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- Myeloma: Diagnosis and Management.
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- Chapter 1. Communication and support
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NCBI Bookshelf. Myeloma: Diagnosis and Management. The specific information and support needs of patients with myeloma and their families and carers at diagnosis and treatment planning, and during and after treatment including end of life care. What are the specific information and support needs of patients with myeloma and their families and carers?
View in own window. The evidence suggests that the unmet information needs of myeloma patients are low, and patients are generally satisfied with the information they receive. The most common unmet information needs surrounded the need for patients to know more about their future prognosis and include the cause and course of disease as well as side effects and long-term effects of treatment. However there were some patients who found experiential information unhelpful or even harmful.
Evidence from one study on palliative care demonstrated that information on palliative care was not easily available and most patients who were aware of palliative care gained their information from personal experiences they had in the past. There was a contrast between some participants wanting early discussions on palliative care and some only wanting information when needed. With regards to support needs the evidence suggests that the majority of the unmet support needs of myeloma patients are emotional and psychosocial.
The most common preferences were relaxation and counseling. Other common support needs include continuity of care, seeing the person in the patient, more time with healthcare professionals and support to manage ongoing symptoms such as fatigue, pain and mobility.
Evidence concerning carers determined that carers information needs were in relation to understanding myeloma symptoms better and what is normal, financial advice and information around prognosis. While the most frequently reported unmet supportive care needs of the carers were the same as the patients the partners had their own additional needs that were not reported by patients.
Anxiety and depression were common in carers with anxiety being higher in partners than in patients.
Evidence about the information and support needs of patients with myeloma and carers was identified from 14 studies Table 1. All 14 studies addressed the needs of patients whilst 3 studies also examined carer needs. Furthermore, recall bias may have been present in some studies where participants were asked to retrospectively recall the information and support that was provided.
Download PDF K. Diagnostic accuracy of tests for suspected plasma cell disorders. Using bivariate diagnostic random-effects meta-analysis. In this strategy patients with a negative serum protein electrophoresis test would go on to have a serum free light chain test. Three studies were identified which aimed to determine the most clinically effective diagnostic testing strategy for plasma cell disorders.
In one UK study, 2, patients with suspected plasma cell dyscrasias were tested with serum protein electrophoresis with either urine protein electrophoresis UPE or serum free light chain analysis McTaggart et al. One study reported the diagnostic accuracy of different testing strategies in patients investigated for monoclonal gammopathy.
Neither of these testing strategies missed a case of myeloma Vermeersch et al. A further study only included patients with an existing plasma cell disorder including myeloma, smouldering myeloma, MGUS , primary amyloidosis Katzmann et al.
Some patients with myeloma have lower M-protein levels so this criterion alone has imperfect sensitivity for myeloma.
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Some patients with myeloma have lower clonal bone marrow plasma cell percentages so this criterion alone has imperfect sensitivity for myeloma. Evidence about the use of serum free light chains for discrimination of myeloma from MGUS came from two studies Wolff et al and Bergon et al including patients. Two studies Carulli et al, and Frebert et al, , including patients, evaluated multiparameter flow cytometry MFC for the discrimination of myeloma from MGUS.
Bacher et al compared the proportion of plasma cells identified using bone marrow cytomorphology with those found using MFC in patients. This proportion was higher with bone marrow cytomorphology than with MFC: the median proportion of plasma cells was 8.
However in 1. Evidence from about cytogenetic abnormalities came from one study Bacher et al, including patients with myeloma or MGUS.
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Diagnostic accuracy of tests for detection of myeloma in patients with renal failure. In one study of 82 patients with acute renal failure, seven were diagnosed with multiple myeloma using SPE, IFE and bone marrow biopsy. The modified renal reference FLC range 0.
The studies were at generally low risk of bias and there were few applicability concerns Figure 2. Three studies had unclear applicability concerns due to patient selection Park , Cirit , and Hutchison because they included only patients with renal failure. In other studies there were applicability concerns because patients were included on the basis of the index test results e.
Bergon , Frebert In Katzmann although myeloma patients were the largest group their results were excluded from the analysis. For studies looking at discrimination of myeloma from MGUS , the reference standard consensus diagnostic criteria often included the index test itself.
Can investigations done at the diagnosis of myeloma, including trephine biopsy , immunophenotyping and cytogenetic and molecular genetic tests accurately predict treatment outcomes for example, can they identify patients with a poor prognosis for whom an alternative treatment approach may be preferable?
Five studies were identified that investigated the prognostic value of immunohistochemistry. Each of the 5 studies investigated different markers. P53 expression and ki antigen expression were found to be independent risk factors for OS Chang et al. Fourteen studies were identified that investigated the prognostic value of flow cytometry.
Volume 3. Pubblicazioni del triennio 2009-2011 [PDF
All 14 studies found flow cytometry was able to identify myeloma patients with a poor prognosis. However not all studies could confirm their results in a multivariate model. The identified studies all used flow cytometry to investigate a number of different markers. Five studies assessed the prognostic value of clonal circulating plasma cells and all 5 studies concluded that clonal circulating plasma cells were an independent risk factor for patient survival Gonsalves et al.
Myeloma: Diagnosis and Management.
CD antigens were investigated by flow cytometry in a number of studies. CD was found to be prognostic in one study Mateo et al.
Renzo Ruggieri - Carnevale Карнавал Максим Линьков (баян)
All 3 studies found that hyperdiploid patients had increased survival compared to non-hyperdiploid patients. But whether DNA content is an independent risk factor remains uncertain.
One study reported that DNA content remained significant in a multivariate model Paiva et al.
A high plasma cell proliferation index was reported to be associated with worse survival compared to a lower plasma cell proliferation index in 4 studies. The association remained significant after taking into account other risk factors in a multivariate model in one study Paiva et al.
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A multivariate model was not included in the other 3 studies Minarik et al. The poor prognosis associated with a high proliferative index may be overcome by the use of novel agents Minarik et al. A low plasma cell apoptosis index was reported to be associated with worse survival compared to a higher plasma cell apoptosis index in 2 studies Minarik et al. These studies did not include a multivariate model so it is uncertain whether the apoptosis index is an independent prognostic factor for patient survival in myeloma.
Eight studies were identified that investigated the prognostic value of serum free light chains FLC. All 8 studies found serum FLC to be prognostic. Two studies reported that abnormal FLC was independently prognostic for a higher risk of progression from smoldering myeloma to active myeloma Dispenzieri et al.
Two further studies also reported serum FLC to be predictive for patient survival in myeloma, however multivariate analysis was not done and so it is unclear whether serum free chains were an independent prognostic factor in these studies Dispenzieri et al. Thirty four studies were identified that investigated the prognostic value of FISH.
Chapter 1. Communication and support
The most common genetic abnormalities assessed were: t 11;14 , t 4;14 , t 14;16 , del 17p , del 13q , del 1p , 1q gains, del p53 and hyperdiploidy. To summarise the results in newly diagnosed myeloma patients Table 2. Summary of prognostic FISH studies for newly diagnosed myeloma. This association did not remain significant in the multivariate model.
Del 17p was included in 12 studies Table 2. Del 13q was included in 14 studies Table 2. Del 1p was included in 6 studies Table 2.
Amp 1q was included in 13 studies Table 2. Del p53 was included in 3 studies Table 2. Hyperdiploidy was included in 5 studies Table 2. To summarise the results in asymptomatic patients Table 2. Summary of prognostic FISH studies for smoldering myeloma.
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Del 17p was included in 2 studies Table 2. One study reported an association between the genetic abnormality and TTP but the result lost significance after multivariate analysis. Del 13q was included in 3 studies Table 2. Amp 1q was included in 2 studies Table 2. Hyperdiploidy was included in 2 studies Table 2. No studies investigated the prognostic importance of del 1p or del p53 in asymptomatic myeloma.
A number of studies divided patients into high, standard or low risk groups based on the genetic abnormalities they carried or lacked.
It is difficult to compare across studies as different studies used different genetic abnormalities. However all studies reported that myeloma patients classed as high risk with adverse genetic abnormalities had a worse prognosis for survival compared to patients that were in the low risk group without the established adverse genetic abnormalities Boyd et al. Similarly, smoldering myeloma patients defined as high risk had a worse prognosis for progression to active myeloma Neben et al.
The included studies are high quality studies with a low risk of bias table 5 , although some studies do not include a multivariate model in the analysis to determine whether the assessed prognostic risk factor is independent of other risk factors. Treatment heterogeneity is an issue between as well as within studies. Download PDF 1. Table 2. Checklists to identify risk of bias PDF, K. All 12 studies reported sensitivity for myeloma.
Only 6 reported specificity due to a lack of people without myeloma in the other 6 studies.