Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Concise Review
  • Published:

Update on second primary malignancies in multiple myeloma: a focused review

Abstract

The last decade has seen significant advances in the management of patients with multiple myeloma (MM). With increasingly effective therapies, MM patients are living longer. With improvements in survival, long-term complications including second primary malignancies are becoming new challenges in providing optimal care for MM patients. Three randomized studies have demonstrated possible clinical benefit with maintenance lenalidomide for patients with MM. These same studies have also demonstrated an increased risk of second primary malignancies. In this review, we will update on the current information regarding mechanisms and risk of developing second primary malignancies with a particular focus on disease- and treatment-related factors.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Palumbo A, Hajek R, Delforge M, Kropff M, Petrucci MT, Catalano J et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 2012; 366: 1759–1769.

    Article  CAS  Google Scholar 

  2. Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med 2012; 366: 1782–1791.

    Article  CAS  Google Scholar 

  3. McCarthy PL, Owzar K, Hofmeister CC, Hurd DD, Hassoun H, Richardson PG et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med 2012; 366: 1770–1781.

    Article  CAS  Google Scholar 

  4. Thomas A, Mailankody S, Korde N, Kristinsson SY, Turesson I, Landgren O . Second malignancies after multiple myeloma: from 1960s to 2010s. Blood 2012; 119: 2731–2737.

    Article  CAS  Google Scholar 

  5. Kyle RA, Pierre RV, Bayrd ED . Multiple myeloma and acute myelomonocytic leukemia. N Engl J Med 1970; 283: 1121–1125.

    Article  CAS  Google Scholar 

  6. Bergsagel DE, Bailey AJ, Langley GR, MacDonald RN, White DF, Miller AB . The chemotherapy on plasma-cell myeloma and the incidence of acute leukemia. New England J Med 1979; 301: 743–748.

    Article  CAS  Google Scholar 

  7. Osserman EF, Takatsuki K, Talal N . Multiple myeloma I. the pathogenesis of ‘amyloidosis’. Semin Hematol 1964; 1: 3–85.

    CAS  PubMed  Google Scholar 

  8. Mailankody S, Pfeiffer RM, Kristinsson SY, Korde N, Bjorkholm M, Goldin LR et al. Risk of acute myeloid leukemia and myelodysplastic syndromes after multiple myeloma and its precursor disease (MGUS). Blood 2011; 118: 4086–4092.

    Article  CAS  Google Scholar 

  9. Roeker LE, Larson DR, Kyle RA, Kumar S, Dispenzieri A, Rajkumar SV . Risk of acute leukemia and myelodysplastic syndromes in patients with monoclonal gammopathy of undetermined significance (MGUS): a population-based study of 17 315 patients. Leukemia 2013; 27: 1391–1393.

    Article  CAS  Google Scholar 

  10. Matarraz S, Paiva B, Diez-Campelo M, Corral LL, Perez E, Mateos MV et al. Myelodysplasia-associated immunophenotypic alterations of bone marrow cells in myeloma: are they present at diagnosis or are they induced by lenalidomide? Haematologica 2012; 97: 1608–1611.

    Article  CAS  Google Scholar 

  11. Korde N, Liu QY, Kwok M, Manasanch EE, Simakova O, Mailankody S et al. Early myelodysplastic changes in substantial proportion of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) patients. Blood 2012; 120, Abstract 1805.

  12. Waldenstroem J . Melphalan therapy in myelomatosis. Br Med J 1964; 1: 859–865.

    Article  CAS  Google Scholar 

  13. McElwain TJ, Powles RL . High-dose intravenous melphalan for plasma-cell leukaemia and myeloma. Lancet 1983; 2: 822–824.

    Article  CAS  Google Scholar 

  14. Usmani SZ, Sexton R, Hoering A, Heuck CJ, Nair B, Waheed S et al. Second malignancies in total therapy 2 and 3 for newly diagnosed multiple myeloma: influence of thalidomide and lenalidomide during maintenance. Blood 2012; 120: 1597–1600.

    Article  CAS  Google Scholar 

  15. Dimopoulos MA, Richardson PG, Brandenburg N, Yu Z, Weber DM, Niesvizky R et al. A review of second primary malignancy in patients with relapsed or refractory multiple myeloma treated with lenalidomide. Blood 2012; 119: 2764–2767.

    Article  CAS  Google Scholar 

  16. Srivastava G, Rana V, Lacy MQ, Buadi FK, Hayman SR, Dispenzieri A et al. Long-term outcome with lenalidomide and dexamethasone therapy for newly diagnosed multiple myeloma. Leukemia 2013; 27: 2062–2066.

    Article  CAS  Google Scholar 

  17. Palumbo A, Bringhen S, Kumar SK, Lupparelli G, Usmani SZ, Waage A et al. Second primary malignancies with lenalidomide therapy for newly diagnosed multiple myeloma: a meta-analysis of individual patient data. Lancet Oncol 2014; 15: 333–342.

    Article  CAS  Google Scholar 

  18. Kantarjian HM, Keating MJ, Walters RS, Smith TL, Cork A, McCredie KB et al. Therapy-related leukemia and myelodysplastic syndrome: clinical, cytogenetic and prognostic features. J Clin Oncol 1986; 4: 1748–1757.

    Article  CAS  Google Scholar 

  19. Zhu YX, Braggio E, Shi CX, Bruins LA, Schmidt JE, Van Wier S et al. Cereblon expression is required for the antimyeloma activity of lenalidomide and pomalidomide. Blood 2011; 118: 4771–4779.

    Article  CAS  Google Scholar 

  20. Lopez-Girona A, Mendy D, Ito T, Miller K, Gandhi AK, Kang J et al. Cereblon is a direct protein target for immunomodulatory and antiproliferative activities of lenalidomide and pomalidomide. Leukemia 2012; 26: 2326–2335.

    Article  CAS  Google Scholar 

  21. Dualan R, Brody T, Keeney S, Nichols AF, Admon A, Linn S . chromosomal localization and cDNA cloning of the genes (DDB1 and DDB2) for the p127 and p48 subunits of a human damage-specific DNA binding protein. Genomics 1995; 29: 62–69.

    Article  CAS  Google Scholar 

  22. Turesson I, Velez R, Kristinsson SY, Landgren O . Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study. J Clin Oncol 2010; 28: 830–834.

    Article  Google Scholar 

  23. Kristinsson SY, Anderson WF, Landgren O . Improved long-term survival in multiple myeloma up to the age of 80 years. Leukemia 2014; e-pub ahead of print 14 January 2014; doi:10.1038/leu.2014.23.

    Article  CAS  Google Scholar 

  24. Usmani SZ, Crowley J, Hoering A, Mitchell A, Waheed S, Nair B et al. Improvement in long-term outcomes with successive total therapy trials for multiple myeloma: are patients now being cured? Leukemia 2013; 27: 226–232.

    Article  CAS  Google Scholar 

  25. Landgren O, Thomas A, Mailankody S . Myeloma and second primary cancers. N Engl J Med 2011; 365: 2241–2242.

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by the Intramural Research Program of the National Cancer Institute of the National Institutes of Health. The authors wish to thank Joe Barker and Emily Steplowski at Information Management Systems, Rockville, MD and Dr Lynn Goldin, Division of Cancer Epidemiology & Genetics, NCI for processing of data and for statistical analysis.

Author Contributions

OL and SM drafted the manuscript. Both authors were involved in the interpretation of the data, and reviewed and approved the submitted version of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to O Landgren.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on the Leukemia website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Landgren, O., Mailankody, S. Update on second primary malignancies in multiple myeloma: a focused review. Leukemia 28, 1423–1426 (2014). https://doi.org/10.1038/leu.2014.22

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2014.22

Keywords

This article is cited by

Search

Quick links