bleed or severe DM Reduce Thalidomide dose for grade 3-4 toxicity

18 VDTPACE Induction Hold PACE chemotherapy if ANC < 500 or platelets < 70,000 Hold Platinol if serum creatinine > 2 mg/dl Reduce Adriamycin by 50% for hepatic dysfunction

19 Melphalan x mg/m 2 followed by peripheral stem cell transplant for each treatment For patients > 70 years of age or with serum creatinine > 3 mg/dl, reduce Melphalan to 140 mg/m2

20 Maintenance Velcade, Thalidomide, dexamethasone for one year Thalidomide and dexamethasone for two more years

21 Gene Expression Profiling Identify high risk patients Individualize treatments Shaughnessy, 2006

22 Immunotherapy 56 hi CD56 Cytokine Secreting NK cells CD3 56 lo Cytotoxic NK cells Van Rhee, 2006

23 First Trial of NK-cell Therapy in Myeloma NK Cells Delayed AutoTx days FLUDARA+ DEX + MEL Daily IL-2 Enrolled 8 patients with advanced disease who had: High risk cytogenetics or gene expression profile Relapse after transplant Van Rhee, 2006

24 Supportive Care

25 Pharmaceuticals Growth factors: G-CSF, Epoetin alfa Anticoagulants: Lovenox Bisphosphonates; pamidormate (Aredia)

26 Effects of Exercise on Cancer Related Insomnia and Fatigue Elizabeth Ann Coleman, PhD, Sharon K. Coon, PhD, Kathy Richards, PhD, Elias J. Anaissie, MD, Bart Barlogie, MD, PhD, Carol B. Stewart, BS, Robert Kennedy, PhD, Kimblerly Lockhart, BS, Paula McNatt, LPN University of Arkansas for Medical Sciences; Little Rock, AR, USA Funded by: National Institutes of Health/NINR and OrthoBiotech, Inc.

27 UAMS Campus

28 Objective To compare usual care with a home based individualized exercise program (HBIEP) incorporating aerobic and strength resistance training on fatigue, nighttime sleep, and performance in patients receiving intensive treatment for MM and epoetin alfa therapy

29 Inclusion Criteria Newly diagnosed MM Enrolled in Total Therapy III Able to exercise

30 Study Design 15-week experimental period Measurements at 3 time points: enrollment in the transplant protocol Before 2 nd chemotherapy Before 1 st transplant Plan to enroll 200 patients

31 Types of Exercises Images not available

32 Actigraph Images not available

33 Sleep Patterns Mean No. of Minutes of Nighttime Sleep HBIEP n=56 Usual Care n=66 n=61 n=58 n=68 n=57 T1 T2 T3 Assessment HBIEP, home-based individualized exercise program.

34 Dynamometer Images not available

35 Weight Lifted, Pounds n=40 HBIEP Usual Care Pounds n=37 n=41 n= T1 Assessment T2 *Due to lifting restrictions, the sample size is small; therefore, only the results of T1 and T2 are reported. HBIEP, home-based individualized exercise program.

36 6-Minute Walk Test Mean No. of Feet Walked in 6 Minutes n=66 n=68 n=56 n=61 n=51 n=51 T1 T2 T3 Assessment HBIEP Usual Care HBIEP, home-based individualized exercise program.

37 Exercise Effects Exercise group was able to do significantly more of usual personal care/hygiene activities throughout the study with similar difficulty level 94% vs. 86% (p =.03)

38 References Additional references not on handout: Barlogie, et al., New England Jouranl of Medicine, 2006;354;10: Tariman, J.D., Oncology Nursing Forum, Nov. 2005;32(6)

39 Thank you!