Managing multiple myeloma in the over 70s: a review

A survey study investigating perceptions and acceptance of the whole-body imaging techniques used for the diagnosis of myeloma

INTRODUCTION

The purpose of this study was to investigate patient perceptions and acceptance of the three whole-body imaging (WBI) modalities used for diagnosing myeloma; radiographic skeletal survey (RSS), low-dose whole-body computed tomography (LD-WBCT) and whole-body magnetic resonance imaging (WB-MRI). The secondary aim was to explore the factors affecting the acceptance of whole-body imaging for myeloma.

METHODS

60 participants (median age = 58.5 years old) recruited from three NHS trusts and social media completed a survey in which they scored their experiences of each WBI modality on nine 5-point rating scales. Spearman's correlation coefficient, Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were used to compare scores between different WBI techniques. Participants were invited to provide additional open text responses for interpretation using thematic analysis.

RESULTS

All modalities demonstrated high levels of acceptability (median score = 4). WB-MRI was perceived as more stressful (p=<0.01) and claustrophobic (p=<0.01) than RSS and LD-WBCT. Thematic analysis showed patients understood the importance of imaging but had concerns about exacerbated pain and the results. WB-MRI was difficult to tolerate due to its duration. Respondents were averse to the physical manipulation required for RSS while remaining stationary was perceived as a benefit of LD-WBCT and WB-MRI. Staff interactions had both positive and negative effects on acceptance.

CONCLUSIONS

Despite the psychological and physical burdens of WBI, patients accepted its role in facilitating diagnosis. Staff support is vital for facilitating a positive whole-body imaging experience. Healthcare practitioners can improve WBI acceptance by understanding the burdens imposed by WBI and adopting the personalised care model.

IMPLICATIONS FOR PRACTICE

Patient experience can be improved by tailoring examinations to individual needs. RSS can be as burdensome as other WBI techniques and could be superseded by LD-WBCT or WB-MRI.

Multiple myeloma, race, insurance and treatment

PURPOSE

Multiple Myeloma (MM), the second leading blood malignancy, has complex and costly disease management. We studied patterns of treatment disparities and unplanned interruptions among the MM patients after the Affordable Care Act to assess their prevalence and effect on survival.

MATERIALS AND METHODS

This retrospective study of 1002 MM patients at a tertiary referral center used standard guidelines as a reference to identify underuse of effective treatments. We used multivariate logistic regression and Cox proportionate hazard to study the prognostic effect on survival.

RESULTS

Median age in the cohort was 63.0 [IQR: 14] years. Non-Hispanic White (NHW) patients were older (p = 0.007) and more likely to present with stage I disease (p = 0.02). Underuse of maintenance therapy (aOR = 1.98; 95 % CI 1.12-3.48) and interruptions in treatment were associated with race/ethnicity and insurance (aOR = 4.14; 95 % CI: 1.78-9.74). Only underuse of induction therapy was associated with overall patient survival.

CONCLUSION

Age, race, ethnicity and primary insurance contribute to the underuse of treatment and in unplanned interruptions in MM treatment. Addressing underuse causes in such patients is warranted.

Effect of comprehensive nursing intervention on constipation in patients with prenatal hemorrhage due to central placenta previa

AIM

To evaluate the effect of comprehensive nursing intervention on constipation in patients with prenatal hemorrhage due to central placenta previa.

METHODS

A total of 60 patients with constipation and prenatal hemorrhage due to central placenta previa treated at Xinchang County People's Hospital from February 2015 to February 2018 were selected and divided into a control group (30 cases) and an observation group (30 cases). Both groups were given routine nursing intervention, and the observation group was additionally given comprehensive nursing intervention. The constipation symptom and efficacy evaluation scale was used to evaluate the improvement of constipation symptoms before and after nursing. The Patient Assessment of Constipation Symptom (PAC-SYM) was used to evaluate the self-perception of both groups before and after nursing. The Patient-Assessment of Constipation Quality Of Life (PAC-QOL) was used to evaluate the quality of life before and after care in the two groups of patients, and to compare the effect of nursing care on the relief of constipation symptoms.

RESULTS

After nursing, the scores of defecation, excessive bowel movement, stool characteristics, defecation time, frequency of defecation, bloating, falling, and indefiniteness after nursing were significantly lower in both groups than the scores before nursing (P < 0.05). The constipation symptoms in the observation group and the improvement of curative effect were significantly better than that of the control group (P < 0.05). The PAC-SYM scores of fecal traits, rectal symptoms, and abdominal symptoms in both groups were lower than the scores before nursing (P < 0.05). The improvement of PAC-SYM score was significantly better in the observation group than in the control group (P < 0.05). The PAC-QOL scores of post-care physiology, anxiety, social psychology, and satisfaction were significantly lower in both groups than the scores before care (P < 0.05). The PAC-QOL scores after nursing care were significantly lower in the observation group than in the control group (P < 0.05).

CONCLUSION

Comprehensive nursing intervention can effectively relieve constipation symptoms in patients with prenatal hemorrhage due to central placenta previa and improve their quality of life.

MMSA-1 expression pattern in multiple myeloma and its clinical significance

Multiple myeloma-associated antigen-1 (MMSA-1) is a novel multiple myeloma (MM)-associated antigen which has been recently identified. Herein, we have tried to examine its clinical significance by studying the relationship between its expression and selected clinicopathological features. We extracted mononuclear cells from the bone marrow of MM patients and healthy donors and compared the MMSA-1 expression by RT-PCR and Western blot analysis. In addition, we also analyzed MMSA-1 expression in patients that were grouped based on selected clinical parameters. Moreover, the impact of MMSA-1 on patients' survival was also explored. MMSA-1 mRNA and protein were significantly upregulated in MM patients in comparison with healthy donors. Moreover, among the newly diagnosed and relapsed/refractory patients, the MMSA-1 expression was higher in relapsed/refractory patients. In addition, MMSA-1 mRNA expression not only showed significantly higher correlation with clinical parameters such as age, Durie and Salmon stage, bone lesion condition, albumin, creatinine and lactate dehydrogenase but also has a close relationship with myeloma bone disease-related cytokines, genetic abnormalities and treatment response. Multivariate COX analysis predicted MMSA-1 and LDH levels to be independently associated with a poor progression-free survival and overall survival in myeloma patients. Our findings provide initial proof of concept that MMSA-1 is a potent gene that is specifically expressed in MM patients and could be a feasible biomarker and independent prognostic factor.

Autologous haematopoietic cell transplantation in elderly patients with multiple myeloma

High-dose chemotherapy with melphalan followed by autologous haematopoietic cell transplantation (AHCT) is a standard of care in young patients (<65 years) with multiple myeloma. Most myeloma patients, however, are older than 65 years at the time of diagnosis, and the findings of numerous single-centre and registry studies provide evidence that AHCT can be a feasible and effective treatment option in these patients. Nevertheless, AHCT is not generally recommended as standard treatment in the elderly, due to the fact that a benefit of AHCT over conventional-dose therapy has not been demonstrated by prospective randomized trials. Yet, the use of AHCT has increased substantially in older patients in recent years, and an increasing number of reports suggest comparable outcomes for older and younger patients after AHCT. In this review we summarize the results of AHCT for elderly patients with multiple myeloma.