However, in the case of multiple myeloma, the plasma cells so produced are not able to effectively perform their function, thus, the risk of infection in patients suffering from multiple myeloma increases.
The malignant plasma cells produce the M-protein, a higher level of which is the characteristic feature of few diseases including multiple myeloma. The immune system is at a low level even when the number of antibodies present in the blood is high. This is due to the reason that these antibodies are secreted by malignant cells and are not effective in providing any sort of protection.
The proteins secreted by the cancerous cells affect the other organs such as kidney leading to kidney failure. The condition cannot be cured but can be transformed into a remission state.
The aim of the therapy is to slow the progression of the disease and to keep the disease in remission stage. Myelodysplastic syndrome is a type of blood disorder in which the immature cells originated from the stem cells fails to get matured. Thus, the number of all the matured cells, i. The condition can be treated permanently though stem cell transplant; however, this option is not available to all the patients due to certain restrictions attached to it.
The lower rates of myelosuppression in these patients may reflect a different mechanism of action of lenalidomide in the non-del 5q state. In summary, while the erythroid responses seen in these patients were not as profound or as durable as those with the del 5q , there is a clinical utility for lenalidomide in patients with transfusion-dependent low-risk MDS without this karyotype abnormality.
Further clinical trials are under way or in planning to test the efficacy of lower doses of lenalidomide for MDS and also the use of lenalidomide in combination with erythropoietin. Conclusion Immunodulatory drugs have been shown to provide strong, durable responses for a high proportion of patients with MM and MDS, and in the case of MM have been shown to increase overall survival.
The side effects of myelosuppression can be managed with growth factors such as G-CSF, and the risk of venous thrombosis is greatly reduced with the use of prophylactic aspirin or other anticoagulation. The main question of whether lenalidomide or thalidomide could be used in place of autologous stem cell transplant for MM remains to be determined with clinical trials. However, patients who cannot tolerate this procedure can be treated with excellent results with combinations of low-dose lenalidomide or thalidomide with standard agents such as melphalan plus prednisone.
There is no doubt that lenalidomide is a powerful agent for use in MDS with interstitial deletion of the long arm of chromosome 5, whether it is isolated or in conjunction with more complex karyotypes. The robust response rate and durable freedom transfusions have made this drug a first choice for treatment of this condition. Lenalidomide has also shown activity, to a lesser extent, in non-del 5q -containing MDS as well, and potentially works through a different mechanism of action.
One caveat is that the trials of lenalidomide in MDS have all been performed mostly in patients with prognostically favorable low to intermediate-1 IPSS scores, and caution should be used if treating patients with higher-grade MDS. As more clinical studies are conducted with lenalidomide and other IMiDs for MM and the MDS, we should expect that these drugs will become an important part of the therapeutic armamentarium of the hematologist treating malignant diseases.
The pleiotropic action of IMiDs provides a basis for understanding the complex pathophysiology underpinning MM and MDS, and hopefully will help elucidate the main transforming events for these diseases in the future. Acute lymphoblastic leukaemia ALL is a group of malignant haematological disorders characterised by accumulation of lymphoid cell precursors that replace normal bone marrow elements and inhibit the production of functional blood cells.
Acute myeloid leukaemia AML is a complex and heterogeneous disease characterised by a multitude of molecular abnormalities. Better understanding of the mutational landscape has resulted in the development of targeted treatments in the last decade. Chronic lymphocytic leukemia, diffuse large B-cell lymphoma, and follicular lymphoma are the three most common lymphoproliferative malignancies. The standard first-line therapy is rituximab and combination chemotherapy, usually the CHOP cyclophosphamide, doxorubicin, vincristine, and […].
Quick Links:. Article Information. CA Cancer J Clin, ;— Progress in the knowledge of how a particular type of myelodysplastic syndrome MDS is produced. This other scientific paper, published this trimester in the prestigious journal Cancer Cell by a team of scientists from American and Spanish institutions, including the Josep Carreras Leukaemia Research Institute have identified the precise mechanism involved in some cases of MDS 5q- Syndrome.
This discovery could be used in the future to develop a possible disease therapy. The cellular study, in this case, has prepared the way for the delicate task of finding a new drug that is safe and effective for people. The coordination of this project has been carried out by the group of Dr. Benjamin Ebert in Boston and by the group of Dr. Under the name myelodysplastic syndromes or MDS there are a number of diseases whose common feature is that stem cells, the cells responsible for producing all blood cells, have a defect that makes them produce abnormal cells which are unable to perform their normal functions.
This type of MDS rarely transforms to leukaemia and treatment is regular observation or blood transfusion only. Red blood cells are affected, causing anaemia. Read more here. Similar to RA, but in this case the red blood cells are unable to process the iron that normally goes into making haemoglobin, the oxygen-carrying component of the red cell. Instead the iron granules are deposited in a way that forms a ring around the nucleus of a developing red blood cell — this is called a ringed sideroblast.
One or more blood cell types are affected. There is a greater likelihood of transforming to acute myeloid leukaemia. These are a group of diseases that have characteristics of both myelodysplastic abnormal bone marrow cells producing too few blood cells and myeloproliferative abnormal bone marrow cells producing too many blood cells neoplasms.
Overall, MDS is relatively uncommon, with an incidence of between four to five per , of the population. However, in patients over the age of 60, this increases to anything from 20 to 50 per , It is therefore one of the more common haematological disorders in the elderly.
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