MIRT Faculty Publish Articles In recent editions of the Journal Of Clinical Oncology

Myeloma Institute for Research and Therapy physicians authored two recent articles in the Journal of Clinical Oncology, the primary forum of scientific discourse for the American Society of Clinical Oncology (ASCO). Summaries of the articles are included below:

Avascular Necrosis of Femoral and/or Humeral Heads in Multiple Myeloma: Results of a Prospective Study of Patients Treated with Dexamethasone-Based Regimens and High-Dose Chemotherapy

Giampaolo Talamo, Edgardo Angtuaco, Ronald C. Walker, Li Dong, Marisa H. Miceli, Maurizio Zangari, Guido Tricot, Bart Barlogie, and Elias Anaissie

Published in the Journal of Clinical Oncology, Volume 23, Number 22,
August 1, 2005

Avascular necrosis (AVN) of bone, also known as ischemic or aseptic necrosis, is thought to be caused by disruption of blood flow to the affected area. AVN can cause damage to the bone, which leads to pain and which may progress to fractures that in turn can worsen the pain and limit range of motion. Diagnosis is confirmed by magnetic resonance imaging (MRI). In cancer patients, AVN can occur as the result of corticosteroid therapy, which may reduce blood flow to the affected bone, or as a result of radiation therapy.

MIRT researchers evaluated the occurrence of AVN in 553 myeloma patients undergoing intensive therapy, including chemotherapy with corticosteroids, and autologous stem cell transplantation. In addition, they studied the role of thalidomide in the development of AVN. Findings revealed that AVN is not common among these patients and that symptomatic AVN was extremely rare.

When present, AVN more commonly affected both femoral heads, yet was without symptoms in most patients. AVN was more common in males than in females and in younger patients. An additional risk factor was a larger cumulative dose of dexamethasone. Thalidomide was not a risk factor. That finding was in contrast to concerns based on thalidomide’s antiangiogenic properties.

Dr. Elias Anaissie, director of supportive care at the Myeloma Institute and senior author of the article, advises that lowering the cumulative dose of corticosteroids should be considered in young male myeloma patients undergoing intensive chemotherapy with dexamethasone. Importantly, the study results confirm that thalidomide can be safely administered without concerns about increasing the risk for AVN.

F-Flourodeoxyglucose Positron Emission Tomography Contributes to the Diagnosis and Management of Infections in Patients With Multiple Myeloma: A Study of 165 Infectious Episodes

T. Mahfouz, M.H. Miceli, F. Saghafifar, S. Stroud, L. Jones-Jackson, R. Walker, M.L. Grazziutti, G. Purnell, A. Fassas, G. Tricot, B. Barlogie, E. Anaissie


Published in the Journal of Clinical
Oncology, Volume 23, Number 31,
November 1, 2005

Researchers at the Myeloma Institute have demonstrated that positron emission tomography (PET) using fluorine-18 flourodeoxyglucose (FDG) can help with diagnosis and management of infections, even in patients with severely compromised immune systems.

Patients undergoing chemotherapy, alone or in conjunction with stem cell transplantation, have significantly suppressed immune systems, which places them at high risk for infection. Furthermore, if infection does set in, there may not be overt symptoms of infection, since the immune system does not respond as it would in a healthy individual. This can result in delayed treatment of the infection.

Since FDG accumulates in metabolically active cells, including neoplastic and inflammatory cells, researchers hypothesized that FDG-PET might be used as a diagnostic tool for identifying infection.

Over a 3½-year period, 2,631 FDG-PET scans were performed in 1,110 patients with multiple myeloma for staging of cancer and/or diagnosis of suspected infection. In 248 of the 1,110 patients, the scans showed increased radiotracer uptake at extramedullary sites and bone and joint lesions that is not typical for myeloma. Records of these 248 patients were reviewed to identify those that indeed experienced infection. A total of 165 infections were identified in 143 patients. Infections included those caused by bacteria, mycobacteria, fungi and viruses. FDG-PET detected infections not detectable by conventional diagnostic testing, determined the extent of infection in 32 episodes and contributed to modification of therapy in 55 episodes. Additionally, FDG-PET identified 20 episodes of silent infection, i.e. abnormal FDG uptake in patients who had no signs or symptoms of infection at the time of the PET scan and who subsequently showed signs of infection at the abnormal uptake sites based on diagnostic work-up or who subsequently developed signs and symptoms of infection at the uptake sites.

Dr. Elias Anaissie, director of supportive care at the Myeloma Institute and senior author of the article, advises that FDG-PET can be useful in clinical settings, such as when conventional imaging suggests persistent abnormalities before resumption of immunosuppressive antineoplastic therapy. It might also be a useful tool for monitoring response to infection.