ONJ Osteonecrosis of the jaw

Osteonecrosis of the jaw in patients with multiple myeloma treated with zoledronic acid.

Cetiner S, Sucak GT, Kahraman SA, Akı SZ, Kocakahyaoglu B, Gultekin SE, Cetiner M, Haznedar R.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey.

Intravenous bisphosphonates-the potent inhibitors of osteoclast-mediated bone resorption are among the most commonly prescribed drugs in the management of multiple myeloma (MM). Zoledronic acid (ZA) is a new generation potent intravenous bisphosphonate that has been approved for the treatment and prevention of bone lesions, and/or hypercalcemia associated with MM. Osteonecrosis of the jaw (ONJ) is an emerging serious side effect of the new generation bisphosphonates with a growing number of reports related to this pathological entity. ONJ usually appears following oral surgical and dental procedures but sometimes occur spontaneously. These cases are mostly seen and treated by dentists and oral surgeons. The aim of this study was to discuss the frequency, characteristics, risk factors, management and histopathological features of ZA induced ONJ based on the literature and illustrated with five own cases. Thirty-two patients with MM who received ZA for a median period of 26.5 +/- 18.7 months (min: 5 months, max: 76 months) were evaluated. ONJ was detected in five patients and mean drug duration time was 34 months. The frequency was 15% and the patients were usually symptomatic. There was no significant difference in terms of the duration of ZA in patients with and without ONJ. Management of these established cases were performed with medical treatment, minor debridement, sequestrectomy, and combining bone resection with autologous platelet rich plasma. Our data indicate that ZA therapy has a major role in the development of ONJ a fact that should be considered by physicians treating MM patients.

Elderly Multiple Myeloma Patients

New generation pharmacotherapy in elderly multiple myeloma patients.

Ataergin SA, Kindwall-Keller T, Berger NA, Lazarus HM.

Gulhane (GATA) Faculty of Medicine Department of Medical Oncology and Bone Marrow Transplantation Unit, 06018, Etlik, Ankara, Turkey.

BACKGROUND: Observational databases have demonstrated that the overall prognosis of multiple myeloma patients has markedly improved over the past decade, yet the greatest strides have been attained in younger rather than older patients. OBJECTIVE: To review recent clinical trials that include new generation agents (thalidomide, lenalidomide and bortezomib) and autologous stem cell transplantation in older multiple myeloma patients. RESULTS: Conventional regimens such as melphalan plus prednisone can be improved with the addition of thalidomide or bortezomib: more patients attain complete and near-complete remission, and progression-free survival rates are nearly doubled. In addition, autologous hematopoietic stem cell transplantation studies show that this treatment approach can be used successfully in selected older myeloma patients in whom the toxicity profile of autotransplant and resulting overall survival may be similar to that obtained in the younger patient group. CONCLUSIONS: In the advanced-age population, implementation of new therapies results in significant benefits in older as well as younger patients.

Emerging Therapies for Multiple Myeloma

Emerging therapies for multiple myeloma.

Podar K, Tai YT, Hideshima T, Vallet S, Richardson PG, Anderson KC.
Dana-Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Boston, MA 02115, USA. klaus_podar@dfci.harvard.edu

Multiple myeloma (MM) is a clonal plasma cell malignancy clinically characterized by osteolytic lesions, immunodeficiency, and renal disease. There are an estimated 750,000 people diagnosed with MM worldwide, with a median overall survival of 3 - 5 years. Besides chromosomal aberrations, translocations, and mutations in essential growth and tumor-suppressor genes, accumulating data strongly highlight the pathophysiologic role of the bone marrow (BM) microenvironment in MM pathogenesis. Based on this knowledge, several novel agents have been identified, and treatment options in MM have fundamentally changed during the last decade. Thalidomide, bortezomib, and lenalidomide have been incorporated into conventional cytotoxic and transplantation regimens, first in relapsed and refractory and now also in newly diagnosed MM. Despite these significant advances, there remains an urgent need for more efficacious and tolerable drugs. Indeed, a plethora of preclinical agents awaits translation from the bench to the bedside. This article reviews the scientific rationale of new therapy regimens and newly identified therapeutic agents - small molecules as well as therapeutic antibodies - that hold promise to further improve outcome in MM.

PMID: 19249983 [PubMed - in process

MULTIPLE MYELOMA FACT SHEET

What is multiple myeloma?

Multiple myeloma is an incurable yet treatable cancer of the blood in which plasma cells are overproduced in the bone marrow. Plasma cells are a type of white blood cell found in bone marrow that produces the antibodies to help the body fight infections.[i] Multiple myeloma occurs when abnormal cells develop in the bone marrow and divide uncontrollably, eventually crowding out healthy blood cells. Over time these cells can spread to the solid part of the bone, causing fractures and pain.

Fast Facts

Multiple myeloma is the second most prevalent blood cancer after non-Hodgkin's lymphoma and accounts for 1.3 per cent of all new cancer cases in Canada and 1.9 per cent of all cancer deaths.[ii]

According to the most recent Canadian Cancer Society statistics, of the approximately 6,000 Canadians living with the disease, about 1,350 will die this year and 2,100 new patients will be diagnosed across Canada.

Once considered a disease of the elderly, the average age at diagnosis of people with multiple myeloma is the early 60s, with many patients much younger.
Multiple myeloma affects slightly more men than women.

Causes and risk factors

Despite the tremendous amount of work that has gone into the search into the cause of myeloma, to date no cause of this disease has been identified. However, a possible link between exposure to chemicals, pollutants, radiation, or other environmental risk factors and a greater risk of developing myeloma has been suggested.[iii] In most cases, individuals who develop multiple myeloma have no clear risk factors.

Symptoms and diagnosis

There are often no symptoms in the early stages of myeloma. In some cases, myeloma may be discovered by accident during routine blood testing. When present, symptoms may be vague and similar to those of other conditions.

The growth of malignant plasma cells in the bone marrow crowd out healthy blood cells and impact the body in a number of ways, including:

• Producing fewer red blood cells, which can result in anemia and fatigue;
• Suppressing healthy white blood cell production, which can lead to recurrent infections;
• Attacking and weakening of bones, which may lead to osteoporosis and result in considerable pain and potential fractures;
• Affecting normal kidney and nerve functions.

Because myeloma is a very complex disease, patients may experience all or none of the above symptoms. The diagnosis of multiple myeloma is often made by way of a routine blood test for other conditions. The existence of anemia and a high serum protein may suggest further testing.[iv]

[i] Canadian Cancer Society. What is multiple myeloma? Available online at:

http://www.cancer.ca/Ontario/About%20cancer/Types%20of%20cancer/What%20is%20multiple%20myeloma.aspx?sc_lang=en Accessed February 17, 2009.

[ii] Myeloma Canada: Cause and Incidence; http://www.myelomacanada.ca/en/incidence_prevalence.htm?t=1 Accessed February 17, 2009.

[iii]Myeloma Canada. Stronger together. (pamphlet). Fall 2008.

[iv] Myeloma Canada. Diagnosis. Available online at: http://www.myelomacanada.ca/en/diagnosis.htm Accessed on February 17, 2009.

ANGUS REID POLL RESULTS: CANADIANS ON CANCER

A SURVEY OF PRECEPTIONS AND ATTITUDES OF CANADIANS TOWARD CANCER AND ACCESS TO MEDICATIONS

SUMMARY OF FINDINGS

KEY FINDINGS
A recent national survey shows that Canadians are divided on how confident they are about having access to the necessary medications, if they were diagnosed with cancer. In fact, 43% of respondents indicated they were not confident that they would have access to the cancer medications they would need.

· Although they are divided in their confidence about having access to the necessary cancer medications, Canadians are optimistic in that they tend to see cancer as something you can live with (64%), as opposed to something you will necessarily die from.

· Greater access to cancer treatments ranked second only to reduced wait times among a list of four potential priorities for government health care spending.

· After being told about the current public insurance coverage for cancer treatments in Canada, the vast majority of Canadians (86%) stated that provincial government programs should pay for all cancer medications approved by Health Canada for those eligible - even if it meant a re-allocation of health care dollars. 84% of respondents felt that all of the provincial governments should have a common list of cancer drugs that they cover instead of having different coverage lists in each province.

· Very few (15%) correctly identify multiple myeloma as a blood cancer. A third (33%) mistakenly identified it as a type of skin cancer and another third (36%) admitted to not knowing what it is.


SURVEY METHODOLOGY

The findings reflect results of a nationwide online survey of adult Canadians conducted by Angus Reid Strategies on behalf of Myeloma Canada. The study was conducted among a randomly selected, representative sample of 1,002 adult Canadians. Below is the breakdown by region:
· British Columbia: n=140
· Alberta: n=123
· Manitoba/Saskatchewan: n=63
· Ontario: n=356
· Quebec: n=224
· Atlantic: n=96

The data were collected between November 14 and 16, 2008. The margin of error for results based on the total sample of 1,002 is +/- 3.1%, 19 times out of 20. Results have been statistically weighted according to Statistics Canada’s most current education, age, gender and region Census data to ensure a representative sample of the entire adult population of Canada.

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For more information, please contact:
Rosalind O’Connell
Hill & Knowlton Canada
(416) 413-4773
rosalind.oconnell@hillandknowlton.ca

Myeloma Canada's Post-ASH Myeloma Web Conference

THE POST-ASH MYELOMA WEBINAR IS HAPPENING A WEEK FROM TODAY: FEBRUARY 18

IF YOU HAVE NOT YET REGISTERED, CLICK ON THE LINK BELOW TO COMPLETE THE ONLINE REGISTRATION FORMREGISTRATION IS FREE

DON’T MISS OUT ON THIS UNIQUE OPPORTUNITY TO LEARN ABOUT THE LATEST RESEARCH AND ADVANCES IN THE TREATMENT OF MYELOMA

http://www2.eventsvc.com/myeloma/021809

In its continuing efforts to provide valuable information and updates to the Canadian myeloma community, Myeloma Canada is presenting a national web conference (webinar) highlighting the advances in myeloma research presented at the recent American Society of Hematology (ASH) meeting held in San Francisco.

The annual ASH meeting is the most important international gathering of clinicians and scientists where the latest research findings in the management of multiple myeloma and other blood disorders are presented and discussed.

Dr Christine Chen of the Princess Margaret Hospital in Toronto and member of Myeloma Canada’s Scientific Advisory Board, will lead the presentation. A 30-minute question and answer session will follow.

Date
Wednesday, February 18, 2009

Time
British Columbia & Yukon: 4:00 pm (Pacific)
Alberta: 5:00 pm (Mountain)
Saskatchewan & Manitoba: 6:00 pm
(Central)Ontario & Quebec: 7:00 pm
(Eastern)Maritimes & Labrador: 8:00 pm
(Atlantic)Newfoundland: 8:30 pm

Requirements
Telephone
Computer
Internet connection

Registration
Registration is free. You are required to register in order to receive the toll-free call-in number and participate in the conference.Simply click on the following link to complete the online registration form.

http://www2.eventsvc.com/myeloma/021809

You are invited to pass this information along to anyone who would benefit from the information that will be presented in the webinar.

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Caring Voices Website

Caring Voices is an online community for cancer survivors. You can use this site to access current resources, learn about upcoming survivorship events, take part in chats and discussions and meet other survivors just like you. Below is this week's schedule of events. To use this site you need to register as a user and it is well worth your while to register. Ed.

Please join us this week on http://www.caringvoices.ca/

Managing Your Fatigue with Renewed Strength
This event is hosted by the General Cancer community.
Date/Time: January 06, 2009 at 8:00 PM EST Duration: 1hrs

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Join Dee Miller, personal trainer and founder of Renewed Strength to discuss how strength and mobility training can help you manage some of the side effects of your cancer treatment. Renewed Strength is a non profit company dedicated to providing strength and mobility training to individuals that have recently gone through cancer treatments such as radiation, chemotherapy and surgery. Radiation Therapy: Your Questions, Before, During and After Treatment, Moderator: Dee Miller.

This event is hosted by the Breast Cancer community.
Date/Time: January 07, 2009 at 12:00 PM EST Duration: 1hrs

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Do you have questions relating to radiation therapy treatment for breast cancer? Or perhaps you would like to share your radiation therapy experience with other breast cancer survivors who are about to begin or have started their treatments? Please join this open chat about Radiation Therapy treatments for Breast Cancer with Shannon Pearson, Clinical Specialist Radiation Therapist.
Moderators: Shannon Pearson
And Looking Ahead . . . . . .Talking Sticks: Meet other Survivors Online

This event is hosted by the Breast Cancer community.
Date/Time: January 13, 2009 at 8:00 PM EST Duration: 1hrs

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Join this open chat for breast cancer survivors who have something they want to talk about or who just want to chat with others who understand their past, present or future experiences.
Moderators: Karen Portelli Spirituality and Cancer

This event is hosted by the General Cancer community.
Date/Time: January 14, 2009 at 12:00 PM EST Duration: 1hrs

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"Spirituality is that part of each individual that longs for meaning, integrity, beauty, dignity, love, acceptance and hope." For many, a diagnosis of cancer brings these themes to the surface in a way they may not have been experienced before. Some have experienced attention to spirituality and it's many expressions to be a foundational resource to cope with life's challenges. You're welcome to join in a time of reflection and discussion regarding that which may have been a support or a challenge to you, personally, in the area of spirituality, and to learn from the experiences of others.

Moderators: Sharon Konyen
A special event in collaboration with Wellspring!Putting Yourself First

This event is hosted by the General Cancer community.
Date/Time: January 14, 2009 at 7:30 PM EST Duration: 1.5hrs.

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With a cancer diagnosis, the need to put yourself first can be a change and a challenge. Join us to discuss various self-care strategies and how to cope with demands and expectations (including saying 'no') in order to create a space for healing. Moderator: Paula Servin, MSW, RSW.Presented on behalf of Wellspring Cancer Support Centres, http://www.wellspring.ca/

Moderators: Paula Servin
Talking Sticks: Open Chat for Survivors

This event is hosted by the Breast Cancer community.
Date/Time: January 16, 2009 at 12:00 PM EST Duration: 1hrs

Join this open chat for breast cancer survivors who have something they want to talk about or who just want to chat with others who understand their past, present or future experiences.
Moderator: Fiorella Lubertacci